Abstract
One of the major drivers of change in the practice of cardiology, in both developed and developing countries, is population change, whose dynamics can be expressed by secular epidemiological and demographic trends, with increasing survival and life expectancy across all age strata. The sole concept of transition, whether epidemiological or demographic, is quite dynamic. From a global health point of view, one element merits attention: developed countries have had longer time to double or triple their population, usually more than one century, whereas the same increases in population size in the developing world occurred just over decades. The epidemiological transition theory, far from being perfect, introduced a booster to the understanding of the changing dynamics of epidemiological profiles and provided a complement to the discourse of the demographic change. In this article, with an special emphasis on the challenges faced by low- and middle-income settings, we describe current debates of the epidemiological transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health systems, prevention and treatment efforts; and physiological traits and human-environment interactions are identified. These challenges provide also an opportunity to redefine the agenda of global health cardiology and global cardiovascular research. This article concludes that a focus on the most populated regions of the world, who bear the highest disease burden related to cardiovascular conditions, will contribute substantially to protect the large gains in global survival and life expectancy accrued over the last decades. It then follows that a renewed workforce in global health cardiology must swiftly adapt to these changing environments. As the world changes, the practice of cardiology, clinical cardiology, global health cardiology and cardiology research will follow suit.
Keywords: Epidemioly, demography, health transitions, developing countries, cardiology, global health
Introduction
As the world changes, the practice of cardiology, clinical cardiology, global health cardiology and cardiology research will follow suit. One of the major drivers of change in the practice of cardiology, in both developed and developing countries, is population change, whose dynamics can be expressed by secular epidemiological and demographic trends, with increasing survival and life expectancy across all age strata. These population changes, at the macro level, are not static nor isolated but occur together with many other individual-level changes and adaptations, including but not limited to access to and usage of technological changes [1], changes in healthcare delivery [2,3], in medical training [4], and in the practice of medicine [5], or even changes within the human subject, taking for example changes in height of populations over time [6] as well as changes within individuals as the recently shown link between microbiota and stroke outcomes [7]. In this regard, over the last few years it is becoming more common —and indeed necessary— to encourage interdisciplinary dialogues to better serve medical interventions at the individual- and population-level.
A long trend process of mutual interaction of technologies, policies and social movements, global demographic transition and its epidemiological correlates continue to increase population size across age group, and since the early nineteenth century it has increased by six times. It is projected to further increase up to ten times by the end of this century, by then most countries will endure demographic aging. Life expectancy will continue to grow, doubled in last two centuries, while female fertility will continue to decline. By early nineteenth century, 70% of women’s adult life was dedicated to bearing children, which has now dropped by 14%, due to lower fertility and longer and healthier living [8].
Much of the transition in mortality and risk factors for non-communicable diseases, including cardiovascular diseases, has been described in detail elsewhere [9–17], but very few have been addressed to a clinical audience, and in particular what does such transitions mean for low- and middle-income settings. In this article we describe current debates and analyze the pertinence and relevance of the epidemiological transition, paired with the demographic transition and signaling other ongoing transitions with direct relevance to cardiovascular conditions. In doing so, we place an emphasis on the challenges of this transition for low- and middle-income settings undergoing rapidly epidemiologic shifts. Finally, this analysis of trends and context provides with an entry point to delineate the need for a global health cardiology practice that aligns with the major challenges in the most populated regions of the world, who bears a growing burden of cardiovascular diseases and conditions.
The epidemiological transition—its definition and its place in history
The epidemiological transition theory —or model— was coined in the early ’70s by Abdel Omran [18]. Published in a time where development debates were influenced by fears of the so-called “demographic explosion,” in Omran’s view the “key difference between epidemiologic transition and demographic transition theories was that the former unlike the latter allowed for multiple pathways to a low-mortality/low-fertility population regime” [19]. In short, Omran’s theory identified three phases of transition, pestilence and famine, receding pandemics, and degenerative and human created. These phases were later nuanced by Olshansky and Ault who added a fourth stage: delayed degenerative diseases [20] —or “hybristic”, influenced by individual behaviors and lifestyles [21]. In relation to cardiovascular disease, Table 1 shows the classic stages of the epidemiological transition. More recently, given the predominance and rise in body mass index worldwide [22], some authors propose a fifth stage in the transition, i.e. the age of obesity and inactivity [23,24].
Table 1.
Stages of the Epidemiological Transition and its global status, by region
Stage | Description | Life expectancy |
Dominant form of CVD |
Percentage of deaths attributable to CVD |
Percentage of the world’s population in this stage |
Regions affected |
---|---|---|---|---|---|---|
Pestilence and famine |
Predominance of malnutrition and infectious diseases |
35 | RHD cardiomyopathy caused by infection and malnutrition |
5–10 | 11 | Sub-Saharan Africa, parts of all regions excluding high-income regions |
Receding pandemics |
Improved nutrition and public health leads to increase in chronic diseases, hypertension |
50 | Rheumatic valvular disease, IHD, hemorrhagic stroke |
15–35 | 38 | South Asia, southern East Asia and the Pacific parts of Latin America and the Caribbean |
Degenerative and human- created |
Increased fat and caloric intake, widespread tobacco use, chronic disease deaths exceed mortality from infections and malnutrition |
60 | IHD, stroke (ischemic and hemorrhagic) |
>50 | 35 | Europe and Central Asia, northern East Asia and the Pacific, Latin America and the Caribbean, Middle East and North Africa, and urban parts of most low- income regions (India) |
Delayed degenerative diseases |
CVD and cancer are leading causes of morbidity and mortality prevention and treatment avoids death and delays onset; age- adjusted CVD declines |
70 | IHD, stroke (ischemic and hemorrhagic), CHF |
<50 | High-income countries, parts of Latin America and, the Caribbean |
From Gaziano T, Reddy KS, Paccaud F, Horton S, et al., editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank; 2011. p. Chapter 33, with permission.
Yet, from a historical point of view, Omran was not the first to link population changes to epidemiologic and mortality patterns. Alternative explanations of the epidemiologic changes in patterns of mortality was described few decades before Omran views came in limelight. Thomas McKeown described secular declines in England’s mortality since the eighteenth century throughout industrialization as a connection with better nutrition and sanitation rather than to medical interventions [25]. Omran thesis, on the other side, was more optimistic about the benefits of technology in the developing world, claiming that mortality decline depended more on developing interventions oriented towards supporting national and international programs of health service provision and environmental control [25]. Subsequent analyses, based on new methods and sources, would reveal some flaws of the McKeown assumptions [26], as has also happened to some of Omran claims, in relation to the double burden or overlapping of both communicable and non-communicable diseases [27].
Importantly from a contextual view, such debates around patterns of mortality took place by the ’70s, after the dominance of a discourse around infectious diseases, by then allegedly soon to be globally controlled, and just some years before emerging and reemerging infectious diseases would recover momentum. In the last two decades the concept of the epidemiological transition has gained even more attention, including its “revisionist” versions [28] stressing the relevance of the concept of societies, particularly for developing countries together with the World Bank, and its approaches in health economics [29], showing concerns about the health of adults and chronic diseases. Far from being a perfect theory to explain transitions, Omran’s epidemiological transition allowed for a conversation in terms of populations and specifically into population’s health. As suggested by others, “an expanded model of transition should account for the immense regional variation in disease burden, disparities in health systems, and the stacking of multiple kinds of epidemics within small areas and over short periods of time” [17].
Not one, but several overlapping transitions
The sole concept of transition, whether demographic or epidemiological, is quite dynamic. From a global health point of view, one element merits attention: developed countries have had longer time to double or triple their population, usually more than one century, whereas the same increases in population size in the developing world just occurred over decades. Whilst most nations accommodate to population growth, other transitions are directly relevant to cardiovascular health. Urbanization, nutrition and diet, food systems [30], culture and technology, interplay one with another to contribute to sustained increased survival in a long-run shift from low to high life expectancy [31].
According to the demographic transition approach, in both the developing and developed world, the longevity transition merits attention [32]. As Figure 1 shows, the average remaining years to be lived at age 60 will continue to increase, with slight advantage for women compared to men. This longevity transition will have different impacts across heterogeneous societies depending on how they deal with mortality declines and growing morbidity. In so doing, healthcare delivery, its workforce, organization and infrastructure, ethics, economics, and health financing will be directly involved in shaping the future patterns of populations morbidity and mortality.
Figure 1. Life Expectancy at age 60, selected regions, 1950 – 2100.
From United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2015 Revision, Key Findings and Advance Tables [Internet]. 2015 [cited 2016 May 4], with permission. Available from: http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf
In the late ’80s, Mexican researchers led by Frenk showed that in low- and middle-income countries, alongside the epidemiological transition, there was a transition in the capacity of the the healthcare system to deal with various conditions. In unequal and heterogeneous countries as in Latin America, the paces of epidemiological transition was rather different when compared to developed countries, as simultaneously communicable, poor nutritional and maternal conditions overlapped with non-communicable diseases, both challenging health systems, a model they called the protracted-prolonged polarized model [33]. To make things even more complex, just one decade before Frenk et al.’s analysis, HIV/AIDS entailed a major unforeseen challenge to health systems and health prioritization, particularly for poor countries in sub Saharan Africa.
Cardiovascular disease mortality and risk factors from an low- and middle-income perspective
Much of the transition in terms of cardiovascular disease risk and mortality has been addressed in various reviews published not so long ago [10–15], hence rather than repeating these findings here again, we intend to articulate such trends with other major ongoing societal transitions and current challenges, especially for the practice of global health cardiology. More recently, for disability and mortality-related analyses, newer and more sophisticated methodological approaches have been developed, quantifying the changes in patterns of epidemiological trends as it relates to socio-demographic conditions [34]. Yet, whilst the data are still limited, a different epidemiology of cardiovascular conditions is anticipated for the poorest populations [35]. As foreseen, cardiovascular conditions have played a chief role in driving a global increased mortality, though mostly due to global aging and population growth [11].
From a global health perspective, this scenario has achieved important high-level political pledges to tackle the impact of non-communicable diseases [36], particularly for cardiovascular diseases [37]. More so, recently, cardiovascular premature mortality has been acknowledged as relevant to the recent advances in health and development and has been included in the indicators set of the new Sustainable Development Goals (SDGs), yet its projections for the next decade are not so optimistic [30,38]. Today’s environment calls to the global health cardiology and preventive cardiology workforce and practitioners to be well acquainted with broader discourses and understanding the basics of time and place, what transitions have occurred over time and where.
The mortality related to cardiovascular diseases is closely linked to changes over time in the profile of cardiovascular risk factors [22,39–42]. One of the seminal longitudinal studies, the Framingham Heart Study, was launched by the late ’40s [43] contributed to the identification of major risk factors for the development of cardiovascular diseases [44,45], such as high cholesterol and elevated blood pressure, today known as common risk factors. In the same vein, high body mass index has recently been acknowledged as playing a major role in global disease burden in the last decades [46]. Therefore, understanding the patterns of common risk factors over time and across geographical regions is paramount for global health cardiology.
Challenges for global health cardiology
In recent decades, a pattern of decreasing trends in cardiovascular disease mortality has been recorded and studied in high-income regions [10,12]. Yet, the dynamics of such trends are far from being completely known and understood in low- and middle-income countries. The concept of the demographic transition calls for an understanding of the dynamics of changes in population age groups, as populations in general are becoming older. These changes are paired with the co-occurrence of multiple risk factors within the same individual, and within populations, which calls for a rethinking of current approaches to disease burden, especially so when health systems are largely designed for the provision of acute care [47]. For example, shifting an analysis of health patterns centered on mortality to one where the focus is primarily on physical functioning, non-fatal morbidity, or disability. Importantly, morbidity is multidimensional by nature, introducing significant challenges related to health system performance, diagnostic technologies, and even cultural conditions such as the role of caregiving in societies. All of these have indeed multiple implications and new data sources, methods and metrics are to be expanded. In doing so, newer efforts to address these challenges will require reinforced values about data generation and data sharing [48,49], where a direct benefit for low- and middle-income counterparts ought to be affirmed and protected [50].
Low- and middle-income countries carry at least three quarters of the premature mortality due to cardiovascular diseases [51,52]. To address this, international targets have been set, back in 2011, i.e. to reduce the risk of premature non-communicable disease deaths by 25% by 2025 [53]. To address this larger goal, it has to be realized that what works in the developed world might not necessarily work nor should be mechanically implemented in low- and middle-income countries. This has been shown in a series of modeling scenarios pursued for each geographical regions [54]. The latest available report from the World Health Organization on noncommunicable diseases signals that only “42 countries had monitoring systems to report on the nine global targets [to achieve 25 by 25]” [55], thus clearly signaling towards substantial gaps in disease surveillance. This, together with the concomitant within-country disparities, are even more evident at the sub-national level. The paucity of data and key information from population-based studies on cardiovascular disease incidence, remission, medical care, and risk or protective factors [10,11] will somewhat restrain our understanding of cardiovascular disease trends and dynamics in low- and middle-income settings, a major challenge for global health cardiology.
Challenges at the level of health systems are far more complex [56] and ranges from ensuring adequate strategies for primary, secondary, and tertiary prevention [57,58], together with health care delivery services and systems that are affordable, accessible, culturally appropriate and of quality, to legal frameworks and policies. In a world where life expectancy is increasing, how to sustain ideal cardiovascular health across the lifespan [59] and for longer periods over the lifecourse of individuals, and populations, remains pivotal to accrue future larger gains in reducing morbidity and mortality. This is more evident in low- and middle-income countries characterized by contrasting settings with persistent inequality, where poverty will contribute to and impact on demographic and epidemiological transitions [35,60–62]. For example, what primary prevention interventions might work, in the long run, in countries where obesity in early years is increasingly common as in emerging economies or in countries transitioning from low-to middle-income status? In a world where aging and increasing survival are expected to be a major driver of demographic and epidemiological changes, what are the most appropriate approaches to address comorbidity, not only cardiovascular but including other physical and mental chronic conditions? From an economic and development standpoint, acknowledging major underestimations in the costs associated to non-communicable diseases at the household and national levels [63,64], what are the costs of not making major decisions to address avoidable mortality and disability?
Finally, in the area of basic sciences and population health, further areas of interest are related to sex and gender differences in relation to mortality, disability and distribution of risk factors in men and women. Two main drivers usually account for such discrepancies. First, women have longer lifespans in practically all countries, although in some high-income countries such as the United Kingdom this female advantage in life-expectancy is predicted to be reduced in the coming years [65]. Second, women tend to be worse off in receiving care for cardiovascular diseases [66,67], usually linked to more common gender-based discriminations, including access to prevention and treatment. Yet, a third factor that warrants attention for the practice of global health cardiology relates to the physiopathology of heart’s aging and its sex differences as a new field or research whose better understanding might suggest avenues to provide better treatment [68]. Besides aging, an important element of women’s health agenda directly related to non-communicable diseases is pre-eclampsia, where hypertension, obesity and anemia affect the health of the mother [69]. In terms of the offspring, one of the outcomes of pre-eclampsia is a restriction of fetal growth, characterized by already well described long term consequences for increased risk of non-communicable diseases, including cardiovascular and metabolic conditions [70–72]. Adding to the complexity offered by low- and middle-income settings, the observed pathophysiologic changes will be compounded with, and will require broader expansions to explicitly assess the human-environment interactions, particularly cardiovascular and metabolic adaptations to high-altitude settings [73–77].
Without extenuating the long list of potential challenges, we have expanded upon Roth et al.’s knowledge gaps (Table 2) [17], and presented in this section some key aspects in terms of i) patterns of risk factors over time, ii) disease surveillance and meeting global targets, iii) health systems, prevention and treatment efforts, and iv) physiological traits and human-environment interactions. All of them, in addition to challenges to overcome, should be seen as opportunity to redefine the agenda of global health cardiology and global cardiovascular research. As Huffman et al. have argued [78], this will also require incorporating additional tools and skills such as implementation science, health systems research, and health policy research.
Table 2.
Knowledge Gaps and Suggested Next Steps
Gaps in Knowledge | Suggested Next Steps |
---|---|
Mortality data remain absent or of limited quality in some countries, particularly in the poorest regions |
|
Little is known about variation in cardiovascular risk factors and disease burden within some countries |
|
Changes in cardiovascular mortality are more complex than suggested by a stepwise model of epidemiological transition |
|
CVD: cardiovascular disease; LMIC: low- and middle-income countries.
From Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015 Oct 27;132(17):1667–78, with permission.
Unifying global transitions and the practice of Global Health Cardiology—why does this matter?
The impressive attainments in cardiovascular diagnosis and treatment in the last decades in high-income settings cannot overlook the fact that most of them are yet to reach the majority of people living in the global South. Information gaps, such as awareness about actual disease burden and risk factors trends are still present [79], including under-diagnosis and misdiagnosis [80]. Yet, if something was learned from the original conception of the epidemiological transition is that long term trends of change in population’s health cannot be overlooked, from larger global and regionals health and development agendas. For example, today’s world also host millions of people currently living with HIV, which has now become a chronic condition whose cardiovascular conditions might be neglected [81].
Given that current transition trends will continue its course, the uniqueness of cardiovascular diseases might soon become outdated due to its narrow disease-specific approach when contrasted with individuals living with comorbidities. Therefore, more collaborative, interdisciplinary, and integrative work —as observed with mental health, including the successful models of collaborative care to improve the management of depressive disorders [82–85]— will be the norm and the demands by patients and by health institutions, both public and private. How can cardiology, and global health cardiology, as a medical specialty prepare for such transition? And, how can health and social protection systems ensure that the increasing demands for cardiology and cardiac rehabilitation are aligned within essential packages of health care provision, with acceptable conditions of quality and dignity? Globally, noncommunicable diseases have been linked to substantial impacts at the macroeconomic, health system, and household levels [63,64,86,87], paired with important challenges to inform policy makers in low-income settings about its associated costs [88]. At the household level, stroke is one example of major financial hardship [89]. At the national level, the rise in hypertension in recent years in Mexico is projected to require an increase in financial requirements of 22–24% [90,91], a scenario where additional complexity is introduced if uninsured populations are considered [92]. Availability and affordability of medicines to those who need them has been reported in a large proportion of communities and households across upper middle-income, lower middle-income, and low-income countries [93].
Furthermore, at the country-level, since most of world population are and will remain facing double disease burden, both infectious and noninfectious diseases, how can cardiology reshape and integrate its offerings within current well established clinical practices? Also, a large share of primary prevention, much needed for cardiology outcomes, require interactions with other nonclinical sectors beyond the clinical settings, and cannot be limited to only those now at retirement ages, but to younger generations, as well. All of these scenarios force the new cadre and workforce of global health cardiologists and practitioners to seek beyond the prescription of pharmacological drugs and devices and will force them to incorporate wider radars of practice and skills to inform their avenues for intervention [30,94–96].
From a demographic and long-term perspective, since we are living today in what it is going to be the century of aging, interventions cannot be limited to those who are currently elderly, but also for those that will reach senior years in the coming decades. How can current adolescents and youth be involved in the prevention, and even treatment, of non-communicable diseases? [97,98]. Challenges and opportunities are even greater when focusing cardiovascular prevention efforts in infancy [99,100]. There is strong evidence to support beneficial effects of child obesity prevention programs on body mass index, particularly for programs targeted to children aged six to 12 years [99]. An overview of systematic reviews of population-level interventions that had an environmental component directed to preventing or reducing obesity in children aged 5–18 years showed modest impact of a broad range of environmental strategies on anthropometric outcomes [100]. Most of unhealthy or protective behaviors and living conditions are initiated and imprinted in these early ages, and today’s technology and information revolution could well accommodate to serve as delivery channels to connect and make prevention opportunities available to these population groups.
From a health services perspective, a major challenge is how to continue sharing priorities between communicable and non-communicable diseases [101], while learning from those other countries whose epidemiological profiles have already changed in the last decades. Other challenges include sustaining an adequate political commitment as a source of legitimate concern to mainstream cardiovascular diseases, particularly in the global South [102].
Not surprisingly, cardiology’s clinical practice, promotion and prevention, cannot easily be limited or simplistically narrowed only to risk factors at the individual level during a one-to-one short-term clinical encounter. Rather, a minimal understanding of the wider contextual frameworks shaping population’s health and health outcomes will enable clinical practitioners to better serve their patients. Such understanding will turn from desirable to essential skills. Consequently, a population health approach is increasingly becoming a core component in the practice of cardiology [103].
The question, then, is not why the practice of cardiology is changing but, on the contrary, what has happened to force and accommodate such change as the norm. This review has signaled major transitions that have occurred in recent decades, with an emphasis placed on low- and middle-income countries. Generational changes, again at the individual- and population-level, have rapidly occurred and became established. One of the obvious examples has been rapidly transitioning from the Barker hypothesis —low birth weight and worse cardiovascular profiles and mortality later in life— to the switch from undernutrition to overweight within a few decades. In the same timeframe, in high-income countries, the benefits of prevention and improved healthcare have been documented, alongside with the known harmful effects of poor access to health care, and income inequalities [104]. Low- and middle-income countries, together with practitioners of global health cardiology, have the opportunity to reshape the anticipated trends of cardiovascular diseases and curb its negative impacts. The demographic transition is introducing large segments of the world’s population into ageing. Having accomplished some major successes with the child survival agenda, especially in low- and middle-income settings, these newer adults deserve not to repeat the same fate of mortality described in the original epidemiological transitions. This is why it matters.
Conclusions
The epidemiological transition theory, ever since it was proposed, was an intellectual booster in order to understand the changing dynamics of epidemiological profiles. The epidemiological transition provided a complement to the discourse of demographic change. Despite its criticisms and revisions, it is still an useful concept influencing public health debates, and has proven to be quite influential, particularly in changing societies. Most countries are facing rapidly emerging needs of populations living longer lifespans, with cardiovascular conditions situated at the very core of increasing disease burdens. In these scenarios of changes in population structures and disease profiles, cardiovascular conditions and its associated comorbidities will continue to challenge health care systems. Protecting large gains in global survival and achievements in life expectancy, notoriously accrued over the last decades in low- and middle-income countries, require a broad range of interventions. Fostering encounters and intersections, from human resources to health systems, from individual to population-wide, from health to non-health sectors, and benefiting from technological changes and human rights approaches will provide a solid basis and framework to ensure long-term access to both prevention services as well as health care. A renewed workforce in global health cardiology must swiftly adapt to these changing environments.
Key Points.
Developed countries had more than one century to double or triple their population, whereas the same increases in population size in the developing world occurred just over decades.
The epidemiological transition theory, far from being perfect, introduced a booster to the understanding of the changing dynamics of epidemiological profiles.
Changes in population structures and disease profiles, cardiovascular conditions and its associated comorbidities will continue to challenge health care systems.
A focus on the most populated regions of the world will contribute to protect the large gains in global survival and life expectancy accrued over the last decades.
From a low- and middle-income country perspective, current challenges provide an opportunity to redefine the agenda of global health cardiology and global cardiovascular research.
Acknowledgments
Many thanks to Antonio Bernabé-Ortiz, Rodrigo M Carrillo-Larco, María Lazo-Porras, and Shiva Raj Mishra for their feedback provided to earlier versions of this manuscript.
Funding sources
Dr. Miranda acknowledges receiving current and past support from the Consejo Nacional de Ciencia, Tecnología e Innovación Tecnológica (CONCYTEC), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982), Grand Challenges Canada (0335-04), International Development Research Center Canada (106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), National Heart, Lung and Blood Institute (5U01HL114180, HHSN268200900028C), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), UnitedHealth Foundation, Universidad Peruana Cayetano Heredia, and the Wellcome Trust (074833/Z/04/A, WT093541AIA, 103994/Z/14/Z).
Footnotes
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Financial conflicts of interest
The authors have nothing to disclose.
Disclaimer
Walter Mendoza is currently Program Analyst Population and Development at the UNFPA Country Office in Peru, institution which not necessarily endorses this contribution.
References
- 1.Fogel RW. Secular trends in physiological capital: implications for equity in health care. Perspect Biol Med. 2003 Summer;46(3 Suppl):S24–S38. [PubMed] [Google Scholar]
- 2.Berwick DM. Era 3 for Medicine and Health Care. JAMA. 2016 Apr 5;315(13):1329–1330. doi: 10.1001/jama.2016.1509. [DOI] [PubMed] [Google Scholar]
- 3.Bauchner H, Berwick D, Fontanarosa PB. Innovations in Health Care Delivery and the Future of Medicine. JAMA. 2016 Jan 5;315(1):30–31. doi: 10.1001/jama.2015.17452. [DOI] [PubMed] [Google Scholar]
- 4.Miller BM, Moore DE, Jr, Stead WW, Balser JR. Beyond Flexner: a new model for continuous learning in the health professions. Acad Med. 2010 Feb;85(2):266–272. doi: 10.1097/ACM.0b013e3181c859fb. [DOI] [PubMed] [Google Scholar]
- 5.Leppin AL, Montori VM, Gionfriddo MR. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions. Healthcare (Basel) 2015 Jan 29;3(1):50–63. doi: 10.3390/healthcare3010050. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.NCD Risk Factor Collaboration (NCD-RisC) A century of trends in adult human height. Elife [Internet] 2016 Jul 26;5 doi: 10.7554/eLife.13410. Available from: http://dx.doi.org/10.7554/eLife.13410. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Benakis C, Brea D, Caballero S, Faraco G, Moore J, Murphy M, et al. Commensal microbiota affects ischemic stroke outcome by regulating intestinal γδ T cells. Nat Med [Internet] 2016 Mar 28; doi: 10.1038/nm.4068. Available from: http://dx.doi.org/10.1038/nm.4068. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Lee R. The Demographic Transition: Three Centuries of Fundamental Change. J Econ Perspect. 2003 Nov 1;17(4):167–190. [Google Scholar]
- 9.Ali MK, Jaacks LM, Kowalski AJ, Siegel KR, Ezzati M. Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates. Health Aff. 2015 Sep;34(9):1444–1455. doi: 10.1377/hlthaff.2015.0570. [DOI] [PubMed] [Google Scholar]
- 10.Ezzati M, Obermeyer Z, Tzoulaki I, Mayosi BM, Elliott P, Leon DA. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol. 2015 Sep;12(9):508–530. doi: 10.1038/nrcardio.2015.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015 Apr 2;372(14):1333–1341. doi: 10.1056/NEJMoa1406656. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013 Feb;99(3):159–162. doi: 10.1136/heartjnl-2012-302300. [DOI] [PubMed] [Google Scholar]
- 13.Danaei G, Singh GM, Paciorek CJ, Lin JK, Cowan MJ, Finucane MM, et al. The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation. 2013 Apr 9;127(14):1493–1502. 1502e1–1502e8. doi: 10.1161/CIRCULATIONAHA.113.001470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.O’Flaherty M, Huffman MD, Capewell S. Declining trends in acute myocardial infarction attack and mortality rates, celebrating progress and ensuring future success. Heart. 2015 Sep;101(17):1353–1354. doi: 10.1136/heartjnl-2015-307868. [DOI] [PubMed] [Google Scholar]
- 15.Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation. 2015 Sep 15;132(11):997–1002. doi: 10.1161/CIRCULATIONAHA.115.015293. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Di Cesare M, Bennett JE, Best N, Stevens GA, Danaei G, Ezzati M. The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries. Int J Epidemiol. 2013 Jun;42(3):838–848. doi: 10.1093/ije/dyt063. [DOI] [PubMed] [Google Scholar]
- 17.Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015 Oct 27;132(17):1667–1678. doi: 10.1161/CIRCULATIONAHA.114.008720. [DOI] [PubMed] [Google Scholar]
- 18.Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971 Oct;49(4):509–538. [PubMed] [Google Scholar]
- 19.Weisz G, Olszynko-Gryn J. The theory of epidemiologic transition: the origins of a citation classic. J Hist Med Allied Sci. 2010 Jul;65(3):287–326. doi: 10.1093/jhmas/jrp058. [DOI] [PubMed] [Google Scholar]
- 20.Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q. 1986;64(3):355–391. [PubMed] [Google Scholar]
- 21.Rogers RG, Hackenberg R. Extending epidemiologic transition theory: a new stage. Soc Biol. 1987;34(3–4):234–243. doi: 10.1080/19485565.1987.9988678. [DOI] [PubMed] [Google Scholar]
- 22.NCD Risk Factor Collaboration (NCD-RisC) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016 Apr 2;387(10026):1377–1396. doi: 10.1016/S0140-6736(16)30054-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Gaziano TA, Prabhakaran D, Gaziano JM. Global Burden of Cardiovascular Disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, editors. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th. Elsevier; 2015. pp. 1–20. [Google Scholar]
- 24.Gaziano JM. Fifth phase of the epidemiologic transition: the age of obesity and inactivity. JAMA. 2010 Jan 20;303(3):275–276. doi: 10.1001/jama.2009.2025. [DOI] [PubMed] [Google Scholar]
- 25.Santosa A, Wall S, Fottrell E, Högberg U, Byass P. The development and experience of epidemiological transition theory over four decades: a systematic review. Glob Health Action. 2014 May 15;7:23574. doi: 10.3402/gha.v7.23574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Szreter S. The Importance of Social Intervention in Britain’s Mortality Decline c. 1850? 1914: a Re-interpretation of the Role of Public Health. Soc Hist Med. 1988;1(1):1–38. [Google Scholar]
- 27.Carolina Martínez S, Carolina MS, Gustavo Leal F, Gustavo LF. Epidemiological transition: model or illusion? A look at the problem of health in Mexico. Soc Sci Med. 2003 Aug;57(3):539–550. doi: 10.1016/s0277-9536(02)00379-9. [DOI] [PubMed] [Google Scholar]
- 28.Caldwell JC. Health transition: the cultural, social and behavioural determinants of health in the Third World. Soc Sci Med. 1993 Jan;36(2):125–135. doi: 10.1016/0277-9536(93)90204-h. [DOI] [PubMed] [Google Scholar]
- 29.Feachem RGA, Kjellstrom T, Murray CJL, Over M, Phillips MA, editors. The Health of Adults in the Developing World. New York: Oxford University Press; 1992. [Google Scholar]
- 30.Hawkes C, Popkin BM. Can the sustainable development goals reduce the burden of nutrition-related non-communicable diseases without truly addressing major food system reforms? BMC Med. 2015 Jun 16;13:143. doi: 10.1186/s12916-015-0383-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Riley JC. The Timing and Pace of Health Transitions around the World. Popul Dev Rev. 2005 Dec 1;31(4):741–764. [Google Scholar]
- 32.Eggleston KN, Fuchs VR. The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life. J Econ Perspect. 2012 Summer;26(3):137–156. doi: 10.1257/jep.26.3.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Frenk J, Bobadilla JL, Sepúlveda J, Cervantes ML. Health transition in middle-income countries: new challenges for health care. Health Policy Plan. 1989 Mar 1;4(1):29–39. [Google Scholar]
- 34.GBD 2013 DALYs and HALE Collaborators. Murray CJL, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet. 2015 Nov 28;386(10009):2145–2191. doi: 10.1016/S0140-6736(15)61340-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Kwan GF, Mayosi BM, Mocumbi AO, Miranda JJ, Ezzati M, Jain Y, et al. Endemic Cardiovascular Diseases of the Poorest Billion. Circulation. 2016 Jun 14;133(24):2561–2575. doi: 10.1161/CIRCULATIONAHA.116.008731. [DOI] [PubMed] [Google Scholar]
- 36.United Nations General Assembly. Resolution Adopted by the General Assembly RES/66/2. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 2011 Adopted September 19, 2011; published January 24, 2012. [Google Scholar]
- 37.Smith SC, Jr, Chen D, Collins A, Harold JG, Jessup M, Josephson S, et al. Moving from political declaration to action on reducing the global burden of cardiovascular diseases: a statement from the global cardiovascular disease taskforce. Circulation. 2013 Dec 3;128(23):2546–2548. doi: 10.1161/CIR.0b013e3182a93504. [DOI] [PubMed] [Google Scholar]
- 38.Ordunez P, Campbell NR. Beyond the opportunities of SDG 3: the risk for the NCDs agenda. Lancet Diabetes Endocrinol. 2016 Jan;4(1):15–17. doi: 10.1016/S2213-8587(15)00488-X. [DOI] [PubMed] [Google Scholar]
- 39.Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014 Aug;2(8):634–647. doi: 10.1016/S2213-8587(14)70102-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Farzadfar F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet. 2011 Feb 12;377(9765):578–586. doi: 10.1016/S0140-6736(10)62038-7. [DOI] [PubMed] [Google Scholar]
- 41.NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016 Apr 9;387(10027):1513–1530. doi: 10.1016/S0140-6736(16)00618-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet. 2011 Feb 12;377(9765):568–577. doi: 10.1016/S0140-6736(10)62036-3. [DOI] [PubMed] [Google Scholar]
- 43.O’Donnell CJ, Elosua R. Cardiovascular Risk Factors. Insights From Framingham Heart Study. Revista Española de Cardiología (English Edition) 2008;61(3):299–310. [PubMed] [Google Scholar]
- 44.Mendis S. The contribution of the Framingham Heart Study to the prevention of cardiovascular disease: a global perspective. Prog Cardiovasc Dis. 2010 Jul;53(1):10–14. doi: 10.1016/j.pcad.2010.01.001. [DOI] [PubMed] [Google Scholar]
- 45.Bitton A, Gaziano TA. The Framingham Heart Study’s impact on global risk assessment. Prog Cardiovasc Dis. 2010 Jul;53(1):68–78. doi: 10.1016/j.pcad.2010.04.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287–2323. doi: 10.1016/S0140-6736(15)00128-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Atun R. Transitioning health systems for multimorbidity. Lancet. 2015 Aug 22;386(9995):721–722. doi: 10.1016/S0140-6736(14)62254-6. [DOI] [PubMed] [Google Scholar]
- 48.Davies J, Yudkin JS, Atun R. Liberating data: the crucial weapon in the fight against NCDs. Lancet Diabetes Endocrinol. 2016 Mar;4(3):197–198. doi: 10.1016/S2213-8587(16)00037-1. [DOI] [PubMed] [Google Scholar]
- 49.Davies J, Yudkin JS, Atun R. Liberating data: the WHO response - Authors’ reply. Lancet Diabetes Endocrinol. 2016 Aug;4(8):648–649. doi: 10.1016/S2213-8587(16)30114-0. [DOI] [PubMed] [Google Scholar]
- 50.Engelgau MM, Sampson UK, Rabadan-Diehl C, Smith R, Miranda J, Bloomfield GS, et al. Tackling NCD in LMIC: Achievements and Lessons Learned From the NHLBI-UnitedHealth Global Health Centers of Excellence Program. Glob Heart. 2016 Mar;11(1):5–15. doi: 10.1016/j.gheart.2015.12.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.World Health Organization. Global Status Report on Noncommunicable Diseases 2014. World Health Organization. 2014:298.
- 52.Mendis S, Davis S, Norrving B. Organizational update: the world health organization global status report on noncommunicable diseases 2014; one more landmark step in the combat against stroke and vascular disease. Stroke. 2015 May;46(5):e121–e122. doi: 10.1161/STROKEAHA.115.008097. [DOI] [PubMed] [Google Scholar]
- 53.Pearce N, Ebrahim S, McKee M, Lamptey P, Barreto ML, Matheson D, et al. Global prevention and control of NCDs: Limitations of the standard approach. J Public Health Policy. 2015 Nov;36(4):408–425. doi: 10.1057/jphp.2015.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Sacco RL, Roth GA, Reddy KS, Arnett DK, Bonita R, Gaziano TA, et al. The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation. Circulation. 2016 Jun 7;133(23):e674–e690. doi: 10.1161/CIR.0000000000000395. [DOI] [PubMed] [Google Scholar]
- 55.Noncommunicable diseases prematurely take 16 million lives annually, WHO urges more action [Internet] [cited 2016 Jul 30];World Health Organization. 2015 Available from: http://www.who.int/mediacentre/news/releases/2015/noncommunicable-diseases/en/
- 56.Robinson HM, Hort K. Non-communicable diseases and health systems reform in low-and-middle-income countries. Pac Health Dialog. 2012 Apr;18(1):179–190. [PubMed] [Google Scholar]
- 57.Schwalm JD, McKee M, Huffman MD, Yusuf S. Resource Effective Strategies to Prevent and Treat Cardiovascular Disease. Circulation. 2016 Feb 23;133(8):742–755. doi: 10.1161/CIRCULATIONAHA.115.008721. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Ordunez P. Cardiac rehabilitation in low-resource settings and beyond: the art of the possible. Heart [Internet] 2016 Jun 10; doi: 10.1136/heartjnl-2016-309804. Available from: http://dx.doi.org/10.1136/heartjnl-2016-309804. [DOI] [PubMed] [Google Scholar]
- 59.Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010 Feb 2;121(4):586–613. doi: 10.1161/CIRCULATIONAHA.109.192703. [DOI] [PubMed] [Google Scholar]
- 60.Sliwa K, Acquah L, Gersh BJ, Mocumbi AO. Impact of Socioeconomic Status, Ethnicity, and Urbanization on Risk Factor Profiles of Cardiovascular Disease in Africa. Circulation. 2016 Mar 22;133(12):1199–1208. doi: 10.1161/CIRCULATIONAHA.114.008730. [DOI] [PubMed] [Google Scholar]
- 61.Ribeiro ALP, Duncan BB, Brant LCC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular Health in Brazil: Trends and Perspectives. Circulation. 2016 Jan 26;133(4):422–433. doi: 10.1161/CIRCULATIONAHA.114.008727. [DOI] [PubMed] [Google Scholar]
- 62.Miranda JJ, Wells JCK, Smeeth L. [Transitions in context: findings related to rural-to-urban migration and chronic non-communicable diseases in Peru] Rev Peru Med Exp Salud Publica. 2012 Jul;29(3):366–372. doi: 10.1590/s1726-46342012000300012. [DOI] [PubMed] [Google Scholar]
- 63.Muka T, Imo D, Jaspers L, Colpani V, Chaker L, van der Lee SJ, et al. The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol. 2015 Apr;30(4):251–277. doi: 10.1007/s10654-014-9984-2. [DOI] [PubMed] [Google Scholar]
- 64.Jaspers L, Colpani V, Chaker L, van der Lee SJ, Muka T, Imo D, et al. The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol. 2015 Mar;30(3):163–188. doi: 10.1007/s10654-014-9983-3. [DOI] [PubMed] [Google Scholar]
- 65.Bennett JE, Li G, Foreman K, Best N, Kontis V, Pearson C, et al. The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. Lancet. 2015 Jul 11;386(9989):163–170. doi: 10.1016/S0140-6736(15)60296-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 66.Pastorius Benziger C, Bernabe-Ortiz A, Miranda JJ, Bukhman G. Sex differences in health care-seeking behavior for acute coronary syndrome in a low income country, Peru. Crit Pathw Cardiol. 2011 Jun;10(2):99–103. doi: 10.1097/HPC.0b013e318223e375. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 67.Dracup K. The challenge of women and heart disease. Arch Intern Med. 2007 Dec 10;167(22):2396. doi: 10.1001/archinte.167.22.2396. [DOI] [PubMed] [Google Scholar]
- 68.Keller KM, Howlett SE. Sex Differences in the Biology and Pathology of the Aging Heart. Can J Cardiol [Internet] 2016 Apr 7; doi: 10.1016/j.cjca.2016.03.017. Available from: http://dx.doi.org/10.1016/j.cjca.2016.03.017. [DOI] [PubMed] [Google Scholar]
- 69.Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis. PLoS One. 2014 Mar 21;9(3):e91198. doi: 10.1371/journal.pone.0091198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 70.Cooper C, Phillips D, Osmond C, Fall C, Eriksson J. David James Purslove Barker: clinician, scientist and father of the "fetal origins hypothesis". J Dev Orig Health Dis. 2014 Jun;5(3):161–163. doi: 10.1017/s2040174414000099. [DOI] [PubMed] [Google Scholar]
- 71.Charles M-A, Delpierre C, Bréant B. [Developmental origin of health and adult diseases (DOHaD): evolution of a concept over three decades] Med Sci. 2016 Jan;32(1):15–20. doi: 10.1051/medsci/20163201004. [DOI] [PubMed] [Google Scholar]
- 72.Wells JCK, Pomeroy E, Walimbe SR, Popkin BM, Yajnik CS. The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective. Front Public Health. 2016 Jul 7;4:145. doi: 10.3389/fpubh.2016.00145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 73.Penaloza D, Arias-Stella J. The heart and pulmonary circulation at high altitudes: healthy highlanders and chronic mountain sickness. Circulation. 2007 Mar 6;115(9):1132–1146. doi: 10.1161/CIRCULATIONAHA.106.624544. [DOI] [PubMed] [Google Scholar]
- 74.Hultgren HN. Effects of altitude upon cardiovascular diseases. J Wilderness Med. 1992 Aug 1;3(3):301–308. [Google Scholar]
- 75.Caravita S, Faini A, Bilo G, Villafuerte FC, Macarlupu JL, Lang M, et al. Blood Pressure Response to Exercise in Hypertensive Subjects Exposed to High Altitude and Treatment Effects. J Am Coll Cardiol. 2015 Dec 22;66(24):2806–2807. doi: 10.1016/j.jacc.2015.10.031. [DOI] [PubMed] [Google Scholar]
- 76.Bilo G, Villafuerte FC, Faini A, Anza-Ramírez C, Revera M, Giuliano A, et al. Ambulatory blood pressure in untreated and treated hypertensive patients at high altitude: the High Altitude Cardiovascular Research-Andes study. Hypertension. 2015 Jun;65(6):1266–1272. doi: 10.1161/HYPERTENSIONAHA.114.05003. [DOI] [PubMed] [Google Scholar]
- 77.Miele CH, Schwartz AR, Gilman RH, Pham L, Wise RA, Davila-Roman VG, et al. Increased Cardiometabolic Risk and Worsening Hypoxemia at High Altitude. High Alt Med Biol. 2016 Jun;17(2):93–100. doi: 10.1089/ham.2015.0084. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 78.Huffman MD, Labarthe DR, Yusuf S. Global cardiovascular research training for implementation science, health systems research, and health policy research. J Am Coll Cardiol. 2015 Apr 7;65(13):1371–1372. doi: 10.1016/j.jacc.2015.02.023. [DOI] [PubMed] [Google Scholar]
- 79.Lerner AG, Bernabe-Ortiz A, Gilman RH, Smeeth L, Miranda JJ. The “rule of halves” does not apply in Peru: awareness, treatment, and control of hypertension and diabetes in rural, urban, and rural-to-urban migrants. Crit Pathw Cardiol. 2013 Jun;12(2):53–58. doi: 10.1097/HPC.0b013e318285ef60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 80.Nkoke C, Luchuo EB. Coronary heart disease in sub-Saharan Africa: still rare, misdiagnosed or underdiagnosed? Cardiovasc Diagn Ther. 2016 Feb;6(1):64–66. doi: 10.3978/j.issn.2223-3652.2015.08.01. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 81.Guaraldi G, Zona S, Menozzi M, Carli F, Bagni P, Berti A, et al. Cost of noninfectious comorbidities in patients with HIV. Clinicoecon Outcomes Res. 2013 Sep 23;5:481–488. doi: 10.2147/CEOR.S40607. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 82.Thota AB, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012 May;42(5):525–538. doi: 10.1016/j.amepre.2012.01.019. [DOI] [PubMed] [Google Scholar]
- 83.Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA. 2003 Jun 18;289(23):3145–3151. doi: 10.1001/jama.289.23.3145. [DOI] [PubMed] [Google Scholar]
- 84.Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012 Aug;169(8):790–804. doi: 10.1176/appi.ajp.2012.11111616. [DOI] [PubMed] [Google Scholar]
- 85.Diez-Canseco F, Ipince A, Toyama M, Benate-Galvez Y, Galán-Rodas E, Medina-Verástegui JC, et al. [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings] Rev Peru Med Exp Salud Publica. 2014;31(1):131–136. [PubMed] [Google Scholar]
- 86.Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst. 2013 Aug 16;11:31. doi: 10.1186/1478-4505-11-31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 87.Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, et al. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol. 2015 May;30(5):357–395. doi: 10.1007/s10654-015-0026-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 88.Brouwer ED, Watkins D, Olson Z, Goett J, Nugent R, Levin C. Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review. BMC Public Health. 2015 Nov 26;15:1183. doi: 10.1186/s12889-015-2538-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 89.Heeley E, Anderson CS, Huang Y, Jan S, Li Y, Liu M, et al. Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke. 2009 Jun;40(6):2149–2156. doi: 10.1161/STROKEAHA.108.540054. [DOI] [PubMed] [Google Scholar]
- 90.Arredondo A, Zuñiga A. Epidemiological changes and financial consequences of hypertension in Latin America: implications for the health system and patients in Mexico. Cad Saude Publica. 2012 Mar;28(3):497–502. doi: 10.1590/s0102-311x2012000300010. [DOI] [PubMed] [Google Scholar]
- 91.Arredondo A, Duarte MB, Cuadra SM. Epidemiological and financial indicators of hypertension in older adults in Mexico: challenges for health planning and management in Latin America. Int J Health Plann Manage [Internet] 2016 May 30; doi: 10.1002/hpm.2362. Available from: http://dx.doi.org/10.1002/hpm.2362. [DOI] [PubMed] [Google Scholar]
- 92.Arredondo A, Aviles R. Costs and epidemiological changes of chronic diseases: implications and challenges for health systems. PLoS One. 2015 Mar 17;10(3):e0118611. doi: 10.1371/journal.pone.0118611. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 93.Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016 Jan 2;387(10013):61–69. doi: 10.1016/S0140-6736(15)00469-9. [DOI] [PubMed] [Google Scholar]
- 94.Wells JCK. Obesity as malnutrition: the dimensions beyond energy balance. Eur J Clin Nutr. 2013 May;67(5):507–512. doi: 10.1038/ejcn.2013.31. [DOI] [PubMed] [Google Scholar]
- 95.Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013 Sep 5;369(10):954–964. doi: 10.1056/NEJMra1203528. [DOI] [PubMed] [Google Scholar]
- 96.Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000 Jul 6;343(1):16–22. doi: 10.1056/NEJM200007063430103. [DOI] [PubMed] [Google Scholar]
- 97.Baker R, Taylor E, Essafi S, Jarvis JD, Odok C. Engaging young people in the prevention of noncommunicable diseases. Bull World Health Organ. 2016 Jul 1;94(7):484. doi: 10.2471/BLT.16.179382. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 98.Diez-Canseco F, Boeren Y, Quispe R, Chiang ML, Miranda JJ. Engagement of adolescents in a health communications program to prevent noncommunicable diseases: Multiplicadores Jóvenes, Lima, Peru, 2011. Prev Chronic Dis. 2015 Mar 5;12:E28. doi: 10.5888/pcd12.140416. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 99.Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD001871. doi: 10.1002/14651858.CD001871.pub3. [DOI] [PubMed] [Google Scholar]
- 100.Cauchi D, Glonti K, Petticrew M, Knai C. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews. Obes Rev [Internet] 2016 Jul 19; doi: 10.1111/obr.12441. Available from: http://dx.doi.org/10.1111/obr.12441. [DOI] [PubMed] [Google Scholar]
- 101.Piot P, Caldwell A, Lamptey P, Nyrirenda M, Mehra S, Cahill K, et al. Addressing the growing burden of non-communicable disease by leveraging lessons from infectious disease management. J Glob Health. 2016 Jun;6(1):010304. doi: 10.7189/jogh.06.010304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 102.Reubi D, Herrick C, Brown T. The politics of non-communicable diseases in the global South. Health Place. 2016 May;39:179–187. doi: 10.1016/j.healthplace.2015.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 103.Williams KA, Sr, Martin GR. New American College of Cardiology Population Health Agenda to Focus on Primary Prevention. J Am Coll Cardiol. 2015 Oct 6;66(14):1625–1626. doi: 10.1016/j.jacc.2015.08.024. [DOI] [PubMed] [Google Scholar]
- 104.Kim D, Kawachi I, Hoorn SV, Ezzati M. Is inequality at the heart of it? Cross-country associations of income inequality with cardiovascular diseases and risk factors. Soc Sci Med. 2008 Apr;66(8):1719–1732. doi: 10.1016/j.socscimed.2007.12.030. [DOI] [PubMed] [Google Scholar]
- 105.Gaziano T, Reddy KS, Paccaud F, Horton S, Chaturvedi V. Cardiovascular Disease. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. 2nd. Chapter 33. Washington, DC: World Bank; 2011. [Google Scholar]
- 106.United Nations, Department of Economic and Social Affairs, Population Division. [cited 2016 May 4];World Population Prospects: The 2015 Revision, Key Findings and Advance Tables [Internet] 2015 Available from: http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf. [Google Scholar]