World Heart Federation : Major CVD issues
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WORLD HEART FEDERATION IDENTIFIES LOW-INCOME COUNTRIES’ MAJOR CARDIOVASCULAR ISSUES AT EUROPEAN CARDIOLOGY CONGRESS

The World Heart Federation and the European Society of Cardiology held a joint symposium at the latter’s annual congress 1-5 September 2007 in Vienna, Austria. The symposium was entitled “Major cardiovascular disease issues in developing countries”.

Presenters included World Heart Federation President Shahryar Sheikh, immediate Past President Valentin Fuster and Chairman of the Scientific Council on Rheumatic Fever and Rheumatic Heart Disease Jonathan Carapetis. Scientific Advisory Board Chairman Sidney Smith was co-chair.

In addition, the World Heart Federation led a “Meet the Experts” session, also chaired by Dr Smith, entitled “Rheumatic heart disease and pregnancy”.

Sheikh explores interventional cardiology in developing countries

Dr Sheikh’s presentation was entitled “Focused role for interventional cardiology and cardiovascular surgery.”

Eighty per cent of advanced cardiac care occurs in the high-income countries accounting for just 16% of the world’s population, he said.

Among his major conclusions he stated that:

  1. Interventional cardiology (defined as catheter-based treatment of heart diseases) “has been the most dramatic breakthrough in the field of cardiovascular care in the last 25 years”.
  2. Interventional cardiology’s growth “has been universal” – even in developing countries.
  3. “Stents have become the dominant coronary intervention strategy worldwide” and are widely used even in developing countries.
  4. Socioeconomic status remains the most important barrier for the appropriate application of cardiovascular care particularly coronary intervention.
  5. Application of primary percutaneous coronary intervention in developing countries remains low because of inadequate local health infrastructures.
  6. Guidelines, research and quality control remain future challenges for cardiovascular care in developing countries.
  7. Cardiovascular disease remains a great challenge. The keys are evidence-based therapies and reduction of major risk factors.

Fuster urges UN to amend Millennium Development Goals

Dr Fuster lamented the United Nations’ continuing failure to amend its Millennium Development Goals to take into account the epidemiological transition that is taking place in most developing countries. The epidemiological transition involves a “shift from nutritional deficiencies and infectious diseases to degenerative diseases (i.e. cardiovascular disease)”, he said.

At present, the Millennium Development Goals specifically embrace only HIV/AIDS, tuberculosis and malaria; child mortality; and maternal mortality.

Among the specific reasons that he gave for integrating cardiovascular disease among the Millennium Development Goals were:

  • The predominance of cardiovascular disease and the other chronic diseases in the global burden of disease. All told, the chronic diseases accounted for 60% of deaths in 2005. Eighty per cent of those deaths occurred in low- and middle-income countries.
  • The fact that cardiovascular disease affects people of working age at higher rates in low- and middle-income countries.
  • Integrating cardiovascular disease and the other chronic diseases will strengthen the United Nations’ ability to reach its poverty-reduction goals.
  • Control and treatment of cardiovascular disease would cost-effectively reduce poverty and improve health.

Among specific improvements that could be made to the Millennium Development Goals, Dr Fuster said, would be language to:

  • Reduce smoking and exposure among parents and children.
  • Fight childhood overweight and obesity.
  • Pursue both infectious and chronic disease primary prevention in resource-constrained settings.
  • Implement community-, school- and work-based health programmes.

“Cardiovascular disease and chronic diseases are being ignored by policy-makers and development aid agencies,” he said. “Limited funds mean limited action directed at prevention and control. This is a serious concern and the situation must be rectified.” Some positive signs are already evolving.

Carapetis links rheumatic heart disease to poverty

Dr Carapetis’ presentation was entitled “Rheumatic heart disease: the continuing epidemic”.

He delineated the disease’s high prevalence in Africa, the Near East, the South Pacific Islands and among aboriginal populations in Australia and New Zealand. Overall, 79% of cases occur in less-developed countries, he said.

He emphasized the importance of secondary prevention with penicillin injections as a means of preventing rheumatic heart disease. Carapetis also highlighted recent findings relating to screening of school-aged children for rheumatic heart disease, and appealed for more work to enable echocardiographic screening in developing countries.

He touted the World Heart Federation’s Rheumatic Heart Disease Network as an international clearing house for training materials and best practices guidelines.

Meet the experts

The participants in the “Meet the Experts” session on rheumatic heart disease and pregnancy were D L Adamson, R J C Hall, J W Roos-Hesselink, Bernard Iung and C M Otto.

For more information about the European Society of Cardiology Congress, visit the European Society of Cardiology web site.

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