“Providing cardiovascular care to populations in developing countries is one of our primary challenges,” said Stephen MacMahon, D.Sc., Ph.D., during the annual Paul Dudley White International Lecture.

“The American Heart Association could play a critical role. There is a real need for leadership, and the AHA could provide that leadership,” said Dr. MacMahon, professor of cardiovascular medicine at the University of Sydney.
“The growing burden of cardiovascular disease in middle- and low-income countries is largely unknown,” Dr. MacMahon said.

Between 2000 and 2020, the toll from cardiovascular disease in the developed world is expected to grow from 5 million to 6 million deaths a year. In the developing world, the cardiovascular toll will jump from 10 million a year to 19 million a year over the same period.

The causes, prevention and treatment of cardiovascular disease in the developing world are the same as in developed nations, he said.
Obesity, hypertension, diabetes, smoking and other risk factors play a familiar role. What the developing world lacks is effective prevention and treatment.
There is a dramatic shortage of skilled healthcare workers in less-developed countries, Dr. MacMahon said.
The few available physicians, nurses and other healthcare professionals are seldom trained in preventive care or incentivized to provide it.

In rural India, he said, only one person in six with a history of myocardial infarct is receiving aspirin.
“That is simply a failure of the healthcare system to deliver,” he said.
Drug treatment is just as effective in the developing world as in other populations, but access is problematic.
A 30-day supply of generic ACE inhibitors or hypertension and hyperglycemia medications costs about one day’s wages in developing countries, Dr. MacMahon said, but generics are rarely available.
Providers typically offer brand-name products that cost five days’ to 50 days’ income.

The key to reducing inequalities in care is to make cardiovascular disease a priority, he said.
The World Health Organization only recently recognized that cardiovascular disease equals HIV/AIDS in morbidity and mortality in the developing world. The World Bank has no financial commitment to cardiovascular disease, nor do the governments of most developing countries. Pharmaceutical companies devote few resources that are not related to a specific product.
That leaves the AHA, Dr. MacMahon said. “The AHA is the one organization that has major influence with all of the stakeholders,” he said.