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Abstract
Developing countries are subject to the same risks that have contributed to the high
incidence of cardiovascular diseases in the already developed countries. Improvements
in life expectancy at birth lead to predictable shifts in the cause-of-death structure
over time. The stage at which cardiovascular diseases may be considered to be ‘actively
emerging’ corresponds to a life expectancy level between 50 and 60 years and, at this
level, cardiovascular disease mortality accounts for 15–25% of all deaths. The average
life expectancy at birth in developing countries for the year 2000 is projected to
be 60 years or more and it may be expected that by that time cardiovascular diseases
would be actively emerging or established in virtually every country. In many developing
countries today, life-style pattern that is associated with high rates of coronary
heart disease is not yet widespread and it is therefore logical that a strategy of
prevention should include efforts to inhibit the entrenchment and spread of unhealthy
life-styles in the community (i.e., primordial prevention). At the country level,
cardiovascular disease prevention and control cannot be considered in isolation and
must be related to prevailing national health priorities and competing claims from
other sectors of development. In poorer countries where life expectancy is below 50
years primordial prevention activities are likely to be restricted – perhaps to smoking
and hypertension control. In middle-income countries a broader based approach to primordial
prevention is feasible and is more likely to be acceptable.