IOM: Global risk-reduction programs needed to prevent, monitor CVD
Almost 80 percent of cardiovascular disease (CVD) deaths occur in low- and middle-income countries, while heart and circulatory diseases cause 30 percent of deaths in these countries. Implementing risk-reduction initiatives that monitor diet, exercise and tobacco use are necessary to stop what has now become a fatal epidemic, according to a report published from the Institute of Medicine (IOM) on March 22.

“We know that CVD is a major cause of death and disability in the developing worlds, but we are not doing enough to address it,” said Valentin Fuster, MD, PhD, committee chair and director of the Mount Sinai School of Medicine in New York City.

The 365-page report outlined programs and action strategies in which public groups, policymakers and other entities should work together to implement in order to prevent CVD.

“Success will require finding the right balance of regulatory policies from national governments and voluntary actions from industry because agricultural practices, food distribution and marketing systems and cultural preferences vary across nations,” the report stated.

The report recommends that pharmaceutical, medical device firms, insurance companies and public health groups work together to develop accessible, affordable tools and therapies to help curb disease in all nations.

One theory is to have an initiative led by the International Food and Beverage Association that would provide strategies to improve dietary patterns such as high-salt, high-fat and high-sugar diets—all contributors to the development of CVD.

“Policymakers in each country, working with their partners, will need to determine how best to carry out these risk-reduction initiatives in light of the particular conditions, infrastructure and resources available in each nation,” the report stated.

For example, the report said that while enforcing taxes on tobacco products may be successful for some countries, others may create public awareness campaigns about smoking dangers, while others may more feasibly restrict smoking in public places.

“It is important to recognize that there is no single strategy that will work everywhere, so it is critical to search for locally relevant solutions that will be feasible in the settings where they are needed,” Fuster said.

Additionally, the report made the following recommendations that, if implemented, could help hinder CVD:
  • Recognize chronic disease as a development assistance priority: Agencies must add CVD and related diseases as an area of focus for funding and development programs.
  • Improve local data: Government systems to monitor health should be implemented to further control chronic diseases and risk factors and funds should be allocated for the prevention and control of diseases.
  • Implement policies to promote cardiovascular health: “These policies may include laws, regulations, changes to fiscal policy and incentives to encourage private-sector alignment”;
  • Include chronic disease in health systems strengthening: Should form evidence-based prevention programs to manage, prevent and diagnose CVD;
  • Improve national coordination for chronic diseases: Establish a commission to work with other policymakers and private and public sectors to communicate and coordinate efforts that promote disease prevention;
  • Research to assess what works in different settings: Research what programs or policy works best, where;
  • Disseminate knowledge and innovation among similar countries: Make CVD trends and successful interventional strategies public;
  • Advocate for chronic diseases as a funding priority: Advocate through various resource to create awareness of CVD and its implications;
  • Define resource needs: Research and assess the resources needed to prevent and implement programs to hinder CVD; and
  • Report global CVD progress.

“If this challenge is not met, it will be impossible to achieve better health worldwide,” said Fuster. “Leaders in the field of cardiovascular health need to think and act more globally, and it is also incumbent upon the global health and development community to do more to confront CVD and other chronic diseases. This is a problem that will require strong leadership at the highest levels,” he concluded.