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Neglected diseases in cardiology: a call for urgent action

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 176–177 (2008)Cite this article

The practice and science of cardiology have witnessed unprecedented progress during the past 50 years. These advances have led to considerable reductions in mortality and morbidity from cardiovascular disease (CVD), and contributed to prolonged life expectancy and enhanced quality of life. Unfortunately, these benefits have not reached the majority of the world's population—those who live in developing countries. The WHO have reported that 16.7 million people died from CVDs in 2002, 80% of whom lived in low-to-middle-income countries, and they predict that CVD will be the leading cause of death in the developing world by 2010.1 Furthermore, CVD accounted for a global burden of 148 million disability adjusted life years in 2002.1 The rise in cardiovascular mortality and morbidity in developing countries has been caused by the lack of preventive and therapeutic measures for common conditions such as hypertension, atherosclerosis, and congenital heart disease, as well as for 'neglected' diseases, which almost exclusively affect the poorest people in developing countries.2,3 Although accurate data are scarce, there is increasing evidence that these neglected CVDs now affect over 30 million people.4,5 In this Viewpoint we highlight some of these diseases—which we believe are potentially preventable—discuss their impact on global health, and suggest possible prevention and treatment strategies.

Our first example of a neglected CVD is Chagas disease, which is caused by the protozoan parasite Trypanosoma cruzi and leads to dilated cardiomyopathy in 30% of infected people.6 In 2004, the WHO estimated that there were 13 million people infected with this disease in Latin America, with 200,000 new infections and 14,000 deaths occurring per year.1 The disease predominantly affects the rural poor, who are most exposed to the insect vector (triatomines). Chagas disease has been neglected by the scientific community and pharmaceutical industry, with no new drug development since the 1970s.7 Management of Chagas disease involves early diagnosis and treatment with the antiparasitic drugs benznidazole or nifurtimox, which although toxic, have been shown to be effective in treating early infection.8 Chronic Chagas disease is currently managed symptomatically, with pace makers or implantable cardioverter-defibrillators, medical treatment of heart failure, and occasionally heart transplantation. Access to treatment is, however, very limited. Preventing Chagas disease depends largely on vector control, although insecticide spraying is labor-intensive and expensive, and triatomine resistance to insecticides has been reported. Blood products for transfusion, a recognized source of Chagas disease transmission, are now screened for T. cruzi in Latin America and the US. A new global network for the elimination of Chagas disease by 2010 was set up by the WHO in 2007.9 The achievability of this target is hampered by the many gaps in our knowledge of this neglected disease. The sequencing of the T. cruzi genome in 2005 should, however, act as a stimulus for further research and drug development.

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Authors and Affiliations

  1. S Yacoub is an Academic Clinical Fellow in Infectious Diseases, and S Kotit is a PhD student at the National Heart and Lung Institute, both at Imperial College London, UK,,

    Sophie Yacoub & Susy Kotit

  2. AO Mocumbi is a Cardiologist and PhD student at the Maputo Heart Institute, Mozambique,

    Ana Olga Mocumbi

  3. MH Yacoub is Professor of Cardiac Surgery at Imperial College London, Director of Research at the Harefield Heart Science Centre, Harefield, UK, and Professor of Surgery at the University of Florence, Italy.,

    Magdi H Yacoub

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  1. Sophie Yacoub
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  2. Susy Kotit
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  3. Ana Olga Mocumbi
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  4. Magdi H Yacoub
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Correspondence to Magdi H Yacoub.

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The authors declare no competing financial interests.

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Yacoub, S., Kotit, S., Mocumbi, A. et al. Neglected diseases in cardiology: a call for urgent action. Nat Rev Cardiol 5, 176–177 (2008). https://doi.org/10.1038/ncpcardio1129

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