Cardiovascular disease epidemiology in developing countries: ethics and etiquette

Coronary artery disease in the developing world

BACKGROUND

Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide, with >4.5 million deaths occurring in the developing world. Despite a recent decline in developed countries, both CAD mortality and the prevalence of CAD risk factors continue to rise rapidly in developing countries. The objectives of the current article are to review (1) the literature regarding CAD mortality and the prevalence of CAD risk factors in the developing world, and (2) prevention and control measures.

METHODS

We conducted a MEDLINE search of the English language literature for the years 1990 to 2002 to identify articles pertaining to the prevalence of CAD in developing countries. The search was performed using the following key terms: coronary artery disease, developing countries, ischemic heart disease, incidence, prevalence, prevention and risk factors. We also obtained relevant statistical information from The World Health Organization's Internet database.

RESULTS

There is a paucity of data regarding CAD and its prevalence in the developing world. However, it is projected that CAD mortality rates will double from 1990 to 2020, with approximately 82% of the increase attributable to the developing world. Existing data suggest that rapid socioeconomic growth in developing countries is increasing exposure to risk factors for CAD, such as diabetes, genetic factors, hypercholesterolemia, hypertension, and smoking. There is a relative lack of prevention and control measures to decrease exposure to these risk factors in developing countries.

CONCLUSION

Documented information on the prevalence of CAD in developing countries is sparse, but there is sufficient data to suggest an impending epidemic. Prevention and targeted control of risk factors for CAD could potentially reduce the impact of CAD in the developing world as it has in industrialized nations.

Development of guidelines for non-indigenous people undertaking research among the indigenous population of north-east Victoria

The Department of Rural Health, University of Melbourne, has developed a framework for conducting research in partnership with Indigenous communities. The framework addresses past inappropriate research practices, incorporates cultural understandings, and outlines culturally appropriate protocols. The four parts of the framework are a committee to initiate, direct and oversee all research projects; a Koorie Team to guide research; a set of research guidelines; and a policy for the department. The framework has been used to develop strong relations with Koorie communities and conduct various health projects.