Focus on: Promoting Cardiovascular Health (I)
Promoting Cardiovascular Health Worldwide: Strategies, Challenges, and OpportunitiesPromoción de la salud cardiovascular global: estrategias, retos y oportunidades

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Abstract

Cardiovascular disease is the leading cause of death in the world, affecting not only industrialized but, above all, low- and middle-income countries, where it has overtaken infectious diseases as the first cause of death and its impact threatens social and economic development. The increased prevalence of cardiovascular disease in recent years together with projected mortality for the coming decades constitute an irrefutable argument for the urgent implementation of well-planned interventions to control the pandemic of cardiovascular diseases, especially in the more economically deprived countries. The combination of behavioral, social, environmental, and biological factors, and others related to health care systems, that contribute to the development of cardiovascular diseases requires a multi-sector strategy that promotes a healthy lifestyle, reduces cardiovascular risk factors, and cuts mortality and morbidity through quality health care services. These proposals should be guided by leaders in the scientific community, government, civil society, private sector, and local communities.

Resumen

Las enfermedades cardiovasculares son la primera causa de muerte en el mundo, y afectan no solo a países industrializados, sino sobre todo a países de ingresos medios-bajos, donde han superado a las enfermedades infecciosas como primera causa de muerte y su impacto amenaza al desarrollo social y económico de estas regiones. El aumento en la prevalencia de las enfermedades cardiovasculares de los últimos años, junto con las proyecciones de mortalidad para las próximas décadas, supone un argumento irrefutable acerca del carácter urgente de implementar intervenciones bien planificadas para controlar la pandemia de enfermedades cardiovasculares, especialmente en los países económicamente más deprimidos. La combinación de factores de comportamiento, sociales, medioambientales, biológicos y relacionados con sistemas de salud que contribuyen al desarrollo de la enfermedades cardiovasculares requiere una estrategia multisectorial que promueva estilos de vida saludables, reduzca los factores de riesgo cardiovascular y disminuya la mortalidad y la morbilidad a través de servicios sanitarios de calidad. Dichas propuestas deben ser dirigidas por líderes de la comunidad científica, el gobierno, la sociedad civil, el sector privado y las comunidades locales.

Section snippets

INTRODUCTION

The world population continues to grow at an unstoppable rate. Simultaneously, the population is aging and we are witnessing an alarming increase in specific cardiovascular risk factors (CVRF), like bad nutrition habits and obesity, with an unquestionable impact on the state of health of the population at large. And so we find ourselves facing a cardiovascular disease (CVD) pandemic that has complex multi-factor causes in which different sectors of society are implicated. Cardiovascular health

GLOBAL DIMENSION OF CARDIOVASCULAR DISEASE: IMPACT ON HEALTH CARE AND THE ECONOMY

The health of the world population is at serious risk, given the universal presence of CVRF. The consumer society we live in does not encourage healthy living and the consequences of this are even more devastating if we bear in mind the social inequalities, economic context, and demographic explosion of the last 20 or more years. The growth of bad nutrition habits, obesity, and high blood pressure increasingly contributes to the expanding CVD epidemic. The factors influencing this deterioration

CARDIOVASCULAR DISEASE IN LOW–MIDDLE INCOME COUNTRIES

According to a study published in The Lancet, 80% of the burden of chronic diseases and 70% of deaths due to NCD in individuals aged < 70 years occur in only 23 countries.18 To illustrate what is behind this trend, let us take the example of India, where more than 1 billion inhabitants have rates of cardiovascular morbidity and mortality that are increasing more rapidly and affecting younger individuals than in the western countries.19 The country's economic growth, with rates among the highest

STRATEGIES AND OPPORTUNITIES IN CONTROLLING THE CARDIOVASCULAR DISEASE EPIDEMIC: CARDIOVASCULAR HEALTH PROMOTION

Cardiovascular prevention can be focused on the individual or the population. At the individual level, a stratification strategy is used, in which individuals undergo a study of the presence of risk factors and those identified as being above a cutoff point receive treatment. The advantage of this strategy is that the subject receives individualized treatment that optimizes the risk:benefit ratio. However, screening costs are very high and the risk prediction of most of the tools currently used

THE “POLYPILL”: A WORLDWIDE OPPORTUNITY IN SECONDARY PREVENTION

In the developed world, access to quality health care systems and therapies of proven effectiveness in reducing cardiovascular mortality has successfully mitigated the consequences of CVD and has increased survival. However, the worldwide reality is quite different. Half of all the world's patients with acute myocardial infarction do not receive cardioprotective therapy to avoid the recurrence of cardiovascular events, and only 13% of those in low–middle-income countries receive treatment.28

CONCLUSIONS

The scientific societies are under an obligation to use their knowledge and experience in the worldwide fight against CVD and chronic conditions. Recently-proposed innovations include strategies to control tobacco and reduce dietary sodium, which could prevent > 1 million deaths per year in the emerging countries, at a cost of approximately $0.50 per person per year.37, 38

The use of cheap, safe pharmacologic therapies in fixed combinations, like the “polypill”, represents another promising

CONFLICTS OF INTEREST

None declared.

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