domestic product (GDP) there is an increase and then a decline in the major biological risks for CVD for both men and women.

Economic development is a major factor driving the epidemiological transition. For example, differences in GDP per capita explain almost two-thirds of the differences in female obesity among 37 developing countries (Monteiro et al., 2004). Within countries, CVD is also closely related to income level. CVD and its risks are concentrated among the lowest socioeconomic groups of the more developed (upper-middle and high income) countries, and among middle and high income populations of low-middle income countries (McLaren, 2007; Monteiro et al., 2004). However, even in some countries that have seen little economic progress, a transition to chronic disease can be observed. In part of rural Bangladesh, for example, estimated chronic disease-related mortality went from 8 to 68 percent, while estimated communicable disease mortality dropped from 52 to 11 percent (Ahsan Karar et al., 2009). Because CVD is rising in low and middle income countries and among the lowest socioeconomic groups in high income countries while falling among the wealthy, CVD is one of the few diseases that increases global health inequalities (Becker et al., 2005). Indeed, CVD and its related risks are gradually becoming diseases of the poor, and these divergences are pushing life expectancy in opposite directions in high income and low and middle income countries.

Not only can economic development influence trends in CVD risk, but also CVD can affect economic development. High CVD prevalence has likely depressed economic growth in high income countries in the past. This effect has lessened with recent declines in CVD in high income countries (Becker et al., 2005). CVD and other chronic diseases already have an economic impact in low and middle income countries, as described later in this chapter. The potential to result in a brake on economic growth may emerge as CVD risk rises (Suhrcke and Urban, 2006). Therefore, serious economic concerns remain for developing countries; however, the diminishing negative economic effects of CVD with decreasing prevalence in high income countries suggests that there is potential for risk and disease prevention to protect those countries from more serious economic ramifications.

Conclusion 3.1: In general, CVD risks are rising among low income countries, are highest for middle income developing countries, and then fall off for countries at a more advanced stage of development. This pattern reflects a complex interaction among average per capita income in a country, trends in lifestyle, and other risk factors, and health systems capacity to control CVD. Thus, the challenge facing low income developing countries is to continue to bring down prevalence of infectious diseases while avoiding an overwhelming rise in CVD, especially under conditions of resource limitations. This will require balancing



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