Challenges and Perspectives for Cardiology in the Developing World: Joint Views from Africa and Latin America

Health cannot be a question of income; it is a fundamental human right." Nelson MandelaCardiovascular health in developing countries, notably in the regions of Africa and Latin America, poses unique challenges that warrant in-depth analysis and an interdisciplinary approach.The medical landscape in these contexts is marked by a complex intersection of factors, including structural limitations, restricted financial resources, and a diversity of cultural and socioeconomic conditions. 1 This editorial aims to explore the pressing challenges and promising prospects for Cardiology in these two continents, providing a joint perspective that seeks to highlight similarities, disparities, and opportunities to improve cardiovascular health in communities at different stages of development.Africa has the poorest countries in a single continent.Of the top 30 poorest countries in the world, 23 are in Africa, representing 76.6% of the total countries on the list, with almost 1.1 billion people in poverty, as per the report of the 2023 Multidimensional Poverty Index (MPI), which measures the acute deprivations in health, education, and living standards that people face simultaneously. 2Africa, the least developed continent, faces a complex intersection of economic and public health challenges.Despite modest economic growth, the highest proportion of the world's poor, 54.8%, are from Africa, which holds significant inequalities and vulnerabilities. 1,3Poverty disproportionately affects low-income countries and regions, 57.3% and 639 million people, and Sub-Saharan Africa has a higher average poverty rate, 41.1%, than Latin America and the Caribbean, 37.9%.Also, endemic diseases such as malaria, HIV/AIDS, and tuberculosis persist, while noncommunicable diseases, such as cardiovascular disease (CVD), are growing as public health concerns in Africa and Latin America.It is essential to mention that the leading causes of agestandardized deaths worldwide were the same from 1990 to 2019: ischemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infection, in descending order.However, in 2021, COVID-19 replaced stroke as the second leading standardized cause of death.In 2021, the highest age-standardized death rates from COVID-19 occurred in Sub-Saharan Africa, Latin America, and the Caribbean, and mortality from COVID-19 exceeded deaths from CVD in these regions.Few countries had MPI data consolidated during the COVID-19 pandemic, and the impacts of the COVID-19 pandemic on poverty and inequalities will likely be more significant in the coming years.There will likely be a substantial reduction in life expectancy in these regions in subsequent years, interrupting the cycle of incremental gains observed previously (Figure 1). 4 There is a significant intersection between the COVID-19 pandemic and CVD globally, especially in Latin America, the Caribbean, North Africa, and Sub-Saharan Africa.It is worth highlighting the impact of SARS-CoV-2 on the cardiovascular system and patients with CVD, the competition for health resources, and mitigation policies that compromised CVD care, partially