Control of Cardiovascular Diseases in Developing Countries Research, Development, and Institutional Strengthening (1998) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-10
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The transition recognizes, primarily because of the aging population worldwide, that the spectrum of disease in developing countries is changing from one of communicable diseases and perinatal and nutritional disorders to one of predominantly noncommunicable disease, most notably cardiovascular disease (CVD)
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Given the enormous potential for applying research and technological advances to prevention and treatment of CVD, there is hope that the epidemic can be controlled. The following observations suggest that premature death can be avoided and the quality of life improved in middle and later years: · dramatic declines in CVD mortality in Western countries; · geographic variations in CVD mortality; and · established associations of adult mortality with modifiable risk factors, such as tobacco use and obesity.
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5. Initiate pilot studies to evaluate essential vascular packages of effective, low-cost drugs.
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If the surveys are appropriately designed to allow repeated observations of many individuals and to take successive independent samples, they can also be used to quantify the strength of association between a CVD risk factor with eventual development of disease. However, patient follow-up in many developing country populations is difficult because of a lack of vital registration systems, high population mobility, and variable access to medical care.
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Ideally, the occurrence of first myocardial infarctions should be studied to avoid survival bias and postmorbid modification of risk factors. Key conditions that might be studied using case-control methods include acute myocardial infarction, acute stroke, transient ischemic attacks, congestive heart failure, and peripheral vascular disease.
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evaluate the cost-effectiveness of tobacco cessation programs anned at changing the behavior of current smokers; and (5) estimate the economic impact of tobacco control on developing countries that grow and manufacture tobacco or tobacco products for domestic or foreign markets in order to encourage the change to alternative crops and manufacturing.
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Aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and cholesterol-lowering statin drugs reduce the probability of death and subsequent nonfatal major vascular events in patients with established ischemic heart disease. However, to have a sustained impact in developing countries, these drugs will have to be inexpensive and widely accessible.
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Develop and Assess Algorithms of Affordable Clinical Care for CVD Recommendation 10. Research should be undertaken to develop al gor~thms for affordable diagnosis and management of hypertension, dyslipidem~a, diabetes, acute myocardial infarction, angina, stroke, transient ischem~c attacks, congestive heart failure, peripheral vascular disease, post-myocardial infarction rehabilitation and risk management, and poststroke rehabilitation and risk management.
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training programs in cardiovascular epidemiology, clinical research methodology, health policy research, and health economics; (2) institutional capacity for undertaking integrated research relevant to CVD control; and (3)
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Yet the evidence that premature death can be avoided and quality of life improved in later years includes dramatic declines in CVD mortality in Western countries, geographic variation in CVD mortality, and established associations of adult mortality with modifiable risk factors, such as tobacco use and obesity. Reducing the prevalence of these risk factors has been shown to decrease mortality in both middle-aged and older persons and to lead to less disability and a better quality of life in later years.
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