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05-07-2011 | Cardiology | Article

Stroke bigger problem than IHD for low-income countries


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MedWire News: Countries with a low national income have a higher burden of mortality and morbidity from stroke than from ischemic heart disease (IHD), which is more of a problem for wealthier countries, shows research.

"At first, one might think that this is simply a reflection of the different patterns of risk factors operating in different countries, but it is actually much more complicated than that," said researcher Anthony Kim (University of California, San Francisco, USA).

As expected, Kim and study co-author Claiborne Johnston, also from the University of California, San Francisco, found that a higher prevalence of diabetes in a country and a higher average serum cholesterol level were associated with lower mortality from stroke relative to IHD, after controlling for national income.

But the lower a country's national income or World Bank income category was, the higher was its stroke mortality rate relative to that of IHD.

This may reflect the impact of limited resources, suggest the researchers. For example, aspirin is a cheap and widely available preventive medication, but has a far smaller cost-effectiveness ratio against myocardial infarction than against stroke - in other words, it prevents more cardiac than stroke events for the same cost.

For their analysis, which appears in the journal Circulation, Kim and Johnston reviewed data from the World Health Organization and the World Bank on 192 countries.

They report that, overall, mortality rates and disease burden were greater for IHD than for stroke. However, stroke mortality rates exceeded IHD mortality rates in 74 (39%) countries and more disability-adjusted life-years were lost from stroke than from IHD in 62 (32%) countries, largely in China, Africa, and South America.

Countries in the Middle East, North America, Australasia, and most of Europe had a higher IHD than stroke burden, while Russia had high rates of both conditions.

"Researchers and policy makers often think of stroke and heart disease together when designing cardiovascular disease prevention programs. But there may be important reasons to consider the two separately as well," said Kim.

He added: "Ultimately, the goal is to better understand the reasons behind these differences in order to develop interventions to address the specific issues in a particular country."

In an accompanying editorial, Sidney Smith (University of North Carolina School of Medicine, Chapel Hill, USA) said: The upcoming United Nations high-level meeting on September 19 and 20, 2011 represents an unprecedented opportunity for those involved in the prevention and treatment of CVD [cardiovascular disease]… to act and initiate priority programs and interventions that can avert the evolving pandemic of CVD and address the devastating worldwide effect of NCDs [non-communicable diseases]."

He added that he hopes that the United Nations will "rise to the challenge and not miss this unique opportunity."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid

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