• Prevention & Screening

Risk factors that contribute to the development of cardiovascular disease (CVD) include smoking, hypertension, dyslipidemia, obesity, and impaired glucose tolerance. Many of these risks can be reduced with lifestyle modification (eg, improved diet and exercise); yet, the burden of disease remains high, particularly in the developing world. In an effort to address the global health challenge of CVD, the US National Institute of Medicine (IoM) released a report, illustrating the global evolution of this epidemic and offering recommendations to manage this growing problem.

C. James Hospedales, MD, MPH, Pan American/World Health Organization, discussed these preventive measures and policy approaches, suggested by the IoM, as well as potential barriers. Limited knowledge concerning the feasibility and effectiveness of CVD prevention policies and programs represents a challenge in this area. The lack of financial resources and infrastructure in low and middle income countries poses other obstacles that must be addressed. Competing health and development priorities also hinder regional and global support for these initiatives. Therefore, the IoM recommends building the knowledge base, creating local solutions that can benefit from global support, organizing resources, and forming collaborations to meet resource needs to overcome these challenges. The ultimate goal of the IoM report is to implement successful CVD programs and policies that will lead to a 2% annual reduction in death rates that are related to major chronic diseases.

Dr. Hospedales challenged the Caribbean Cardiac Society to help with this initiative as a leadership organization to advocate for cost-effective national and local policies that promote health (ie, tobacco taxes and dietary salt reduction programs). Clinicians may strengthen the quality and breadth of these programs by educating clinical staff, joining national committees that promote CVD prevention (ie, Healthy Caribbean Coalition), and supporting local hospital initiatives. Concentration on a healthy workplace and the implementation of preventative models within individual practices may also encourage community support. Details regarding the IoM global CVD report are available at www.iom.edu/globalcvd.

In Barbados, CVD has been a leading cause of illness and death since 2003, with heart attack and stroke responsible for one-third of all deaths on the island. The economic burden of chronic noncommunicable diseases (CNCDs), such as CVD, compounds the problem and with CNCDs, treatment often does not result in a cure. Angela Rose, MSc, University of the West Indies Chronic Disease Research Centre (CDRC), Cave Hill, Barbados, discussed the impact of CVD on health in Barbados.

There are poor outcomes from CNCDs in Barbados. For example, one-third of patients who suffer an acute myocardial infarction (MI) die within 2 weeks. One-third of patients following an acute stroke die within 4 weeks. Additionally, CNCDs account for ∼50% of disability-adjusted life-years in the Caribbean, resulting in a large reduction in labor supply and productivity, as most of those affected are of working age. The poorest people are at highest risk for CNCDs. Unfortunately, they are also less financially able to manage the burden of disease. The good news is that 80% of CNCDs are preventable with lifestyle and diet modifications. Therefore, prevention is crucial to ease the treatment issues that are currently faced in the Caribbean.

The Barbados National Registry (BNR) for CNCDs is an initiative of the Barbados Ministry of Health (MoH). The recently launched BNR is a national surveillance system comprising three population-based surveys and registries that are focused on stroke, acute MI, and cancer. Preliminary data have revealed an unmet need for preventative action and standardized interventions to disrupt the spiraling burden of CNCD in this region.

Another MoH funded initiative being implemented by the CDRC is the “Health of the Nation” study, a population-based survey which will evaluate the impact of acute MI and stroke on quality of life and the economy in the hopes of formulating a plan for future health care programs. MI and stroke survivors will be followed in order to evaluate regional access to rehabilitation services and improve diagnostic approaches. Medication compliance and the sources of risk factors will also be assessed to assist in the development of future intervention protocols. Ms. Rose concluded that CVD may be a “looming disaster” for Barbados as we are currently focused on treatment (ie, the of the disease cycle). Prompt measures are needed to change this focus to more preventative measures. The Barbados MoH is starting to effect this change through its surveillance and research study efforts, which will provide valuable information for future action.

• © 2010 MD Conference Express