Misconceptions about cardiovascular diseases — heart attacks, stroke and high blood pressure — have existed for many years and have in effect become myths. Most of them stem from factual observations during the early phase of the current global epidemic and have become deeply rooted in the minds of policymakers, health professionals and the public alike. Since these misconceptions adversely influence the allocation of resources and undermine actions to prevent and control cardiovascular diseases, they need to be firmly squashed.
Myth 1: Heart disease is a problem of developed countries
Every year, cardiovascular diseases cause around 15 million deaths in the world (30% of all deaths), and of these about two-thirds occur in developing countries. So the absolute number of deaths from these causes is twice as high in developing countries as in the industrialized world. Over twice as many deaths from stroke occur in developing countries as in industrialized countries; and the numbers of deaths due to heart attacks are equal in poor and rich countries. It is estimated that in China and India combined, which account for half the population of the developing world, between five and six million deaths are caused each year by cardiovascular diseases.
Myth 2: Heart disease is a problem of the rich
All societies include “early adopters” and “late adopters” of lifestyle changes. Early in the heart disease epidemic, affluent people in developing countries had the means and the opportunity to adopt new lifestyles, involving behaviour such as choosing foods rich in fat and calories, buying cars and using tobacco. Since these goods have become affordable for mass consumption “unhealthy” behaviour of this kind has become common across all social classes. Today, affluent people, especially the urban rich, have better access to health information concerning risk factors in the media and they also possess the means to modify their behaviour in favour of a healthier lifestyle (healthy diets, leisure-time physical activity, abstinence from tobacco). They constitute the “early adopters”, while the urban poor and rural communities — with limited access to information and little time or money for “healthy foods” and “fitness clubs” — lag behind. As a result, risky behaviour develops, and risk factors increase.
Recent studies from Latin America and South-East Asia, where coronary heart disease is particularly common, indicate that many coronary risk factors are more prevalent among those with lower socioeconomic standing and that the poor are, indeed, at higher risk of heart attacks.
In industrialized countries too, where the epidemic began among the urban rich, though some decades earlier than in the developing world, cardiovascular diseases are now more common in the relatively poor. When the worldwide heart disease epidemic fully develops, the poorest countries and the poorest people within society will be the worst affected.
Myth 3: Heart disease is mostly a man’s disease
While coronary heart disease is, in general, less common in pre-menopausal women than in men, in many parts of the world it is the most common cause of death in women, even those aged under 65. Heart disease, as well as its risk factors, varies to a surprising degree between populations. For example, women aged 35-64 years in Glasgow, Scotland, and in Belfast, Northern Ireland, have higher heart attack rates than men in some parts of southern Europe, according to a recent WHO study on trends in cardiovascular diseases (the WHO MONICA Project).
Hypertension and stroke are also major problems that affect women. Given the longer life expectancy of women, they contribute increasingly to cardiovascular deaths and disability after the sixth decade. The result is that, over their entire lifespan, women and men are equally affected by heart attacks and stroke — a fact that has long been neglected by doctors and health professionals, and by women themselves. Furthermore, pregnancy-associated hypertension is an important health problem in the developing world, where it is the major cause of premature birth and perinatal death, and is also responsible for up to one-third of all maternal deaths.
Myth 4: Heart disease is a problem of old age
Atherosclerotic cardiovascular diseases (coronary heart disease and stroke) and hypertension increase with age. But research in industrialized countries shows that about one-third of heart attacks and one-quarter of strokes occur in people below the age of 65. Many of the deaths due to cardiovascular diseases also occur early, one-quarter of them below the age of 70. In the developing world, the situation is even more marked: up to half of all deaths attributable to heart diseases occur in persons younger than 70; and a great number of working-age adults suffer from these diseases. This has an enormous impact on the economic situation of individuals and families as well as on society as a whole, and hampers efforts to alleviate poverty.
Myth 5: Heart disease is not susceptible to community action
The predominant factors contributing to the risk of cardiovascular diseases appear to be acquired, and to be lifestyle-related rather than genetic. Risk factors can be modified within a “healthy environment” that supports appropriate lifestyle practices, and most cardiovascular diseases are preventable. The prevention of heart diseases in individuals calls for the active promotion of health in populations.
Programmes that combine community mobilization with governmental regulation through taxation, legislation and pricing policies have proved to be effective in controlling tobacco and encouraging healthier diets in numerous industrialized countries. From these experiences, it is clear that community, national and even global action are key elements in combating the advancing epidemic of cardiovascular diseases in the developing world. Community mobilization can best be attained through educating the public, patients, professionals and policymakers, based on the advice of health professionals.
Myth 6: Heart disease is no longer a public health issue
There is a widespread mistaken belief that the total burden of cardiovascular diseases is diminishing. Despite declining mortality, heart disease remains the dominant public health problem in industrialized countries. Eastern European countries are at present experiencing the highest mortality rates due to cardiovascular diseases. A major cause for concern is the projected rise of these diseases in developing countries in the next century. It is predicted that by 2020 the number of deaths due to heart attacks and stroke in the developing world will have doubled as compared with 1990.
The reasons for this anticipated acceleration of the epidemic are increasing life expectancy related to a decline in infant mortality, unhealthy lifestyle changes related to industrialization and urbanization, and longer periods of exposure to the risk factors of heart disease because of improved socioeconomic conditions.
The public health consequences of an uncontrolled epidemic of cardiovascular diseases in the developing world would be disastrous. Not only would millions of productive years of life be lost, but the high costs of technology-intensive management of these diseases would impose a heavy financial burden on affected individuals, their families and society as a whole. The global epidemic needs a global response now, in the form of an international effort to create awareness and stimulate action in all countries and all sectors of society.