Cardiovascular disease (CVD) is a leading cause of death in the world, killing nearly 17 million people annually, according to the report published in this week's print issue of Circulation: Journal of the American Heart Association.
"This document will be the foundation for a major international effort by the World Heart Federation with a special focus on reducing the burden of cardiovascular disease in countries and regions with developing economies where nearly 80 percent of the mortality from CVD occurs," said Sidney C. Smith Jr., M.D., former president of the American Heart Association and lead author of the report from the World Heart and Stroke Forum Guidelines Task Force of the World Heart Federation.
The task force said CVD risk factors should be the focus for prevention. "The rising prevalence of CVD worldwide is in part a reflection of a rising prevalence of CVD risk factors in many nations," they wrote. Among these are increasing rates of cigarette smoking, high blood pressure, cholesterol disorders, diabetes and aging populations -- and individuals with multiple risk factors.
"To modify these factors, CVD specialists need to team with physicians, epidemiologists and public health officials to change lifestyle habits in their countries," said Smith, who is a professor of medicine and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine in Chapel Hill, N.C.
The task force recommends 10 strategic principles as a template for countries to develop clinical guidelines and programs to meet their needs for CVD prevention:
- Governments, national societies and foundations should collaborate to develop clinical and public health guidelines for CVD prevention that target risk factors.
- Evidence-based guidelines should incorporate professional judgment in translating such evidence into clinical practice, addressing all areas of CVD risk.
- Total CVD risk assessment should be based on epidemiological risk factor data appropriate to the population to which it is applied.
- Policy recommendations and guidelines should emphasize a total risk approach for CVD prevention.
- The intensity of interventions should be determined by a person's total risk of CVD -- with more aggressive treatment for higher-risk patients.
- National cardiovascular societies/foundations should promote routine collection of national vital statistics on the causes and outcomes of CVD for use in developing national policies.
- National professional societies should inform policymakers of risk factor targets and drug therapies for CVD prevention that are culturally and financially appropriate to their nation, and ask the government to incorporate CVD prevention into legislation when relevant.
- National professional societies/foundations should facilitate CVD prevention through education and training programs for health professionals.
- National professional societies should assess the nation's progress in achieving lifestyle, risk factor, and therapeutic targets defined in the national guidelines.
- Health professionals should include CVD prevention as an integral part of their daily clinical practice.
"The causes of CVD are common to all parts of the world," Smith said. "But the approaches to its prevention at a societal or individual level will differ between countries for cultural, social, medical and economic reasons."
He emphasized that, although the recommendations in this report focus on clinical management of patients with established CVD and those at high risk, "it is essential that each country include a societal approach to CVD prevention."
The World Heart Federation is committed to helping the global population achieve a longer and better life through prevention and control of heart disease and stroke, with a particular focus on low and middle-income countries. The Federation is comprised of 179 member societies of cardiology and heart foundations from about 100 countries and continental members covering the regions of Asia-Pacific, Europe, the Americas and Africa.
Task force members include Rod Jackson, MBChB, Ph.D.; Thomas A. Pearson, M.D., M.P.H., Ph.D.; Valentin Fuster, M.D., Ph.D.; Salim Yusuf, D.Phil.; Ole Faergeman, M.D., D.MSc.; David A. Wood, MSc; Michael Alderman, M.D.; John Horgan, M.D.; Philip Home, M.A., D.Phil., D.M.; Marilyn Hunn, B.S.; and Scott M. Grundy, M.D., Ph.D.
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