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25 by 25: Achieving Global Reduction in Cardiovascular Mortality

  • Public Health Policy (TA Gaziano, Section Editor)
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Abstract

Four non-communicable diseases—cardiovascular disease, chronic respiratory disease, diabetes mellitus, and cancer—account for over 60 % of all deaths globally. In recognition of this significant epidemic, the United Nations set forth a target of reducing the four major NCDs by 25 % by 2025. Cardiovascular disease alone represents half of these deaths and is the leading cause of death globally, representing as much as 60 % of all deaths in regions such as Eastern Europe. In response, the WHO set specific targets on conditions and risk factors and changes in the health systems structure in order to achieve the goals. The focus was set on lifestyle risk factors—physical activity, salt-intake, and tobacco—and established conditions—obesity, hypertension, and diabetes mellitus. Health system efforts to improve medical treatment of high risk are encouraged. Efforts to achieve the goal are being promoted by leading international CVD organizations.

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References

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

  1. World Health Organization (WHO) Global Health Observatory Database [database on the Internet]. 2008. Available from: http://www.who.int/gho/database/en/.

  2. Bloom DE, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. The global economic burden of noncommunicable diseases. Cambridge: Program on the Global Demography of Aging, Harvard TH Chan School of Public Health; 2012.

    Google Scholar 

  3. Bloom DE, Chisholm D, Jané-Llopis E, Prettner K, Stein A, Feigl A. From burden to" best buys": reducing the economic impact of non-communicable disease in low-and middle-income countries. Cambridge: Program on the Global Demography of Aging, Harvard TH Chan School of Public Health; 2011.

    Google Scholar 

  4. World Health Organization. Global Strategy for the prevention and Control of Noncommunicable Diseases, March 2000. Available from: http://apps.who.int/gb/archive/pdf_files/WHA53/ea14.pdf?ua=1.

  5. World Health Organization. United Nations Millennium Declaration 55/2. September, 2000. Available from: http://www.unorg/en/ga/search/view_docasp?symbol=A/RES/55/2.

  6. World Health Organization. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. RESOLUTION/66/2. September, 2011. Available from: http://www.whoint/nmh/events/un_ncd_summit2011/political_declaration_enpdf.

  7. World Health Organization. WHO framework convention on tobacco control. Geneva: World Health Organization; 2003. Available from: http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf.

    Google Scholar 

  8. World Health Organization. 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Available from: http://www.who.int/nmh/publications/9789241597418/en/index.html. World Health Organization.

  9. World Health Organization. Sixty-Fifth World Health Assembly Resolutions, Decisions, Annexes. Available from: http://www.who.int/mediacentre/events/2012/wha65/en/. WHA65/2012/REC/1. May 21–26, 2012.

  10. United Nations Assembly General (UNAG). The future we want. New York: United Nations; 2012. Available from: http://www.uncsd2012.org/content/documents/727The%20Future%20We%20Want%2019%20June%201230pm.pdf.

    Google Scholar 

  11. Haines A, Alleyne G, Kickbusch I, Dora C. From the earth summit to Rio+20: integration of health and sustainable development. Lancet. 2012;379(9832):2189–97.

    Article  PubMed  Google Scholar 

  12. Alleyne G, Binagwaho A, Haines A, Jahan S, Nugent R, Rojhani A, et al. Embedding non-communicable diseases in the post-2015 development agenda. Lancet. 2013;381(9866):566–74. This article explains the importance of having the goals for controlling non-communicable diseases in the UN development goals for success in reducing the CVD burden.

    Article  PubMed  Google Scholar 

  13. Sachs JD. From millennium development goals to sustainable development goals. Lancet. 2012;379(9832):2206–11.

    Article  PubMed  Google Scholar 

  14. Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372(14):1333–41. This article explains the driving forces for increasing overall CVD mortality inlcuding population growth and aging of the population despited declines in age-djusted death rates due to improvements in care or risk factors.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Gaziano TA, Pagidipati N. Scaling up chronic disease prevention interventions in lower- and middle-income countries. Annu Rev Public Health. 2013;34:317–35. Reviews the interventions both at the individual level and at the population or policy levet that can contribute to the reduction in cardiovascular disease mortaltiy and the potential challenges implementing them.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007;50(22):2128–32.

    Article  PubMed  Google Scholar 

  17. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356(23):2388–98.

    Article  PubMed  CAS  Google Scholar 

  18. Nabel EG, Braunwald E. A tale of coronary artery disease and myocardial infarction. N Engl J Med. 2012;366(1):54–63.

    Article  PubMed  CAS  Google Scholar 

  19. O'Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013;99(3):159–62.

    Article  PubMed  Google Scholar 

  20. Jha P, Ranson MK, Nguyen SN, Yach D. Estimates of global and regional smoking prevalence in 1995, by age and sex. Am J Public Health. 2002;92(6):1002–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014;370(1):60–8.

    Article  PubMed  CAS  Google Scholar 

  22. Balbinotto Neto G, Silva EN. The costs of cardiovascular disease in Brazil: a brief economic comment. Arq Bras Cardiol. 2008;91(4):198–9. 217–8.

    Article  PubMed  Google Scholar 

  23. Piano MR, Benowitz NL, Fitzgerald GA, Corbridge S, Heath J, Hahn E, et al. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation. 2010;122(15):1520–44.

    Article  PubMed  Google Scholar 

  24. Oberg M, Jaakkola MS, Woodward A, Peruga A, Pruss-Ustun A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139–46.

    Article  PubMed  Google Scholar 

  25. Pell JP, Haw S, Cobbe S, Newby DE, Pell ACH, Fischbacher C, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med. 2008;359(5):482–91.

    Article  PubMed  CAS  Google Scholar 

  26. Cronin EM, Kearney PM, Kearney PP, Sullivan P, Perry IJ. Impact of a national smoking ban on hospital admission for acute coronary syndromes: a longitudinal study. Clin Cardiol. 2012;35(4):205–9.

    Article  PubMed  Google Scholar 

  27. Gupta R, Gupta N, Khedar R. Smokeless tobacco and cardiovascular disease in low and middle income countries. Indian Heart J. 2013;65(4):369–77.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jha P CF, Moore J, Gajalakshmi V, Gupta PC, Peck R, Asma S, Zatonski W. Chapter 46: Tobacco Addiction, Disease Control Priorities in Developing Countries, 2nd Edition. Jamison DT BJ, Measham AR, Alleyne G, Claeson M, Evans D, Jha P, Mills A, Musgrove P, editor. Washington DC: Oxford University Press and The World Bank; 2006.

  29. Pagidipati NJ, Gaziano TA. Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation. 2013;127(6):749–56.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Blecher E. The impact of tobacco advertising bans on consumption in developing countries. J Health Econ. 2008;27(4):930–42.

    Article  PubMed  Google Scholar 

  31. Higashi MH, Truong KD, Barendregt JJ, Nguyen PK, Vuong ML, Nguyen TT, et al. Cost effectiveness of tobacco control policies in Vietnam. Appl Health Econ Health Policy. 2011;9(3):183–96.

    Article  PubMed  Google Scholar 

  32. Moodie C, MacKintosh AM, Hammond D. Adolescents’ response to text-only tobacco health warnings: results from the 2008 UK youth tobacco policy survey. Eur J Pub Health. 2009;ckp199.

  33. Wakefield MA, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ open. 2013;3(7), e003175.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011;305(17):1777–85.

    Article  PubMed  CAS  Google Scholar 

  35. O'Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306(20):2229–38.

    Article  PubMed  Google Scholar 

  36. World Health Organization. Sodium intake for adults and children: Guideline, 2012. Available from: http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf?ua=1&ua=1.

  37. Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ open. 2013;3(12), e003733.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;337(21):1491–9.

    Article  PubMed  CAS  Google Scholar 

  39. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354(15):1601–13.

    Article  PubMed  CAS  Google Scholar 

  40. Wyness LA, Butriss JL, Stanner SA. Reducing the population's sodium intake: the UK food standards Agency's salt reduction programme. Public Health Nutr. 2012;15(02):254–61.

    Article  PubMed  Google Scholar 

  41. 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(9604):2044–53.

    Article  PubMed  Google Scholar 

  42. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362(7):590–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Smith-Spangler CM, Juusola JL, Enns EA, Owens DK, Garber AM. Population strategies to decrease sodium intake and the burden of cardiovascular disease: a cost-effectiveness analysis. Ann Intern Med. 2010;152(8):481–7. W170-3.

    Article  PubMed  Google Scholar 

  44. World Health Organization. Review of best practice interventions to promote physical activity in developing countries. Background document prepared for the WHO Workshop on Physical Activity and Public Health. Geneva: 2005.

  45. Willett WC, Koplan JP, Nugent R, Dusenbury C, Puska P, Gaziano TA. Chapter 44. Prevention of chronic disease by means of diet and lifestyle changes (Table 44.2). In: Jamison DT BJ, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease control priorities in developing countries. New York and Washington DC: Oxford University Press and the World Bank; 2006.

    Google Scholar 

  46. Eriksson KF, Lindgarde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia. 1991;34(12):891–8.

    Article  PubMed  CAS  Google Scholar 

  47. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  PubMed  CAS  Google Scholar 

  48. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.

    Article  PubMed  CAS  Google Scholar 

  49. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.

    Article  PubMed  CAS  Google Scholar 

  50. Venkat Narayan KM ZP, Kanaya AM, Williams DE, Engelgau MM, Imperatore G, Ramachandran A. Chapter 30. Diabetes: the pandemic and potential solutions. In: Jamison DT BJ, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease control priorities in developing countries. 2nd ed. New York, NY and Washington DC: Oxford University Press and The World Bank; 2006.

    Google Scholar 

  51. Farzadfar F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3 · 0 million participants. Lancet. 2011;377(9765):578–86.

    Article  PubMed  Google Scholar 

  52. Mendis S, Fukino K, Cameron A, Laing R, Filipe Jr A, Khatib O, et al. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ. 2007;85(4):279–88.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HG, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011;89(6):412–21.

    Article  PubMed  PubMed Central  Google Scholar 

  54. van Mourik MS, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord. 2010;10:25.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Masoudi FA, Bonow RO, Brindis RG, Cannon CP, Debuhr J, Fitzgerald S, et al. ACC/AHA 2008 statement on performance measurement and reperfusion therapy: a report of the ACC/AHA task force on performance measures (work group to address the challenges of performance measurement and reperfusion therapy). J Am Coll Cardiol. 2008;52(24):2100–12.

    Article  PubMed  Google Scholar 

  56. Weinstein MC, Stason WB. Cost-effectiveness of interventions to prevent or treat coronary heart disease. Annu Rev Public Health. 1985;6(1):41–63.

    Article  PubMed  Google Scholar 

  57. Orlandini A, Diaz R, Wojdyla D, Pieper K, Van de Werf F, Granger CB, et al. Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes. Eur Heart J. 2006;27(5):527–33.

    Article  PubMed  Google Scholar 

  58. Weinstein MC, Stason WB. Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med. 1977;296(13):716–21.

    Article  PubMed  CAS  Google Scholar 

  59. Sikri N, Bardia A. A history of streptokinase use in acute myocardial infarction. Tex Heart Inst J. 2007;34(3):318–27.

    PubMed  PubMed Central  Google Scholar 

  60. Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation. 2005;112(23):3547–53.

    Article  PubMed  Google Scholar 

  61. Giugliano RP, Llevadot J, Wilcox RG, Gurfinkel EP, McCabe CH, Charlesworth A, et al. Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II. Eur Heart J. 2001;22(18):1702–15.

    Article  PubMed  CAS  Google Scholar 

  62. Kramer JM, Newby LK, Chang WC, Simes RJ, Van de Werf F, Granger CB, et al. International variation in the use of evidence-based medicines for acute coronary syndromes. Eur Heart J. 2003;24(23):2133–41.

    Article  PubMed  Google Scholar 

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Correspondence to Thomas A. Gaziano.

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Sagar Dugani and Thomas A. Gaziano declare that they have no conflict of interest.

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Dugani, S., Gaziano, T.A. 25 by 25: Achieving Global Reduction in Cardiovascular Mortality. Curr Cardiol Rep 18, 10 (2016). https://doi.org/10.1007/s11886-015-0679-4

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