Preventing cardiovascular disease in low and middle income countries: How can we do it?

Francesca Boldrini Isabelle Lindenmayer
 
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Sunday brought a day which is likely to go unnoticed by many – World Hypertension Day (May 17th). While many of us are accustomed to the well-worn tradition of a blood pressure reading as the first item of business when interacting with our health providers, this is not the case in many developing countries. This may not sound like a significant concern amid more visible global health challenges, yet cardiovascular disease (CVD) – a major risk factor of which is hypertension – is currently the third leading killer in Africa. While many continue to see hypertension as a condition afflicting richer nations, the reality is that an astounding 75% of deaths due to CVD are in low and middle income countries, according to the PURE study.

Yet not enough is being done to address CVD in these settings, despite the fact that many of the solutions are known. As outlined in the World Heart Federation’s first global roadmap for the secondary prevention of CVD launched earlier this year, just increasing the use of anti-platelet drugs, beta blockers and ACE inhibitors would drive a 75% reduction in CVD, but are currently used in only approximately 20% of the population. In addition, a greater focus on tobacco cessation and perfecting the fruit and fat intake recommendations for low income countries can reduce risk factors even more.

How can we move the needle on these crucial interventions? First, by supporting and contributing to existing efforts.

The World Health Organization has set a target of reducing heart attack and stroke by 25% by 2025 by providing practical tools to improve healthcare and prevent CVD in low, middle and high-income countries. The organization highlights that this is still driven by a lack of integrated primary health care programs for early detection and poor access to treatment. The WHO advocates for more investment in non-communicable diseases (NCDs) more broadly, and has spearheaded tobacco control interventions with the creation of the FCTC. It has also started to more broadly operationalize innovative interventions, such as the Be Healthy, Be Mobile program in collaboration with the ITU. Be Healthy, Be Mobile uses mHealth to raise awareness about risk factors and prevention strategies for CVD.

In parallel, the private sector has begun to take a leadership role in developing implementation evidence for how to drive progress in-country. In partnership with Ministries of Health and NGOs, a number of companies are currently testing different models to increase access to hypertension and diabetes care in low resource settings. One strong example of this is Healthy Heart Africa, launched by AstraZenca in October of last year, which aims to ensure that 10 million patients with hypertension are on treatments to control their condition by 2025. The program takes a health system strengthening approach, working to integrate hypertension education, screening and treatment services into existing health platforms.

So what is missing? Why is progress not happening faster? Our hope is that NCDs will be part of the SDGs come September and that specific targets will be included at least on CVD and tobacco control. This is needed to help the development community more actively focus on the issue of NCDs in the developing world and to bring bilateral and multi-lateral donors to the table. In addition, more implementation evidence is required to demonstrate what it will take to address this growing burden of disease. As policymakers convene this week in Geneva to discuss the various global health challenges we face, let’s all work toward a reality in which we are proactively responding to in-country needs, and no longer perceiving  NCDs as problem of rich countries. The warning signs are clear, and global health priorities and funding must adjust accordingly.

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