Cardiovascular disease (CVD) is the leading cause of death worldwide. According to statistics compiled by the World Health Organization (WHO), more than 13 million people die each year from coronary heart disease (CHD) and stroke.3 WHO statistics also show that more people have died worldwide since 1990 from CHD than from any other disease. Approximately 40% of the annual deaths in the US are attributed to CHD for both men and women. Thus, US death rates from CHD greatly exceed those from all types of cancers. The incidence of this disease in the US is expected to grow as a larger percentage of the population develops obesity and diabetes. As a result of lifestyle changes, primarily in reduced smoking, improved diet and exercise, more aggressive preventive medicine, as well as modern improvements in detection, diagnosis, and treatment, the mortality rates from CHD in both men and women are significantly decreasing in western Europe and the US. Nevertheless, despite these improvements, nearly 25-30% of patients in the US still die within a year of their first heart attack.3 In contrast, from 1990 to 2002 the most dramatic and rapid increases in both CHD incidence and mortality have occurred in developing countries such as Russia, China, India, and the countries of Eastern Europe. Proportionate increases of smaller magnitude have also been observed in South America and Africa.3 While previously considered a disease attributed to the sedentary lifestyle and fatty diets of modern American and western cultures, more than 75% of deaths resulting from CHD now occur in the poorer countries in the world. Based on these trends, WHO estimates that more than 20 million deaths from CHD and stroke will occur globally by 2020.3
CHD has an enormous global economic impact in terms of both the costs to society for treatments and hospitalizations as well as in decreased longevity. WHO estimates that in 2002 the 'healthy years of life lost' due to heart disease approached 10% in low and middle-income countries and rose to approximately 18% in higher-income countries.3 In the US alone, the economic costs due to CHD have been estimated at $400 billion annually.
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