Neglecting Cardiovascular Disease Is Unaffordable. (Round Table Discussion)
Year: 2001
Type: article
Abstract: The emergence and acceleration of cardiovascular disease (CVD) epidemics in low- and middle-income countries is explained by demographic shifts and lifestyle changes propelled by urbanization, industrialization, and globalization. Low birth weight and ethnic diversity in gene-environment interactions may magnify the impact of these changes (1-3). While the determinants of the health transition in low- and middle-income countries are similar to those in the high-income countries, their dynamics are different. The compressed time frame of the transition in poorer countries imposes a double burden of communicable and noncommunicable diseases. Urbanization occurring in prospering economies differs in important respects from that which occurs in settings of poverty and international debt, which restrict resources for public health responses. Organized efforts at prevention began in high-income countries when the epidemic had peaked, and they often accelerated a secular down-swing, while the efforts in low- and middle-income countries are starting when the epidemic is still on its upswing. Strategies to control CVD must be based on recognition of these similarities and differences. Principles of prevention must be based on the evidence gathered in high-income countries, but the interventions must be context-specific and resource-sensitive. Prevention must aim at reduction across the lifespan and be guided by the following facts. First, operates across a continuum for most variables. Second, many more events arise from the moderate middle of the distribution than from the high-risk tail. Third, is multiplied when factors coexist, which they often do. Fourth, the majority of CVD events occur in persons with modest levels of multiple factors rather than in those with a high level of a single factor. Fifth, comprehensive or absolute CVD is the best guide for individual interventions, while population-attributable risk should guide mass interventions, maximizing benefits by bringing about modest distributional shifts. Sixth, a synergistically complementary blend of cost-effective population-wide and high-risk interventions must extend from primary prevention in children to secondary prevention in older adults (4-6). Community empowerment through education (mass and targeted) and policy change (to provide an enabling environment) are essential for health promotion in populations at all stages of health transition. Populations at high need, in addition, strategies and services for early detection and effective control of risk. Opportunistic screening (for tobacco use, being overweight, and high blood pressure) and targeted screening (for diabetes and dyslipidaemia) must be followed by stratification and management. …
Author: K. Srinath Reddy
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W1832827333