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Coronary heart disease (CHD) is the leading cause of death worldwide with the greatest absolute contribution of deaths coming from low-income and middle-income populations.1 At the outset of the global epidemic, early in the 20th century and continuing for a few decades, CHD rates steeply increased stemming from the prosperity and societal-level changes that industrialisation and urbanisation brought to populations.2 These same populations experienced a near universal regression of rates in the latter portion of the century due to a combination of population approaches for prevention as well as advances in medical care. Notably, these countries and populations are typically categorised as high income in the present day. The current concern in high-income countries is whether the decreased rates of CHD have plateaued, especially in the light of major risk factors including obesity, hypertension and type 2 diabetes being on the rise in younger populations.3 With these data in hand, it will be prudent to closely monitor these younger, high-income populations for any reversal of these historical positive trends.
In low-income and middle-income countries, there has been a precipitous increase in CHD due to the natural progression of ongoing nutrition and epidemiological transitions. The question as these countries develop is whether modernity itself exacerbates CHD rates or does the adoption of western dietary and lifestyle habits in today's globalised world individually impact the rates? Recent evidence suggests a multitude of avenues linked to westernisation or globalisation and a poorer CHD risk profile are increasingly prevalent in low-income and middle-income countries. Specifically, there is greater consumption of poor quality dietary commodity foods, increased smoking rates, increased heavy alcohol consumption, increased sedentary pastimes and decreased physical activity levels, as well as the rising tide of obesity.4–7 Indeed, the causes of this global epidemic have largely been established to …