dominant disease in developing countries. Although evidence from developed countries demonstrates that the control of CVD can be approached with measurable benefit through interventions at the individual, community, and national levels, this knowledge and experience have yet to be systematically applied in developing country populations. Thus, one reason the CVD burden persists and will increase in developing countries is because the potential implementation of intervention programs is hampered by the lack of appropriate awareness of cost-effective CVD control options and by concerns that such investments may detract from investments in communicable disease control and childhood, maternal, and reproductive health.

TABLE A-1 Ten Leading Causes of Death for 1990

Rank

Developed Regions

Total Deaths (thousands)

Developing Regions

Total Deaths (thousands)

1

Ischemic heart disease

2,695

Lower respiratory infections

3.915

2

Cerebrovascular disease

1,427

Ischemic heart disease

3,565

3

Trachea, bronchus, and lung cancer

523

Cerebrovascular disease

2,954

4

Lower respiratory infections

385

Diarrheal diseases

2,940

5

Chronic obstructive pulmonary disease

324

Conditions arising during the perinatal period

2,361

6

Colon and rectum cancers

277

Tuberculosis

1,922

7

Stomach cancer

241

Chronic obstructive pulmonary disease

1,887

8

Road traffic accidents

222

Measles

1,058

9

Self-inflicted injuries

193

Malaria

856

10

Diabetes mellitus

176

Road traffic accidents

777

 

Total deaths

10,912

Total deaths

39,554

 

SOURCE: Murray and Lopez, 1996.

Another reason for the persistence of the emerging epidemic of CVD in low-and middle-income populations in developing countries is their increasing adoption of behaviors and life-styles that are known to elevate CVD risk. As indicated in Chapter 2, evidence suggests that the prevalence of established CVD risk factors such as tobacco use, elevated blood pressure, high saturated fat intake, obesity, and diabetes is increasing in these populations. The increasing rates of cigarette smoking alone are expected to increase CVD deaths in developing countries more than 18-fold in the next 22 years. These data are projected in



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