WORLD HEALTH ORGANIZATION DEVELOPS NOVEL AND EFFECTIVE WAYS TO ADDRESS THE EPIDEMIC OF CARDIOVASCULAR DISEASE

The World Health Organization (WHO) is helping to address cardiovascular disease in low- and middle-income countries by adapting and disseminating prevention tools. Charts and the accompanying guideline for prevention of cardiovascular disease will be made available to health-care practitioners later this year. As the World Health Organization’s senior adviser for cardiovascular diseases, Dr Shanthi Mendis spearheaded their development.

By determining a patient’s age, sex, blood pressure and blood cholesterol, and whether he smokes and has diabetes, health-care practitioners can locate on the tools the corresponding risk of a heart attack or stroke. Armed with that knowledge, the health practitioner and the patient can then take appropriate measures to reduce the risk.

“The risk assessment charts are tools that can be used at primary health care centres even in low-resource settings,” Dr Mendis said, adding that they are “quite user-friendly.”

“Our objective is mainly to reduce disease and death due to cardiovascular disease in low- and middle-income countries because that’s where the cardiovascular disease burden is escalating and where our work is most needed,” she said.

Another tool that the WHO uses to address cardiovascular disease is technical specifications for blood pressure measurement devices in low-resource settings. Finding affordable and accurate devices became increasingly difficult since countries began to ban the ones that contain mercury.

“We don’t endorse any particular blood pressure measurement device,” Dr Mendis said. “We merely write specifications for what we consider to be an adequate automated device. The specifications include accuracy and cost.”

Dr Mendis is a professional in the cardiovascular disease programme of the WHO’s department of Noncommunicable Diseases and Mental Health, which is headed by Assistant Director General Dr Catherine Le Galès-Camus. As such, she stays busy helping to put cardiovascular disease on the global health agenda.

Among her duties is to serve as liaison with nongovernmental organizations working to prevent and control cardiovascular disease, including the World Heart Federation. She called the World Heart Federation “one of the important key partners for the programme”, saying that it and the WHO enjoy a “fruitful collaboration”.

In recent years, Dr Mendis in collaboration with other colleagues has published numerous papers about the challenges that low- and middle-income countries face coping with cardiovascular disease. A recent  paper in the June 2007 Bulletin of the World Health Organization investigated the potential of nonphysician health-care providers in cardiovascular disease prevention in primary care. Another paper in the April 2007 Bulletin of the World Health Organization revealed that common medicines for the treatment of cardiovascular disease were unaffordable in many such countries. A publication in the November 2005 issue of the same journal also revealed that significant percentages of heart attack and stroke patients in low- and middle-income countries were not receiving basic care they needed to prevent repeat attacks. 

Dr Mendis emphasized the importance of youth health education.

“Cardiovascular disease has a long incubation period,” she explained. “Blood vessels start depositing fatty material when you are seven or eight years old. If your childhood has been unhealthy with physical inactivity and poor diet, the disease starts manifesting itself in your forties. People have to realize that we need to do something starting from childhood.”

She is encouraged by the priority that WHO Director General Dr Margaret Chan places on cardiovascular disease. In particular, she is inspired by the Director General’s emphasis on improving primary health care.

“If we want to fight for social justice and equity, we need to strengthen primary health care,” Dr Mendis said.