Multimorbidity and cardiovascular disease: a perspective on low- and middle-income countries

Abstract

New and changing patterns of multimorbidity (MM), i.e., multiple concurrent acute or chronic diseases in a person, are emerging in low- and middle-income countries (LMICs). The interplay of underlying population-specific factors and lifestyle habits combined with the colliding epidemics of communicable and non-communicable diseases presents new disease combinations, complexities and risks that are not common in high-income countries (HICs). The complexities and risks include those arising from potentially harmful drug-drug and drug-disease interactions (DDIs), the management of which may be considered as MM in the true sense. A major concern in LMICs is the increasing burden of leading cardiovascular diseases, prevalence of associated risk factors and co-occurrence with other morbidities. New models of MM management and integrated care can respond to the needs of specific multimorbid populations, with some LMICs making substantial progress (e.g., integration of tuberculosis and HIV services in South Africa). But there is a dearth of relevant data on the changing patterns and underlying factors and determinants of MM, the associated complexities and risks of DDIs in MM management, and the barriers to integrated care in LMICs. This requires careful attention.

Keywords: Africa; Multimorbidity (MM); cardiovascular disease (CVD); low income countries; middle income countries; poverty.

Figure 1

Life expectancy at birth for both sexes. Findings from the Global Burden of Disease Study 2017 (13).

Figure 2

Trends in life expectancy for individuals initiating antiretroviral therapy at age 35 years from Rwanda, South Africa, United Kingdom (UK), and high-income countries in North America and Europe. Published by Egger & Johnson in The Lancet Global Health in 2015 (38).