Advertisement

Challenges and Opportunities for Cardiovascular Disease Prevention

  • Manuel Franco
    Affiliations
    Department of Epidemiology, Atherothrombosis and Imaging, National Center for Cardiovascular Research (CNIC), Madrid, Spain

    Department of Epidemiology, Welch Center for Prevention, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
    Search for articles by this author
  • Richard S. Cooper
    Affiliations
    Department of Preventive Medicine and Epidemiology, Loyola University Medical School, Maywood, Ill
    Search for articles by this author
  • Usama Bilal
    Affiliations
    Department of Epidemiology, Atherothrombosis and Imaging, National Center for Cardiovascular Research (CNIC), Madrid, Spain
    Search for articles by this author
  • Valentín Fuster
    Correspondence
    Requests for reprints should be addressed to Valentín Fuster, MD, PhD, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029
    Affiliations
    Department of Epidemiology, Atherothrombosis and Imaging, National Center for Cardiovascular Research (CNIC), Madrid, Spain

    Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, and the Richard Gorlin, MD/Heart Research Foundation Professor of Cardiology, Mount Sinai School of Medicine, New York, NY
    Search for articles by this author

      Abstract

      Cardiovascular diseases are highly preventable, yet they remain the most common cause of death in the world. The epidemic is receding in industrialized countries; however, many low-income and middle-income countries have experienced an increase in cardiovascular diseases and 80% of all cardiovascular diseases deaths occur there. In the last 20 years, the epidemiology and surveillance of cardiovascular diseases have laid the foundations for public health interventions that may reduce the burden of disease. Relevant population-specific local data are therefore needed to describe the trends and pattern of risk for atherosclerotic diseases. Once the basis for surveillance and epidemiological research has been laid, cardiovascular disease prevention will require approaches adapted for each individual and population. The existence of effective preventive interventions justifies the assertion that coronary heart disease and stroke could be virtually prevented and controlled. Our goal in this review is to summarize the current challenges and opportunities for cardiovascular medicine, focusing on the need for high-quality local surveillance systems that provide the appropriate data needed to develop sound national cardiovascular disease preventive policies.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Beaglehole R.
        • Bonita R.
        Global public health: a scorecard.
        Lancet. 2008; 372: 1988-1996
        • Lopez A.D.
        • Mathers C.D.
        • Ezzati M.
        • Jamison D.T.
        • Murray C.J.
        Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.
        Lancet. 2006; 367: 1747-1757
        • Abegunde D.O.
        • Mathers C.D.
        • Adam T.
        • Ortegon M.
        • Strong K.
        The burden and costs of chronic diseases in low-income and middle-income countries.
        Lancet. 2007; 370: 1929-1938
        • Institute of Medicine
        Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.
        IOM (Institute of Medicine), Washington, DC2010
        • Steinberg D.
        The cholesterol controversy is over.
        Circulation. 1989; 80: 1070-1078
        • Stamler J.
        Lectures on Preventive Cardiology.
        Grune and Stratton, New York1967
        • Dawber T.R.
        • Meadors G.F.
        • Moore Jr, F.E.
        Epidemiological approaches to heart disease: the Framingham Study.
        Am J Public Health Nations Health. 1951; 41: 279-281
        • Kannel W.B.
        • Abbott R.D.
        Incidence and prognosis of unrecognized myocardial infarction.
        N Engl J Med. 1984; 311: 1144-1147
        • Stamler J.
        George Lyman Duff Memorial Lecture.
        Circulation. 1978; 58: 3-19
        • Wilson P.W.
        • D'Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Pencina M.J.
        • D'Agostino Sr, R.B.
        • Larson M.G.
        • Massaro J.M.
        • Vasan R.S.
        Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study.
        Circulation. 2009; 119: 3078-3084
        • Rose G.
        Sick individuals and sick populations.
        Int J Epidemiol. 2001; 30: 427-432
        • Rose G.
        Strategies of prevention: the individual and the population.
        in: Marmot M. Coronary Heart Disease Epidemiology: From Aetiology to Public Health. Oxford University Press, Oxford, UK1991: 631-641 (Chapter 36)
        • Pietinen P.
        • Nissinen A.
        • Vartiainen E.
        • et al.
        Dietary changes in the North Karelia Project (1972-1982).
        Prev Med. 1988; 17: 183-193
        • Salonen J.T.
        • Tuomilehto J.
        • Nissinen A.
        • Kaplan G.A.
        • Puska P.
        Contribution of risk factor changes to the decline in coronary incidence during the North Karelia project: a within-community analysis.
        Int J Epidemiol. 1989; 18: 595-601
        • Puska P.
        • Stahl T.
        Health in all policies—the Finnish initiative: background, principles, and current issues.
        Annu Rev Public Health. 2010; 31: 315-328
        • Vartiainen E.
        • Puska P.
        • Jousilahti P.
        • Korhonen H.J.
        • Tuomilehto J.
        • Nissinen A.
        Twenty-year trends in coronary risk factors in north Karelia and in other areas of Finland.
        Int J Epidemiol. 1994; 23: 495-504
        • Multiple risk factor intervention trial
        Risk factor changes and mortality results.
        JAMA. 1982; 248: 1465-1477
        • Cooper R.
        • Stamler J.
        • Dyer A.
        • Garside D.
        The decline in mortality from coronary heart disease, U.S.A., 1968-1975.
        J Chronic Dis. 1978; 31: 709-720
        • Goldman L.
        • Cook E.F.
        The decline in ischemic heart disease mortality rates.
        Ann Intern Med. 1984; 101: 825-836
        • Hunink M.G.
        • Goldman L.
        • Tosteson A.N.
        • et al.
        The recent decline in mortality from coronary heart disease, 1980-1990.
        JAMA. 1997; 277: 535-542
        • Ford E.S.
        • Ajani U.A.
        • Croft J.B.
        • et al.
        Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.
        N Engl J Med. 2007; 356: 2388-2398
        • Cooper R.S.
        • Osotimehin B.
        • Kaufman J.S.
        • Forrester T.
        Disease burden in sub-Saharan Africa: what should we conclude in the absence of data?.
        Lancet. 1998; 351: 208-210
        • Lloyd-Jones D.M.
        • Hong Y.
        • Labarthe D.
        • et al.
        Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.
        Circulation. 2010; 121: 586-613
        • Centers for Disease Control and Prevention, National Center for Health Statistics
        National Health and Nutrition Examination Survey.
        (Accessed October 26, 2010)
        • Connolly D.C.
        • Oxman H.A.
        • Nobrega F.T.
        • Kurland L.T.
        • Kennedy M.A.
        • Elveback L.R.
        Coronary heart disease in residents of Rochester, Minnesota, 1950-1975.
        Mayo Clin Proc. 1981; 56: 661-664
        • Eagle K.A.
        • Montoye C.K.
        • Riba A.L.
        • et al.
        Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan.
        J Am Coll Cardiol. 2005; 46: 1242-1248
        • National Center for Health Statistics
        Development of the design of the National Center for Health Statistics Hospital Discharge Survey.
        Vital Health Stat 2. 1970; : 1-29
        • Yeh R.W.
        • Go A.S.
        Rethinking the epidemiology of acute myocardial infarction: challenges and opportunities.
        Arch Intern Med. 2010; 170: 759-764
        • World Health Organization
        The World Health Report 2008: Primary Health Care Now More Than Ever.
        World Health Organization, Geneva, Switzerland2008
        • Fuster V.
        Cardiovascular disease and the UN millennium development goals: a serious concern.
        Nat Clin Pract Cardiovasc Med. 2006; 3: 401
      1. Evaluation: the top priority for global health.
        Lancet. 2010; 375: 526
        • Davies A.R.
        • Smeeth L.
        • Grundy E.M.
        Contribution of changes in incidence and mortality to trends in the prevalence of coronary heart disease in the UK: 1996 2005.
        Eur Heart J. 2007; 28: 2142-2147
        • Office for National Statistics of the United Kingdom
        (Accessed May 11, 2010)
        • Mayosi B.M.
        • Flisher A.J.
        • Lalloo U.G.
        • Sitas F.
        • Tollman S.M.
        • Bradshaw D.
        The burden of non-communicable diseases in South Africa.
        Lancet. 2009; 374: 934-947
        • Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services
        A Public Health Action Plan to Prevent Cardiovascular Disease and Stroke.
        CDC, Atlanta, GA2003
        • Chan M.
        Return to Alma-Ata.
        Lancet. 2008; 372: 865-866
        • Graham I.
        • Atar D.
        • Borch-Johnsen K.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice: full text.
        Eur J Cardiovasc Prev Rehabil. 2007; 14: S1-S113
        • Stamler J.
        • Fortmann S.P.
        • Levy R.I.
        • Prineas R.J.
        • Tell G.
        Primordial prevention of cardiovascular disease risk factors: panel summary.
        Prev Med. 1999; 29: S130-S135
        • Kavey R.E.
        • Daniels S.R.
        • Lauer R.M.
        • Atkins D.L.
        • Hayman L.L.
        • Taubert K.
        American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood.
        Circulation. 2003; 107: 1562-1566
        • Caballero B.
        The global epidemic of obesity: an overview.
        Epidemiol Rev. 2007; 29: 1-5
        • Popkin B.M.
        • Gordon-Larsen P.
        The nutrition transition: worldwide obesity dynamics and their determinants.
        Int J Obes Relat Metab Disord. 2004; 28: S2-S9
        • Franco M.
        • Diez-Roux A.V.
        • Nettleton J.A.
        • et al.
        Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis.
        Am J Clin Nutr. 2009; 89: 897-904
        • Romon M.
        • Lommez A.
        • Tafflet M.
        • et al.
        Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes.
        Public Health Nutr. 2009; 12: 1735-1742
        • Mozaffarian D.
        • Katan M.B.
        • Ascherio A.
        • Stampfer M.J.
        • Willett W.C.
        Trans fatty acids and cardiovascular disease.
        N Engl J Med. 2006; 354: 1601-1613
        • Fuster V.
        • King A.
        The dual challenge of BP control.
        Nat Rev Cardiol. 2009; 6: 729-730
        • He F.J.
        • MacGregor G.A.
        A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.
        J Hum Hypertens. 2009; 23: 363-384
        • Gupta R.
        Recent trends in coronary heart disease epidemiology in India.
        Indian Heart J. 2008; 60: B4-B18
        • Critchley J.
        • Liu J.
        • Zhao D.
        • Wei W.
        • Capewell S.
        Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999.
        Circulation. 2004; 110: 1236-1244
        • Mackay J.
        The Tobacco Atlas.
        World Health Organization, Geneva, Switzerland2002
        • Bovet P.
        • Romain S.
        • Shamlaye C.
        • et al.
        Divergent fifteen-year trends in traditional and cardiometabolic risk factors of cardiovascular diseases in the Seychelles.
        Cardiovasc Diabetol. 2009; 8: 34
        • Dowse G.K.
        • Gareeboo H.
        • Alberti K.G.
        • et al.
        Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius.
        BMJ. 1995; 311: 1255-1259
        • World Health Organization (WHO)
        WHO Framework Convention on Tobacco Control.
        WHO, Geneva, Switzerland2003
        • Centers for Disease Control and Prevention (CDC)
        Update to a Public Health Action Plan to Prevent Cardiovascular Disease and Stroke.
        CDC, Atlanta, GA2008
        • Mendis S.
        • Fuster V.
        National policies and strategies for noncommunicable diseases.
        Nat Rev Cardiol. 2009; 6: 723-727
        • Smith Jr, S.C.
        • Jackson R.
        • Pearson T.A.
        • et al.
        Principles for national and regional guidelines on cardiovascular disease prevention: a scientific statement from the World Heart and Stroke Forum.
        Circulation. 2004; 109: 3112-3121
        • World Health Organization (WHO)
        2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases: Prevent and Control Cardiovascular Diseases, Cancers, Chronic Respiratory Diseases and Diabetes.
        WHO, Geneva, Switzerland2008
        • World Health Organization (WHO)
        CVD Risk Management Package for Low-and Medium-resource Settings.
        WHO, Geneva, Switzerland2002
        • Sacks F.M.
        • Campos H.
        Dietary therapy in hypertension.
        N Engl J Med. 2010; 362 (2102–2012)
        • World Health Organization (WHO)
        Global Strategy on Diet, Physical Activity and Health.
        WHO, Geneva, Switzerland2004
        • Bibbins-Domingo K.
        • Chertow G.M.
        • Coxson P.G.
        • et al.
        Projected effect of dietary salt reductions on future cardiovascular disease.
        N Engl J Med. 2010; 362: 590-599
        • Forrester T.
        • Adeyemo A.
        • Soarres-Wynter S.
        • et al.
        A randomized trial on sodium reduction in two developing countries.
        J Hum Hypertens. 2005; 19: 55-60
        • Brownell K.D.
        • Farley T.
        • Willett W.C.
        • et al.
        The public health and economic benefits of taxing sugar-sweetened beverages.
        N Engl J Med. 2009; 361: 1599-1605
        • Franco M.
        • Orduñez P.
        • Caballero B.
        • Cooper R.S.
        Obesity reduction and its possible consequences: what can we learn from Cuba's Special Period?.
        CMAJ. 2008; 178: 1032-1034