Skip to main content

Advertisement

SpringerLink
Log in

Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs)

  • Physical Activity (D Warburton, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

The global epidemic of cardiovascular diseases (CVDs) is spiraling upwards primarily due to a sharp rise in the low and middle income countries (LMICs) which are experiencing rapid health transition driven by socioeconomic, technological and lifestyle changes. LMICs currently face a double burden of communicable and non-communicable diseases, leading to competing claims of health conditions that vie for policy makers’ attention as public health priorities in a setting of limited resources, substantially high out-of-pocket expenditure and weak systems of healthcare delivery. Evidence from high income countries suggests that most CVDs are largely preventable as the major CVD risk behaviours including tobacco use, physical inactivity, unhealthy diet, harmful use of alcohol, are avoidable and modifiable. Effective and sustainable behaviour change strategies for LMICs would require low cost, affordable and scalable interventions. There is limited evidence from LMICs on effective interventions to prevent, control and manage CVDs in LMICs. The global guidelines and framework for addressing CVD calls for an urgent need to identify and assess contextually relevant and resource sensitive health care interventions augmented by policy actions. A combination of population based and high risk individual based strategies which are evidence based, cost-effective, feasible as well as scalable would reduce CVD mortality and its devastating impact in LMICs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. World Health Organization. Global Status Report on non-communicable diseases 2010. Geneva: WHO; 2010.

    Google Scholar 

  2. World Health Organization.: Global health risks: mortality and burden of disease attributable to selected major risks. WHO Geneva. 2009. Accessed online at: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

  3. Mendis S, Puska P, Norrving B et al.: Global Atlas on Cardiovascular Disease Prevention and Control World Health Organization Geneva, Switzerland.2011.This publication provides comprehensive overview on CVD prevention and control, including updated estimates of CVDs and associated risk factors.

  4. World Health Organization.: Causes of death 2008, WHO Geneva 2008 accessed online at http://www.who.int/healthinfo/ global_burden_disease/ cod_2008_sources_methods.pdf.

  5. Pearson TA, Jamison DT, Trejo-guarez H. In Jamison DT, ed. Disease control priorities in developing countries. New York: Oxford University Press, 1993; 577-99

  6. World Health Organization and World Economic Forum. From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries. Geneva, Switzerland: World Health Organization and World Economic Forum: 2011; Accessed online at : www.who.int/nmh/publications/best_buys_summary.

  7. World Health Organization. World Health Statistics.2008; accessed online at www.who.int/whosis/whostat/EN_WHS08_Full.pdf.

  8. World Health organisation. Country cooperation strategy at a glance., 2013; accessed online at http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ind_en.pdf.

  9. Xu K. Household catastrophic health expenditure: A multicountry analysis. Lancet. 2003;362:111–7.

    Article  PubMed  Google Scholar 

  10. World Development Indicators. Accessed online at data.worldbank.org/data…/world-development-indicators.

  11. Engelgau MM, Saharty S, Kudesia P, et al. Capitalizing on the demographic transition: Tackling noncommunicable diseases in South Asia. World Bank: Washington, DC; 2011.

    Google Scholar 

  12. Fowkes F, Gerald R, Rudan D, Rudan I, Aboyans V, Denenberg JO, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40.

    Article  PubMed  Google Scholar 

  13. Gaziano TA. Reducing the growing burden of cardiovascular disease in the developing world. Health Aff. 2007;26(1):13–24.

    Article  Google Scholar 

  14. Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med. 1998;4:1241–3.

    Article  PubMed  CAS  Google Scholar 

  15. Upadhyay PR. An overview of the burden of non-communicable diseases in India. Iranian J Publ Health. 2012;41(3):1–8.

    Google Scholar 

  16. International Diabetes Federation (IDF). Diabetes Atlas 2013. Accessed online at http://www.idf.org/diabetesatlas.

  17. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435–42.

    Article  PubMed  Google Scholar 

  18. World Health Organization. A global brief on high blood pressure (hypertension): preventing heart attacks, strokes and kidney failure. Geneva: WHO; 2013.

    Google Scholar 

  19. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bragg F, Li L, Smith M, Guo Y, Chen Y, Millwood I, et al. Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank. Diabet Med. 2014;31(5):540–51.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. Varbo A, Benn M, Tybjærg-Hansen A, Nordestgaard BG. Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. Circulation. 2013;128(12):1298–309.

    Article  PubMed  CAS  Google Scholar 

  22. Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk–a review of the literature. Eur J Clin Nutr. 2010;64(1):16–22.

    Article  PubMed  CAS  Google Scholar 

  23. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–6.

    Article  PubMed  CAS  Google Scholar 

  24. Mente A, De Koning L, Shannon HS, et al. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169(7):659–69.

    Article  PubMed  CAS  Google Scholar 

  25. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009;339:b4567.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kodama S, Shiro T, Yoriko H, Kazuya F, Chika H, et al. Association Between Physical Activity and Risk of All-Cause Mortality and Cardiovascular Disease in Patients With Diabetes A meta-analysis. Diabetes Care. 2013;36(2):471–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. US Department of Health and Human Services, Physical Activity and Health: A report of the Surgeon General. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for disease Control and Prevention and Health Promotion: 1996.

  28. Li J, Siegrist J. Physical activity and risk of cardiovascular disease—a meta-analysis of prospective cohort studies. Int J Environ Res Publ Health. 2012;2:391–407.

    Article  CAS  Google Scholar 

  29. Ford ES, Capewell S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care. Annu Rev Public Health. 2011;32:5–22.

    Article  PubMed  Google Scholar 

  30. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: Health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044–53.

    Article  PubMed  Google Scholar 

  31. Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, et al. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet. 2011;378:449–55.

    Article  PubMed  Google Scholar 

  32. Mendis S, Chestnov O. The Global Burden of Cardiovascular Diseases: A Challenge to Improve. Curr Cardiol Reports. 2014;16(5):1–9.

    Google Scholar 

  33. World Health Assembly. Global Action Plan for the Prevention and Control of NCD 2013-2020, (WHA 66.10). Geneva, Switzerland: World Health Organization: 2013. This publication provides a roadmap and a menu of policy options which could enable member countries to respond more effectively to achieve national and global targets to combat the rising NCD epidemic.

  34. WHO (2011) Prevention and control of NCDs: priorities for investment, Discussion paper http://www.who.int/nmh/publications/who_bestbuys_to_prevent_ncds.pdf Accessed on 17th May 2014. This publication provides assessment of interventions to address NCDs and its underlying risk factors, using four key criteria viz. health impact, cost-effectiveness, feasibility and cost of implementation.

  35. Puska P. Successful prevention of non-communicable diseases: 25 years of experiences with North Karelia Project in Finland. Public Health Med. 2002;4(1):5–7.

    Google Scholar 

  36. Akkazieva B, Chisholm D, Akunov N, Jacab M. The health effects and costs of the interventions to control cardiovascular disease in Kyrgyzstan 2009; Available online at http://hpac.kg/images/pdf/prp60cvd_eng.pdf.

  37. Shroufi A, Chowdhury R, Anchala R, Stevens S, Blanco P, et al. Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review. BMC Public Health. 2013;13(285):1–13. This publication systematically assesses the evidence on cost effectiveness for preventive CVD intervention in low and middle income countries.

    Google Scholar 

  38. World Health Organisation. Salt reduction and iodine fortification strategies in public health. WHO. 2014; accessed online at http://www.who.int/nutrition/publications/publichealth_saltreduc_iodine_fortification/en/.

  39. Ha DA, Chisholm D. Cost-effectiveness analysis of interventions to prevent cardiovascular disease in Vietnam. Health Policy Plan. 2010;26:210–22.

    Article  PubMed  Google Scholar 

  40. De Boo HA, Harding JE. The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynaecol. 2006;46(1):4–14.

    Article  PubMed  Google Scholar 

  41. Joshi SR, Banshi S, Muruga V, Dani SI, Mithal A, et al. Prevalence of diagnosed and undiagnosed diabetes and hypertension in India—results from the Screening India's Twin Epidemic (SITE) study. Diabetes Technol Ther. 2012;14(1):8–15.

    Article  PubMed  Google Scholar 

  42. World Health Organization. Prevention of cardiovascular disease: Pocket guidelines for assessment and management of cardiovascular risk. Geneva: WHO; 2007.

    Google Scholar 

  43. Lim SS et al. Prevention of cardiovascular disease in highrisk individuals in low-income and middle-income countries:Health effects and costs. Lancet. 2007;370:2054–62.

    Article  PubMed  Google Scholar 

  44. Gaziano TA, Steyn K, Cohen DJ, Weinstein M, Opie L. Cost-effectiveness analysis of hypertension guidelines in South Africa: absolute risk versus blood pressure level. Circulation. 2005;112(23):3569–76.

    Article  PubMed  Google Scholar 

  45. Gaziano Thomas A, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet. 2006;368(9536):679–86.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  46. Gilbert AR, Pinget C, Bovet P, Cornuz J, Shamlaye C, Paccaud F. The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles. Tob Control. 2004;13(2):190–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Murray CJL, Lauer JA, Hutubessy, Niessen L, Tomijima N, Lawes CM, et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003;361(9359):717–25.

    Article  PubMed  Google Scholar 

  48. Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54:1249–55.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Aashish Contractor, Monika Arora, Kiran Saluja and Bidyut K Sarkar have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Sir H.N.Reliance Foundation Hospital, Mumbai, India

    Aashish Contractor

  2. Health Promotion Division, Public Health Foundation of India, New Delhi, India

    Bidyut K. Sarkar, Monika Arora & Kiran Saluja

Authors
  1. Aashish Contractor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bidyut K. Sarkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monika Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kiran Saluja
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aashish Contractor.

Additional information

This article is part of the Topical Collection on Physical Activity

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Contractor, A., Sarkar, B.K., Arora, M. et al. Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs). Curr Cardiovasc Risk Rep 8, 405 (2014). https://doi.org/10.1007/s12170-014-0405-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-014-0405-6

Keywords

Search

Navigation