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Review and Self-Assessment

You are appointed as a cardiac epidemiologist advisor on an international committee setting global health policy. Your committee is assigned to predict health trends in a Pacific East Asian nation with a population and environment very similar to China. At this point in history, the nation is just moving from the first classic stage in the epidemiologic transition (“pestilence and famine”) to the second classic stage (“receding pandemics”). In regard to the anticipated patterns of cardiovascular disease (CVD) in this nation, which of the following is true?

A. As this nation enters the stage of receding pandemics, you would expect the majority of CVD morbidity and mortality to be due to cardiomyopathies secondary to infectious agents.

B. Each nation or geographical location progresses through the five stages of epidemiologic transition identically in regard to CVD risk.

C. In this nation, when CVD mortality peaks, you would expect stroke mortality to be greater than coronary heart disease mortality.

D. One would expect a very homogeneous epidemiologic pattern of CVD risk throughout this nation over time.

E. You anticipate that CVD mortality will inexorably climb as this nation progresses through the five stages of the epidemiologic transition.

The answer is C. (Chap. 2) The global rise in cardiovascular disease (CVD) is the result of an unprecedented transformation in the causes of morbidity and mortality during the 20th century. 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 man-made diseases, and delayed degenerative diseases. A fifth stage, characterized by an epidemic of inactivity and obesity, is emerging in some countries. The stages of the epidemiologic transition are shown in Table 1.

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TABLE 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, cardiomyopathies 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 man-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 ...

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