Heart disease: Big killer in poor nations

A heart patient undergoing surgery at the Kenyatta National Referral Hospital in Nairobi. Heart disease and stroke are one of the biggest killers in low- and middle-income countries. PHOTO| FILE| NATION

Death from non-communicable diseases in low- and middle-income countries is higher than in Western countries, according to new analysis published in the journal Nature.

Of 25.3 million deaths in tropical regions in 2016, 34 per cent were from infectious and parasitic diseases, conditions surrounding pregnancy and birth, and nutritional deficiencies, while 55 per cent were from non-communicable diseases (NCDs) such as cancer and heart disease.

Non-communicable diseases are conditions that cannot pass from person to person. They include cancer, cardiovascular diseases, diabetes, kidney and liver disease, neurological conditions such as dementia, and mental health disorders. Higher NCD deaths are due to late diagnosis when treatment is less effective.

Cardiovascular diseases, especially heart disease and stroke, were found to be one of the biggest killers in low- and middle-income countries, with nearly one in four deaths due to the condition.

High blood pressure is higher in low- and middle-income nations, with the highest levels of blood pressure found in sub-Saharan Africa.

Heart disease in low- and middle-income tropical countries killed at least 90 people for every 100,000 compared to 61 deaths per 100,000 people in Western nations. Stroke death rates were also much higher – at least 49 deaths per 100,000 in developing countries compared to 22 deaths per 100,000 in Western countries.

Cervical, stomach, and liver cancers had higher death rates in low- and middle-income tropical countries as were diabetes death rates, with 32 deaths per 100,000 in developing countries compared to 11 per 100,000 in wealthier nations.

Low- and middle-income tropical countries were defined as any country that had half or more of their land area between the Tropic of Cancer and the Tropic of Capricorn, and included most countries in Africa, Southeast Asia, and Latin America and the Caribbean (around 80 countries in total).

Death rates were adjusted for age differences across the various countries. The team acknowledged that some nations have more robust data than others, but the overall picture remained clear.

“The persistent large burden of cancer and heart disease deaths in developing nations is due to a range of factors – for instance smoking and alcohol use are on the rise in low- and middle-income countries, which would certainly play a role. But this is ultimately a story of poverty, poor housing and nutrition, and inadequate healthcare, that mean diseases such as heart disease and cancer are diagnosed late, and the treatments offered are inadequate,” said lead author Professor Majid Ezzati.

The team outlined 25 recommendations for reducing non-communicable diseases in low- and middle-income countries, including measures to reduce alcohol and tobacco consumption, better housing, and more resources for detecting disease at an early stage and treating it.

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Good cholesterol not always good for heart health

High-density lipoproteins (HDL) transport fat to the liver so that it can be processed, preventing it from accumulating in the body.

This is why they are referred to as “good” cholesterol. Researchers analysed data from 1,138 women aged 45 to 89 years.

They assessed the number and size of HDL particles and the total cholesterol they carried, to establish whether high HDL levels were, in fact, protective for cardiovascular health in post-menopausal women.

The team also considered the impact of women’s age at menopause and how long women took to switch to the post-menopausal period.

Having a high number of small-sized HDL particles seemed to have protective effects for all post-menopausal women, regardless of their age at menopause or how far post menopause they were.

Large-sized HDL particles, on the other hand, indicated an increased risk of cardiovascular disease in women close to menopause. The scientists found a link between high HDL cholesterol and increased risk of atherosclerosis, particularly among women who were older at the time of menopause and those who had lived at least 10 years into the post-menopausal period.

However, a higher concentration of total HDL particles indicated a lower risk of developing atherosclerosis among study participants. - Aggrey Omboki

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