Dear All,
I read a recent article in the Lancet (Aug 25, 2001) by Robert Beaglehole on the importance of global cardiovascular disease prevention which highlights some interesting points.
This year, there is an estimated 56 million deaths globally and 12.5 million of these deaths are due to either coronary heart disease or stroke. Most of these deaths occur in the poorer regions of the world. The prevention models in wealthy countries have little relevance for most of the world where there is persistent poverty and limited resources available to health services and public health services.
Diet, physical inactivity and tobacco use explain at least 75% of the new cases of cardiovascular disease. Only about 5% of the adult population of developed countries do not have any of these risk factors.
Yet we still spend a lot of money researching new risk factors (e.g. genetic abnormalities). A lot of these risk factors are not responsible for the large proportion of cardiovascular disease nor are there affordable strategies to avoid or lower these risk factors.
We continue using the high risk approach to prevention (i.e. individual risk assessment by measuring cholesterol, blood pressure, screening for diabetes etc.). Although this approach can be moderately successful but it is very expensive and have no effect on the global burden of cardiovascular disease. A more cost-effective approach is to try to find ways of enabling people and populations to lower their risk of cardiovascular disease. Some of the strategies which are successful in shifting risk factor distributions include
This is a good argument why the bulk of available resources should be directed to a population approach to primary prevention and why more action is required to focus on the social, economic and political determinants of cardiovascular disease.
Jane Wu
Practising doctor in Sydney
MPH student in UNSW