Control of Cardiovascular Diseases in Developing Countries Research, Development, and Institutional Strengthening (1998) / Chapter Skim
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5 Priorities for Global Research and Development
5 Priorities for Global Research and Development
Pages 44-58
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From page 44... ...
Increases in CVD risk factors precede the CVD epidemic so that strategies for CVD control must focus on the prevention of risk factors as well as their reduction. Control of risk factors may involve: prevention of risk factor development or progression in communities and age groups currently at low risk (primordial prevention)
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From page 45... ...
Such systems are incomplete or nonexistent for many developing countries. About 18 percent of global CVD mortality occurs in China, where the sample registration covers only about 10 percent of the population or about 100 million people in rural and urban settings.
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From page 46... ...
These deaths are likely to include ischemic heart disease, stroke, or other CVD deaths, which would lead to an underestimation of CVD mortality. Ascertaining cause-specific mortality could be strengthened through the use of community-based random samples, sentinel sites, and surveillance systems modeled after those used in the MONICA study, as well as verbal autopsy techniques to determine the cause of death of adults (especially CVD-related deaths)
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From page 47... ...
to monitor cardiovascular mortality levels and trends of clinical events, and the CINDI and CARMEN models to monitor cardiovascular risk factors; · expanding national and regional systems for vital registration; · improving the accuracy and completeness of cause-of-death statistics; and · developing better estimates of disability. Establishing the Levels, Determinants, and Consequences of Risk Factors Cross-Secfional Surveys A major goal of cross-sectional surveys of risk factors is to describe the prevalence and distribution of risk factors, by age, sex, and ethnicity, in representative samples of the population.
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From page 48... ...
Key conditions for study by casecontrol methods are acute myocardial infarction, acute stroke, transient ischemic attacks, congestive heart failure, and peripheral vascular disease. · Prospective studies have the advantage of measuring exposure to a risk factor prior to the development of disease.
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From page 49... ...
The proportion of hemorrhagic stroke is higher in developing country populations (Ready and Yusuf, 19981. Since these events are known to be sensitive to blood pressure, even moderately successful interventions to reduce blood pressure could have a significant impact on CVD incidence.
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From page 50... ...
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 effect in developing countries, these drug packages must be low cost and widely accessible.
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From page 51... ...
treatment of acute coronary ischemia, acute stroke, and transient ischemic attack, chronic coronary ischemia, chronic peripheral vascular disease, and congestive heart failure; 2. management of low-cost, home-based rehabilitation following a stroke or myocardial infarction; and 3.
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From page 52... ...
Other Public Health Interventions Many other issues of program effectiveness can be addressed through systematic demonstration studies designed to yield rigorous results through standardized evaluation and serial implementation in successive communities with comparable pre- and postevaluation strategies. Such approaches can address effects at the community (rather than the individual)
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From page 53... ...
Local knowledge will allow for political, social, and cultural differences among developing country populations, while striving for comparability across studies. Research on tobacco control can help reduce the substantial burden of disease projected for several tobacco-related diseases, including certain cancers and chronic obstructive pulmonary disease as well as CVD (see Chapters 1 and 2; CDC, 1990, 1994; WHO, 1997)
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From page 54... ...
; · the programs provide a natural coalition of various categories of health care providers, each with an important role in the detection or management of hypertension and its sequelae; and · the concept of"comprehensive cardiovascular reduction" as a part of hypertension management makes it possible to incorporate strategies aimed at modifying other CVD risk factors such as tobacco use, high blood lipids, diabetes, and obesity. Thus, the committee recommends that research on hypertension control in developing countries be undertaken to: · estimate the distribution of elevated blood pressure and prevalence of hypertension in population samples; · evaluate the cost-effectiveness of community-based, life-style linked interventions such as improved nutrition and exercise, and reduced smoking to decrease the incidence of high blood pressure;
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From page 55... ...
These reviews could be conducted in hospital settings in several countries, with standardized diagnostic methods. The CVD-related conditions to be included are acute coronary ischemia, acute stroke and transient ischemia, chronic coronary ischemia, chronic peripheral vascular disease, and congestive heart failure.
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From page 56... ...
There are limited data from developing countries on the effectiveness of CVD expenditures. Preliminary estimates from India suggest that populationbased risk factor reduction and low-cost secondary treatments are as costeffective as other interventions included in minimal essential packages of care (Jha et al., forthcoming)
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From page 57... ...
Private-Sector Participation The private sector can participate in population-based prevention programs, as well as in cost-effective case management programs. Partnerships with the private sector may also attract research funding to evaluate population-based interventions for risk factor modification and those testing clinical care algorithms.
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From page 58... ...
Hence, there is a growing need to train individuals and equip institutions to undertake research relevant to CVD control. Regional training programs, modeled after the ISFC seminars and the INCLEN program, could be established in developing countries to focus on the control of CVD and other NCDs.
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