Strategic Priorities of the WHO Cardiovascular Disease Programme

Dr. Rina Amelia, MARS Dept of Community Medicine Block: Cardiovascular

The WHO Programme on Cardiovascular Diseases (CVD) is concerned with prevention, management and monitoring of CVD globally. It aims to develop global strategies to reduce the incidence, morbidity and mortality of CVD by

effectively reducing CVD risk factors and their determinants developing cost effective and equitable health care innovations for management of CVD monitoring trends of CVD and their risk factors

CVD is the name for the group of disorders of the heart and blood vessels and include:
Hypertension (high blood pressure) Coronary heart disease (heart attack) Cerebrovascular disease (stroke) Peripheral vascular disease Heart failure Rheumatic heart disease Congenital heart disease Cardiomyopathies

Facts
In

1999 CVD contributed to a third of global deaths. In 1999, low and middle income countries contributed to 78% of CVD deaths. By 2010 CVD is estimated to be the leading cause of death in developing countries. Heart disease has no geographic, gender or socio-economic boundaries.

CVD in developing countries

Economic transition urbanisation, industrialisation and globalisation bring about lifestyle changes that promote heart disease. These risk factors include tobacco use, physical inactivity, unhealthy diet. Life expectancy in developing countries is rising sharply and people are exposed to these risk factors for longer periods. Newly merging CVD risk factors like low birth weight, folate deficiency and infections are also more frequent among the poorest in low and middle income countries.

Social and economic consequences

Clinical care of CVD is costly and prolonged. These direct costs divert the scarce family and societal resources to medical care. CVD affects individuals in their peak mid life years disrupting the future of the families dependant on them and undermining the development of nations by depriving valuable human resources in their most productive years. In developed countries lower socioeconomic groups have greater prevalence of risk factors, higher incidence of disease and higher mortality. In developing countries as the CVD epidemic matures the burden will shift to the lower socioeconomic groups.

Goal of the WHO Global Strategy

To

effectively control CVD risk factors and to reduce the burden of the fast growing cardiovascular disease (CVD) epidemic particularly in developing countries.

Key areas of work

Reduce major CVD risk factors and their social and economic determinants through community based programmes for integrated prevention of NCDs. Development of standards of care and cost-effective case management for CVD.
Global action to enhance the capacity of countries to meet the health care needs of CVD. Developing feasible surveillance methods to assess the pattern and trends of major CVDs and risk factors and to monitor prevention and control initiatives. Developing effective inter-country, interregional and global networks and partnerships for concerted global action.

Integrated Management of Cardiovascular Risk

Cardiovascular disease (CVD) is a leading cause of mortality and is responsible for one-third of all global deaths. Nearly 85% of the global mortality and disease burden from CVD is borne by low- and middle-income countries. In India, for example, approximately 53% of CVD deaths are in people younger than 70 years of age; in China, the corresponding figure is 35%. The majority of the estimated 32 million heart attacks and strokes that occur every year are caused by one or more cardiovascular risk factors hypertension, diabetes, smoking, high levels of blood lipids, and physical inactivity and most of these CVD events are preventable if meaningful action is taken against these risk factors.

CVD is an important cause of global morbidity and in five of the six WHO Regions it is the leading cause of mortality.

Cardiovascular Risk

Risk factors i.e. smoking, unhealthy diet and physical inactivity are expressed as hypertension, diabetes, obesity and high blood lipid levels, and together contribute to the total cardiovascular risk and are the root causes of the global CVD epidemic

Risk factors account for 75% of the CVD epidemic worldwide

Heart attacks and strokes are leading causes of death and disability, they represent only the tip of an iceberg.

CVDs are responsible for the deaths of 17 million people each year, or approximately onethird of global deaths annually. Hypertension is the most prevalent CVD, affecting at least 600 million people, and is an important contributor to cardiovascular mortality and morbidity

Hypertension as an entry point to cardiovascular risk management

About 15%37% of the adult population worldwide is afflicted with hypertension In general, hypertension prevalence is higher in urban settings compared to rural settings Data from World Health Report 2002 indicate that hypertension is the third most important contributor to the global disease burden among the six risk factors: underweight, unsafe sex, hypertension, unsafe water, tobacco and alcohol. treating hypertension has been associated with a 35%40% reduction in the risk of stroke and a reduction of at least 15% in the risk of myocardial infarction.

a paradigm shift from treatment of hypertension to management of comprehensive cardiovascular risk. Cost-effectiveness of treating hypertension is also determined by the overall cardiovascular risk and not by blood pressure alone

Barriers to cardiovascular risk management

Health policy

The overriding barrier to CVD risk-management programmes in low- and middle-income countries is that there are no formal policies that target CVD as a major health issue. In 2001, a survey of 167 countries in the six WHO Regions found that 57% of the countries lacked a noncommunicable disease policy, and 65% had no CVD plan

Health-care systems

under equipped health facilities; a lack of continuity between primary health care and the secondary- and tertiary-care sectors; poorly-developed information systems; a lack of awareness of the potential health benefits and cost savings of CVD programmes; and the influence of commercial interests on resource allocation.

Barriers to cardiovascular risk management

Health-care providers

the lack of personnel with appropriate training and skills, and an already overburdened workforce. In the WHO global capacity assessment survey, healthcare professionals received no training in the management of noncommunicable diseases in about one-half of the 167 countries surveyed.

Patients, families and the community

A comprehensive CVD risk-management programme relies upon individual patients adhering to daily drug treatments, accepting lifestyle advice, and returning for follow-up assessments Patient adherence needs to be enhanced through the support of family members and the community Families and communities need to be empowered to actively participate in patient care, through health education and through community mobilization programmes.

Menurut Menkes CVD telah menjadi salah satu masalah penting kesehatan masyarakat dan penyebab kematian utama WHO, memperkirakan pa tahun 2030, 23,6 juta orang meninggal karena CVD Riskesdas (2007), menunjukkan prevalensi penyakit jantung 7,2% Penyakit jantung Iskemik : 5,1% dari seluruh penyebab kematian dan penyakit jantung 4,6% dari seluruh kematian