Principles for national and regional guidelines on cardiovascular disease prevention

Abstract

Cardiovascular disease (CVD) is the leading cause of global mortality resulting in nearly 17.5 million deaths worldwide in 2005. Whereas the causes of this epidemic involve the same risk factors, the approaches to its control and prevention can differ in each geographic region because of cultural, social, medical and economic circumstances. In recognition of the need for effective implementation of guidelines to curb the growing worldwide mortality from CVD, the World Heart Federation (WHF) has set forth principles upon which every nation can develop a policy on CVD prevention. The recommended strategies involve treatment of high-risk patients using medical therapies whose benefits have been confirmed by large randomized clinical trials, and the parallel institution of behavioral modification for the general population focused on diet, physical activity and prevention of smoking.As 80% of CVD-related mortality now occurs in countries with developing economies, it is imperative that governments work in partnership with national societies of health-care providers and foundations to develop guidelines that reflect national or regional priorities and resources. The greatest cost-effectiveness for prevention of CVD generally occurs through the treatment of patients at high short-term risk, whether that risk is based on a previous CVD event or determined by high global risk. Among populations at lower short-term risk of CVD, programs directed toward preventing use of tobacco products and encouraging physical activity and proper diet are public health measures that can be highly cost-effective. The health-care budget for each nation should reflect a thoughtful determination, which weighs the specific benefits for primary and secondary prevention programs based on local epidemiologic factors. Importantly, every effort should be made to address financial constraints placed upon the health-care system.The WHF recommends 10 strategic principles for the development of national clinical guidelines: (i) governments, national societies and foundations should collaborate to develop clinical and public health guidelines for CVD prevention that target risk factors; (ii) evidence-based guidelines should incorporate professional judgment on the translation of such evidence into effective and efficient care, addressing all areas of CVD risk; (iii) the assessment of total CVD risk should be based on epidemiological risk factor data appropriate to the population to which it is applied; (iv) policy recommendations and guidelines should emphasize the importance of a total risk reduction for CVD prevention; (v) the intensity of interventions should be a function of the total CVD risk, with lower treatment thresholds for higher-risk patients than for low-risk patients; (vi) national cardiovascular societies and foundations should promote routine, prospective collection of validated national vital statistics on the causes of CVD and outcomes of patients with CVD for use in the development of national policies; (vii) national professional s...

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“…In addition, serum TG is also considered an important risk factor for atherosclerosis [43,44]. Elevated levels of serum TG and LDL, accompanied by reduced HDL levels, are often associated with an increased risk of coronary heart disease [45]. In particular, many studies have found LDL to be the most dangerous among the serum lipids, and the oxidation of LDL leads to its increased penetration of arterial walls [46,47].…”

Reference values for serum lipids and lipoproteins in Spanish adolescents: the AVENA study

“…Coronary heart disease (CHD) is a leading cause of global mortality, accounting for almost 17 million deaths every year (Smith et al 2004). Nearly 80 % of this mortality and disease burden occurs in the industrialized countries; the data for Spain refl ect this picture (Instituto Nacional de Estadistica, 2001).…”

The Impending Cardiovascular Pandemic in China

“…11 The World Heart Federation has outlined principles for national and regional guidelines for CVD prevention that outline essential concepts to assist with the development of guideline-related programs for CVD prevention. 12 As the Institute of Medicine pointed out in its recent report, prevention and better control of CVD worldwide, particularly in low-and middle-income countries, requires coordinated global and local actions to provide sustained efforts, strong leadership, stakeholder collaborations, and substantial investment of financial, technical, and human resources. 13 China now finds itself facing a major crisis with the predicted increase mortality and morbidity from CVD.…”