In the Western Hemisphere approximately 50% of deaths are related to cardiovascular disease. This is due mainly to ischaemic heart disease that could, perhaps, be significantly reduced if smoking were prohibited, life-style moderated (e.g. weight reduction) and the intake of cholesterol and saturated fats reduced. Whilst the incidence of rheumatic heart disease is decreasing in the West, it is stilI an important problem worldwide, predominantly in countries with poor sanitation, overcrowding and malnutrition. Up to one-third of all cardiac cases admitted to hospital in, for example, India, Jamaica, Egypt or the Philippines are due to rheumatic heart disease. Hypertensionis another major cause of mortality, being responsible for 10% of deaths worldwide. The incidence of hypertension usually increases with age and is higher in Western countries. There is also a wide geographical variation in other cardiac diseases: endomyocardial fibrosis is seen in the tropics; cardiac problems associated with protein-energy malnutrition are seen in countries where famine and malnutrition occur; cardiomyopathy is seen with beriberi and myocarditis is seen with other diseases associated with the tropics, e.g. Chagas’ disease, typhoid fever and diphtheria. Congenital heart disease is important in the young and is responsible for approximately 1% of deaths in patients below 15 years of age.
Lastly, pulmonary heart disease is common In countries with a high incidence of smoking.