• MYOCARDIAL DISEASE

Cardiovascular diseases (CVD) in developing countries are now recognised as a major global health problem. According to WHO, in 2012, more than 75% of all deaths due to cardiovascular causes occurred in low and middle income countries (LMIC), where CVD occurs at a younger age, affecting profoundly the workforce and the productivity, with economical consequences.1 The prevalence of CVD in LMIC tends to increase, due to the worldwide trend of urbanisation, change of diet and lifestyle and increase of life expectancy, leading to the ageing of the population.1 There are several barriers for the prevention, recognition and treatment of CVD in developing countries, such as: financial constrains; high costs of medication and devices; and limited access and insufficient availability of healthcare facilities and qualified health personnel. Moreover, most of the knowledge on cardiovascular disease was obtained from experimental, observational and clinical studies performed and published in developed countries.2 This information may not be directly applicable to LMIC populations due to diverse genetic and racial background, cultural factors and the existence of prevalent regional diseases, as Chagas disease in Latin America and HIV-related cardiomyopathy in Africa. Low research productivity is recognised as a barrier to a more efficient approach to prevention and treatment of CVD in LMIC and a cause of the widening gap between cardiovascular morbidity and mortality in wealthier countries compared with poorer countries.2

Sliwa et al3 published a study that points for a route of narrowing this gap, approaching a topic of considerable historical significance: how heart disease may complicate pregnancy. Around 1880, a Scottish physician, James …