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It is widely acknowledged that heart disease and stroke are the leading causes of death and disability in high per capita income countries (HIC).1 What is less appreciated is that this holds true for the low- and middle-income countries (LMIC) as well.1 We are in the midst of a true global cardiovascular disease (CVD) epidemic.2 CVD is responsible for about 30% of all deaths worldwide each year.3 Of note, nearly 80% of these deaths occur in LMIC, and half occur in women. Indeed, CVD is the leading cause of mortality in every region of the world with the sole exception of sub-Saharan Africa, where infectious diseases are still the leading cause. It is anticipated that even in sub-Saharan Africa, CVD will be the leading cause of mortality within the next few years.

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This chapter describes the current global burden of CVD and its risk factors, emphasizing the evolution of the CVD epidemic in developing countries and its contributory factors. Furthermore, the projected trends in the global burden of CVD over the next 2 decades are elucidated, and ongoing efforts by the world community (including the World Health Organization [WHO]) to combat and contain the current epidemic are outlined. The broad term CVD includes coronary heart disease (CHD, which includes myocardial infarction [MI], angina, coronary insufficiency, and coronary death), cerebrovascular disease (including stroke and transient ischemic attacks), peripheral vascular disease, congestive heart failure (CHF), hypertension, and valvular and congenital heart disease.

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Demographic Transition

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The past 2 centuries have witnessed major changes in the demographic characteristics of the human population.4 This transformation (termed demographic transition) involved a progressive change from very high birth and infant mortality rates to low ones. This change was accompanied by a shift from low population growth rates through an intermediate phase of high growth rates, with a consequent major increase in total population. This was then followed by a reversal to low or zero growth rates. The demographic transition results in a conversion of the age distribution of the population from one with a preponderance of young to one with nearly equal representation of all age groups.

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The demographic transition has been driven by the most dramatic improvements ever in the history of human health. Improvements in sanitation, nutrition, and infectious disease control and advances in perinatal care have resulted in lower infant and child mortality rates and an enhancement of overall life expectancy. The improvement in life expectancy began in Europe in the late 19th century and by the second half of the 20th century had spread to the rest of the world. Life expectancy at birth has increased from a global average of 46 years in 1950 to 67 years in 2009.5

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Economic, Social, and Nutritional Transition

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LMIC have been undergoing rapid industrialization, urbanization, economic development, and market globalization over the past 4 decades.1...

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