Trends in the Incidence and Mortality of Coronary Heart Disease in Asian Pacific Region

Abstract

The rates of coronary heart disease are lower in Asia than in developed countries. Singapore has undergone rapid urbanization over the past several decades. In the several decades between the 1960s and 1980s, a rapid increase in the rates of ischemic heart disease was observed, to the extent that Singapore exhibits one of the highest rates of mortality from cardiovascular disease in the Asia-Pacific region, higher even than the rates in North America. Rates of cardiovascular disease have now stabilized, and are declining. This is, a pattern that has been observed in many developed countries. Increased life expectancy has resulted in an epidemiologic transition that has seen chronic non-communicable diseases replace malnutrition and infections as the major causes of mortality. At the same time, there have been changes in nutrient intake and physical activity as well as rapid increases in the levels of several cardiovascular risk factors including obesity, hypertension, hyperlipidemia, diabetes mellitus and systemic inflammation. Furthermore, when present, there is a lack of awareness and sub-optimal treatment of these risk factors. In addition to the changes in environmental exposures related to socio-economic development, it does appear that specific populations are particularly prone to the development of cardiovascular disease and its risk factors. In particular, Asian Indians experience a high rate of coronary heart disease and diabetes mellitus. Emerging data suggests that Chinese may be particularly prone to the adverse effects of obesity in relation to insulin resistance and inflammation. A concerted effort to change lifestyles to prevent the development of coronary heart disease risk factors, and to improve awareness and treatment of risk factors when then develop, is required to halt the epidemic of coronary heart disease that is occurring in Asia.J Atheroscler Thromb, 2014; 21:S2-S8.

Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study

“…Given a continuous economic development in Myanmar, and if preventive policies for NCDs are not put in place, we may expect a similar epidemiologic transition in Myanmar as in other Asian countries, like for example the well documented NCD trends in China [ 38 ]. The development seen in Singapore during the past several decades could also indicate future prospects of Myanmar: a rapid urbanization and economic development, with a demographic transition concomitant with an epidemiological transition, leading to an increase in cardio vascular diseases and their associated factors [ 3 ]. There is available evidence for health promoting interventions in reducing NCD risk in low income setting [ 39 ], which could be considered in plans for NCD policies in Myanmar.…”

“…Non-communicable diseases (NCDs) and malaria, tuberculosis and lower respiratory infections dominate the disease pattern in Myanmar, along with tobacco smoking, high systolic blood pressure and dietary risks as the top three NCD risk factors [ 1 ]. Due to urbanization, more westernized lifestyle and economic development in Myanmar, it is likely that there will be an increase in daily smokers, alcohol consumption, unhealthy food habits, physical inactivity, obesity, hypertension and NCDs such as cerebrovascular disease and ischemic heart disease [ 2 , 3 ]. This kind of health transition has previously been described in the Asian region in countries under rapid economic development [ 3 ].…”

“…When reaching ordinary people, both will probably impact on the disease pattern and life expectancy, leading to a reduction in infectious diseases and an increase in non-communicable diseases (NCDs). However, similar to many other countries it is likely that development, and thus the disease and risk factor pattern, will differ across urban-rural- and ethnic gradients [ 3 ]. It is already documented that health disparities follow these gradients in Myanmar [ 5 ].…”

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

“…Rates of heart failure also appear to be slightly lower in Asian vs Western populations but, as for AF, the number of patients in Asia who develop heart failure each year is high, indicating that the worldwide heart failure pandemic includes Asia . Given that an increase in CHD prevalence often occurs in parallel with better socioeconomic prosperity, the improving socioeconomic status across much of Asia means that the region has high rates of CHD and CHD mortality . It has been estimated that over 60% of the global CHD burden occurs in developing countries, especially in Asia…”

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases

“…Singapore also has her own unique drivers of CVD, such as her rapidly ageing population, the population’s lack of exercise and physical inactivity, as well as a multi-ethnic society which in turn affects CVD risk, due to possible differences in metabolic traits, such as insulin resistance 10 .To the best of our knowledge, studies evaluating the impact of CR programmes in Asia are currently lacking. Our study therefore aims to provide local supporting evidence for community-based CR by assessing participation in a community-based CR programme and its association with LDL and other clinical parameters in patients with CVD in Singapore.…”