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Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries; Fuster V, Kelly BB, editors. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington (DC): National Academies Press (US); 2010.

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Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

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About 10 years ago, in an address as the newly appointed President of the American Heart Association (AHA), I alluded to three serious challenges facing the field of cardiovascular disease: (1) How to support and energize research, which is so crucial to preventing the still-evolving epidemic of cardiovascular disease (CVD)? (2) Is it realistic to expect that this global epidemic can be lessened or avoided solely by professional and public education, or is there a need for more aggressive implementation strategies at a global level? (3) Would a more integrated and cooperative global approach, involving many if not all of the national and international organizations represented at the AHA Scientific Sessions, maximize the effectiveness of individual organizations and their volunteers?

Some of my colleagues diplomatically questioned the arguments of my speech, arguing that the AHA should focus its attention on the United States as the primary objective. At that time, my answer did not differ from the answer I would provide today, although now in much stronger terms after having been exposed even more thoroughly to the realities of the epidemic in low- and middle-income countries as President of the World Heart Federation. Over two-thirds of deaths attributable to CVD worldwide occur in low and middle income countries. Therefore, if the goal of the cardiovascular community is truly to achieve cardiovascular health, I see a clear responsibility to think and act globally, beyond the borders of high income countries.

Aging of populations, globalization, and rapid urbanization are changing disease patterns around the world. The epidemiological transition to a high chronic disease burden is occurring at a particularly rapid rate in developing countries. Thus, solutions for low and middle income countries need to be initiated within a short time frame, which represents an important public health challenge, given that these regions have fewer resources and greater health inequities than high income countries. If this challenge is not met, it will be impossible to achieve better health worldwide. Therefore, just as it is incumbent upon the cardiovascular community in high income countries to think and act globally, it is also incumbent upon the global health community to act upon the needs of cardiovascular disease.

This recognition of the need for action from leaders in both cardiovascular disease and global health served as motivation to accept the Institute of Medicine’s invitation to chair this ad hoc committee, which was charged to study the evolving global epidemic of CVD and to offer conclusions and recommendations pertinent to its control. Since the inception of this study, the committee recognized that it faced a broad task and a complex problem. At our first meeting it became clear that my colleagues shared one of my primary concerns: after substantive efforts of nearly two decades in which convened committees and documents have portrayed the evolving health and economic burden of CVD, in what way could our committee contribute toward a solution? Thus, the committee took on as a driving force the task of evaluating the factors contributing to the profound mismatch or “action gap” between the compelling evidence that had been articulated in previous efforts and the lack of concrete steps to implement actions. Our goal became to identify the necessary next steps to move forward and to define a framework in which to implement these steps.

We approached the task systematically, meeting four times in person, including two public sessions in which a number of additional experts in various fields were gathered to help inform our deliberations. These meetings were supplemented by countless ongoing deliberations through phone calls and email exchanges. Since the very beginning of our “run,” our outstanding study director from the IOM staff, Bridget Kelly, focused our efforts toward a limited number of feasible recommendations which, of course, progressively evolved as we reached our final conclusions over time.

This report reflects the path the committee followed. We reviewed the compelling epidemiological and economic evidence, which we found provides a clear mandate for action. We recognized the need for measurement and evaluation to truly understand the local nature of the epidemic and how best to intervene in ways that are locally relevant. We reconciled our “dream” of an ideal vision to promote cardiovascular health with our understanding of the pragmatic considerations of implementing interventions in low and middle income countries and the limited documentation and evaluation of successful strategies in these settings. Importantly, the committee chose to highlight the emerging importance of targeting mothers, children, youth, and young adults for prevention interventions in order to achieve long-term success in promoting cardiovascular health and reducing the burden of CVD.

Ultimately, the committee recognized that success in overcoming the burden of CVD will require the combined efforts of many players sustained over many years. Success is possible if the major stakeholders in CVD, related chronic diseases, and other areas of global health can be organized at global, national, and local levels to implement the necessary actions to control the global epidemic of CVD. It is the hope of all involved in this project that this report will prove to be a catalyst for action in the next stage of progress in the fight against global cardiovascular disease.

I would like to thank the members of the committee for their devotion of time and energy to this project. It was a privilege and a pleasure to work with my fellow committee members, to learn from them in their respective areas of expertise, and to engage with them in hearty discourse about the issues at hand. Many other experts also gave generously of their time and expertise to contribute to our information-gathering, and their contributions are deeply appreciated. The many other individuals who played a role in this process are listed in the acknowledgments on the following page, and I would like to add a special note of gratitude to the Institute of Medicine and especially to Bridget Kelly, Collin Weinberger, Louise Jordan, and Kristen Danforth, members of the project staff, for their laudable efforts shepherding and supporting the committee through every aspect of this process.

Valentín Fuster, Chair

Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries

Copyright © 2010, National Academy of Sciences.
Bookshelf ID: NBK45684
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