Disclosure: Dr. Arnett has nothing to disclose
Pub Date: Monday, Sept. 17, 2012
Author: Donna Arnett, PhD, MSPH
Affiliation: Current President of AHA, and Chair and Professor, Epidemiology, School of Public Health, University of Alabama at Birmingham
Citation: Smith SC Jr, Collins A, Ferrari R, Holmes DR Jr, Logstrup S, McGhie DV, Ralston J, Sacco RL, Stam H, Taubert K, Wood DA, Zoghbi WA. Our time: a call to save preventable deaths from cardiovascular disease (heart disease and stroke). Circulation. 2012: published online before print September 18, 2012, 10.1161/CIR.0b013e318267e99f.
The Presidential Advisory published today by representatives of the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and the European Society of Cardiology1 is a call to action for the 194 World Health Organization (WHO) Member States to adopt targets that will guide global cardiovascular (CV) public health efforts for the next dozen years. This is part of a larger program to reduce all non-communicable diseases (NCDs) by 25% by 2025. This call to action for Member States as well as groups and individuals in the CV health and disease community is warranted, timely, and critical. The incidence of NCDs now surpasses communicable diseases in the global disease burden. Importantly, CV disease accounts for the majority of deaths, with more 17.1 deaths per year globally. And 82% of those deaths occur in low- and middle-income countries that are currently experiencing a rapid pace of epidemiological transition. Because of this, the growth of CV diseases is expected to disproportionately affect disadvantaged and poor countries. Clearly, global public health efforts are needed to address the ever-widening CV health gaps between and within countries, and to stem the tide of the emerging pandemic of global CV disease.
Bridging political, linguistic, economic, and cultural differences in the context of something as complex as setting public health agendas is no small task. Although stakeholders may have been united in their ultimate goal of reducing disease and mortality, building global consensus on how to achieve this goal no doubt necessitated working through many differences. The working group is to be congratulated on their accomplishments. The American Heart Association enthusiastically affirms the 25% reduction in NCDs by 2025 as well as the four “Suggested Global Targets to Address NCDs With Wide Support” (i.e., addressing physical activity, blood pressure, sodium intake, and tobacco use). Indeed, the four “global targets” are important constituents of the American Heart Association’s (AHA) definition of “ideal cardiovascular health,” a fundamental component of the AHA’s Strategic Impact Goal through 2020. 2 The remaining six “Proposed Targets and Indicators to Address NCDs With Some Support” (addressing saturated fat intake; obesity; alcohol intake; cholesterol; drug therapy; and essential NCD medicines and basic technologies—e.g., access to primary care) are also well represented in the AHA metrics for “ideal cardiovascular health.” These targets and indicators represent well-justified, evidenced-based targets for both high-risk and population approaches to intervention.
As we act globally to reduce NCD mortality by 25% by 2025, it is critically important to consider the improvement of CV health of individuals and populations in order to develop a higher quality of life in all nations, for all people. The Presidential Advisory urges both individual and high-risk approaches. Targeted interventions for individuals with NCDs or at high-risk of NCDs is recommended through a systematic layered approach. Utilizing population approaches to address the primary targets effectively lends itself to a paradigm of primordial as well as primary and secondary prevention. For example, the prevalence of CV risk factors and clinical disease is typically lower in children, adolescents, and young adults than in the middle-aged and older. A paradigm of only risk factor amelioration has little to offer younger people. However, a paradigm that champions ideal health behaviors (e.g., reductions in tobacco use, dietary sodium intake, and physical inactivity, and improved hypertension awareness, detection, and control), should benefit all age strata. This is important since CV diseases are also responsible for major reductions in quality of life and healthy aging, and such strategies will yield benefits in CV mortality reductions well beyond 2025.
It’s important to remember that it is incumbent upon the WHO Member States (and their constituent non-governmental health advocacy organizations and other relevant stakeholders) to find the most effective ways to reach the targets within the context of the specific constraints of their nations. Although Member States are urged to adopt the proposed targets, they are free to adopt additional factors that they feel may be efficacious in helping their population reach the overall 25% mortality reduction by 2025 goal. This is important since it provides flexibility for member countries to adopt country-specific strategies to achieve the 2025 goal, and recognizes that the population attributable risk for various CV risk factors and health behaviors, as well as the tools for monitoring and surveillance, will differ across countries.
In conclusion, bold action is required to reverse the global pandemic of CV disease. And a bold – and realistic - goal has been set: to reduce NCD mortality by 25% by 2025. Since cost-effective and feasible-solutions are available, now is the time for the collective-will of the 194 World Health Organization (WHO) Member States to coalesce to implement these solutions and to achieve this goal. Together, we can accomplish the global CV public health efforts that not only avert millions of CV deaths, but also improve the cardiovascular health of our populations.
- Smith SC Jr, Collins A, Ferrari R, Holmes DR Jr, Logstrup S, McGhie DV, Ralston J, Sacco RL, Stam H, Taubert K, Wood DA, Zoghbi WA. Our time: a call to save preventable deaths from cardiovascular disease (heart disease and stroke). Circulation. 2012: published online before print September 18, 2012, 10.1161/CIR.0b013e318267e99f.
- Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. 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.
-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --