Cardiovascular Disease Burden Around the World

Some more graphs and maps from the World Health Organization. Up above is a large map showing the total burden of heart disease around the world (you should really click to get the large version in a new window).  The unit here is DALY's lost = Disability Adjusted Life Years lost.  So the idea is, given a thousand population how many of them will either be prematurely dead, or effectively disabled, by heart disease.

The surprising thing about this is that the burden of heart disease, measured this way, is generally higher in developing countries, despite their lower fat diets, less obesity, etc.  I'm assuming the explanation for this is that the actual incidence of heart disease is higher in developed countries, but that care is also much better.  If a fifty year old man in a France or the US keels over, he will be rushed to a hospital and given high tech care.  A fifty year old Zambian in a village is perhaps less likely to get a heart attack, but if he does, he's a lot less likely to get to the hospital in time, and when he does, they aren't going to perform triple bypass surgery on him.  However, I haven't yet found international incidence data to confirm this - when I do, I'll post about it.

Of course, it's also noteworthy that most developing countries have experienced large changes of diet in recent decades.  They eat a lot more food, and more of it from animal products.  This is perhaps being increasingly reflected in some of the standard risk factors for cardiovascular disease (heart disease and strokes).  For example, here are WHO estimates for average total cholesterol levels of men, age 15+:

Look at China!  Amongst the highest cholesterol levels in the world.  Note that here the scale is in mMol/L, versus the mg/dL common in the US.  In the US, the official medical advice is that cholesterol levels should be below 200mg/dL to be "normal", which corresponds to about 5.2 mMol/L.  However, the Campbell/Ornish/Esselstyn faction of nutrition scientists argue you should really be below 150mg/dL to pretty much eliminate the risk of cardiovascular disease.  That corresponds to 3.9 mMol/L - levels that are now only common in Africa.

These are very complex statistics to interpret.  In addition to the dietary/exercise input factors, we also have issues like genetic variation: much of the Chinese population has been living largely on rice and vegetables for thousands of years, versus people of European descent who's ancestors have been eating a lot of wheat bread and some dairy and meat for millenia.  This must have led to genetic differences (lactose tolerance for certain, and likely others), that may contribute to different tolerances for modern industrial diets.

Furthermore, we also have large scale interventions in some places.  For example, a sizeable fraction of the US population is on statin drugs that lower cholesterol level, and this is less true in China (though there would appear to be a very large market opportunity there now).  How much of the variation is explained by these different factors, versus others, I do not know.

Moving on to being overweight, here American dominance is unquestioned (except for some very small Polynesian islands).  This map shows the fraction of men 15+ who have a body mass index over 25:

80.5% of American men are overweight (and this is even when you go all the way down to age 15).  And if we look at the fraction of men who are formally obese (BMI > 30), that is even more concentrated:

The data for women are roughly similar, with some interesting wrinkles:

Note that in Latin America and parts of North Africa and the Middle East, women are more apt to be obese than men.

It seems increasingly clear to me that health variables are essentially conjugate to global energy/food issues.  The places where everyone is overweight are for the most part, also the places where per capita oil and food consumption are very high and people drive everywhere.  We in the developed world, and particularly in the US, are living wrong in important ways.  Not only is it destabilizing the biosphere and the climate, but a lot of us carry around the ever increasing evidence in distended folds draped about our midriffs.