Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes and CVD was responsible for less than 10% of all deaths. Today, CVD accounts for approximately 30% of deaths worldwide, including nearly 40% in high-income countries and about 28% in low- and middle-income countries.
The global rise in CVD is the result of an unprecedented transformation in the causes of morbidity and mortality during the twentieth and twenty-first centuries. Known as the epidemiologic transition, this shift is driven by industrialization, urbanization, and associated lifestyle changes and is taking place in every part of the world among all races, ethnic groups, and cultures. The transition is divided into four basic stages: pestilence and famine, receding pandemics, degenerative and human-made diseases, and delayed degenerative diseases. A fifth stage, characterized by an epidemic of inactivity and obesity, may be emerging in some countries (Table 225-1).
Table 225–1. Five Stages of the Epidemiologic Transition |Favorite Table|Download (.pdf)
Table 225–1. Five Stages of the Epidemiologic Transition
|Stage||Description||Deaths Related to CVD, %||Predominant CVD Type|
|Pestilence and famine||Predominance of malnutrition and infectious diseases as causes of death; high rates of infant and child mortality; low mean life expectancy||<10||Rheumatic heart disease, cardiomopathies caused by infection and malnutrition|
|Receding pandemics||Improvements in nutrition and public health lead to decrease in rates of deaths related to malnutrition and infection; precipitous decline in infant and child mortality rates||10–35||Rheumatic valvular disease, hypertension, CHD, and stroke (predominantly hemorrhagic)|
|Degenerative and human-made diseases||Increased fat and caloric intake and decrease in physical activity lead to emergence of hypertension and atherosclerosis; with increase in life expectancy, mortality from chronic, noncommunicable diseases exceeds mortality from malnutrition and infectious disease||35–65||CHD and stroke (ischemic and hemorrhagic)|
|Delayed degenerative diseases||CVD and cancer are the major causes of morbidity and mortality; better treatment and prevention efforts help avoid deaths among those with disease and delay primary events; age-adjusted CVD morality rate declines; CVD affecting older and older individuals||40–50||CHD, stroke, and congestive heart failure|
|Inactivity and obesity||Overweight and obesity increase at alarming rate; diabetes and hypertension increase; decline in smoking rates levels off; a minority of the population meets physical activity recommendations||Possible reversal of age-adjusted declines in mortality||CHD, stroke, and congestive heart failure, peripheral vascular disease|
Malnutrition, infectious diseases, and high infant and child mortality rates that are offset by high fertility mark the age of pestilence and famine. Tuberculosis, dysentery, cholera, and influenza are often fatal, resulting in a mean life expectancy of about 30 years. Cardiovascular disease, which accounts for less than 10% of deaths, takes the form of rheumatic ...