Bertrand E
Service de médicine, hôpital Nord, Chemin des Bourrelys, St-Antoine, Marseille.
Arch Mal Coeur Vaiss. 1997 Jul;90(7):981-5.
Though the environmental and medical conditions are very different, similar population characteristics can be observed in the developing countries. The mean age of the population is young. Most people have a rural way of life, but migrations towards towns result in a disorganized urbanization and in habits more predisposing to cardiovascular diseases. Care access is often difficult for the patients. With respect to risk factors, smoking is increasing, hypertension is highly prevalent and severe, a trend towards obesity is frequent in medium or high economical level people. S or C hemoglobin diseases seem to be associated with coronary heart disease. In spite of very insufficient statistical data, it appears that: cardiovascular disease mortality is increasing when total mortality is decreasing: ischemic and hypertensive heart diseases are increasing when streptococcal or nutritional heart diseases are stabilizing or decreasing. The authors seem to be the different developing countries in respect to the crossing of these curves. Some countries have not reached the crossing. Subsaharan Africa for instance. Others have gone beyond the crossing, some Asian countries for instance. Other countries seem to be at the intersection (Mediterranean or Latin American countries). But many countries suffer the double burden of increasing and decreasing diseases. There is a general lack of prevention owing to other competing priorities and also to economical, social and educational difficulties. However in some developing countries feasibility and efficacy of preventive measures have been proved.
尽管环境和医疗条件差异很大,但在发展中国家仍可观察到相似的人口特征。人口平均年龄较轻。大多数人过着乡村生活,但向城镇的迁移导致城市化无序发展,且养成了更易引发心血管疾病的习惯。患者往往难以获得医疗服务。在风险因素方面,吸烟率在上升,高血压高度流行且严重,在经济水平中等或较高的人群中肥胖趋势较为常见。S型或C型血红蛋白疾病似乎与冠心病有关。尽管统计数据非常不足,但似乎:在总死亡率下降时心血管疾病死亡率在上升;当链球菌性或营养性心脏病趋于稳定或下降时,缺血性和高血压性心脏病在增加。在这些曲线的交叉方面,不同的发展中国家情况各异。一些国家尚未达到交叉点,例如撒哈拉以南非洲地区。其他国家已经越过交叉点,例如一些亚洲国家。还有一些国家似乎正处于交叉点(地中海或拉丁美洲国家)。但许多国家同时面临疾病增加和减少的双重负担。由于其他优先事项的竞争以及经济、社会和教育方面的困难,普遍缺乏预防措施。然而,在一些发展中国家,预防措施的可行性和有效性已得到证实。