Cardiovascular diseases (CVDs) - reducing disease burden and treatment

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They are the leading cause of death and disease burden in many countries, and the number of people living with them is increasing due to factors like population ageing and improved treatments that have resulted in people living longer with CVD.

How can the burden of cardiovascular diseases be reduced?
“Best buys” or very cost effective interventions that are feasible to be implemented even in low-resource settings have been identified by WHO for prevention and control of cardiovascular diseases. They include two types of interventions: population-wide and individual, which are recommended to be used in combination to reduce the greatest cardiovascular disease burden.

Examples of population-wide interventions that can be implemented to reduce CVDs include:

comprehensive tobacco control policies
taxation to reduce the intake of foods that are high in fat, sugar and salt
building walking and cycle paths to increase physical activity
strategies to reduce harmful use of alcohol
providing healthy school meals to children.

At the individual level, for prevention of first heart attacks and strokes, individual health-care interventions need to be targeted to those at high total cardiovascular risk or those with single risk factor levels above traditional thresholds, such as hypertension and hypercholesterolemia. The former approach is more cost-effective than the latter and has the potential to substantially reduce cardiovascular events. This approach is feasible in primary care in low-resource settings, including by non-physician health workers.

For secondary prevention of cardiovascular disease in those with established disease, including diabetes, treatment with the following medications are necessary:

aspirin
beta-blockers
angiotensin-converting enzyme inhibitors
statins.

The benefits of these interventions are largely independent, but when used together with smoking cessation, nearly 75% of recurrent vascular events may be prevented. Currently there are major gaps in the implementation of these interventions particularly at the primary health care level.

In addition costly surgical operations are sometimes required to treat CVDs. They include:

coronary artery bypass
balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage)
valve repair and replacement
heart transplantation
artificial heart operations

Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.

Key facts
CVDs are the number 1 cause of death globally: more people die annually from CVDs than from any other cause.

An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke .

Over three quarters of CVD deaths take place in low- and middle-income countries.

Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2015, 82% are in low- and middle-income countries, and 37% are caused by CVDs.

Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies.

People with cardiovascular disease or who are at high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes, hyperlipidaemia or already established disease) need early detection and management using counselling and medicines, as appropriate.

WHO response
Under the leadership of the WHO, all Member States ( 194 countries) agreed in 2013 on global mechanisms to reduce the avoidable NCD burden including a "Global action plan for the prevention and control of NCDs 2013-2020". This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025 through nine voluntary global targets. Two of the global targets directly focus on preventing and controlling CVDs.

=> Global action plan for the prevention and control of NCDs 2013-2020

The sixth target in the Global NCD action plan calls for 25% reduction in the global prevalence of raised blood pressure. Raised blood pressure is the leading risk factor for cardiovascular disease. The global prevalence of raised blood pressure (defined as systolic and/or diastolic blood pressure more than or equal to 140/90 mmHg) in adults aged 18 years and over was around 24.1% in men and 20.1% in women in 2015. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low- and middle-income countries.

Reducing the incidence of hypertension by implementing population-wide policies to reduce behavioural risk factors, including harmful use of alcohol, physical inactivity, overweight, obesity and high salt intake, is essential to attaining this target. A total-risk approach needs to be adopted for early detection and cost-effective management of hypertension in order to prevent heart attacks, strokes and other complications.

The eighth target in the Global NCD action plan states at least 50% of eligible people should receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. Prevention of heart attacks and strokes through a total cardiovascular risk approach is more cost-effective than treatment decisions based on individual risk factor thresholds only and should be part of the basic benefits package for pursuing universal health coverage. Achieving this target will require strengthening key health system components, including health-care financing to ensure access to basic health technologies and essential NCD medicines.

In 2015, countries will begin to set national targets and measure progress on the 2010 baselines reported in the "Global status report on noncommunicable diseases 2014". The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress in attaining the voluntary global targets by 2025.

« Risk factors & Clinical features

Reference(s)
1). World Health Organization: Cardiovascular diseases (CVDs) - WHO Fact Sheets. Accessed 20.10.17. Available here: http://who.int/mediacentre/factsheets/fs317/en/
2). NHS Choices: Cardiovascular disease. Accessed 22.10.17. Available here: https://www.nhs.uk/conditions/Cardiovascular-disease/Pages/Introduction.aspx
3). Australian Government Department of Health: Cardiovascular disease. Accessed 22.10.17. Available here: https://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio