Strategic Priorities

of the WHO
Cardiovascular
Disease
Programme
Dr. Rina Amelia, MARS
Dept of Community Medicine
Block: Cardiovascular

The WHO Programme on

Cardiovascular Diseases (CVD) is
concerned with prevention,
management and monitoring of CVD
globally.

It aims to develop global strategies to

reduce the incidence, morbidity and
mortality of CVD by

effectively reducing CVD risk factors and their

determinants
developing cost effective and equitable health
care innovations for management of CVD

CVD is the name for the group of

disorders of the heart and blood
vessels and include:
Hypertension (high blood pressure)
Coronary heart disease (heart attack)
Cerebrovascular disease (stroke)
Peripheral vascular disease
Heart failure
Rheumatic heart disease
Congenital heart disease
Cardiomyopathies

Facts
In

1999 CVD contributed to a third

of global deaths.
In 1999, low and middle income
countries contributed to 78% of
CVD deaths.
By 2010 CVD is estimated to be
the leading cause of death in
developing countries.
Heart disease has no geographic,
gender or socio-economic

CVD in developing
countries

Economic transition urbanisation,

industrialisation and globalisation bring
about lifestyle changes that promote heart
disease.
These risk factors include tobacco use,
physical inactivity, unhealthy diet.
Life expectancy in developing countries is
rising sharply and people are exposed to
these risk factors for longer periods.
Newly merging CVD risk factors like low
birth weight, folate deficiency and
infections are also more frequent among
the poorest in low and middle income

Social and economic consequences

Clinical care of CVD is costly and prolonged.

These direct costs divert the scarce family and
societal resources to medical care.
CVD affects individuals in their peak mid life
years disrupting the future of the families
dependant on them and undermining the
development of nations by depriving valuable
human resources in their most productive
years.
In developed countries lower socioeconomic
groups have greater prevalence of risk factors,
higher incidence of disease and higher
mortality.
In developing countries as the CVD epidemic

Goal of the WHO Global

Strategy
To

effectively control CVD risk

factors and to reduce the burden
of the fast growing cardiovascular
disease (CVD) epidemic
particularly in developing
countries.

Key areas of work

Reduce major CVD risk factors and their social

and economic determinants through
community based programmes for integrated
prevention of NCDs.

Development of standards of care and costeffective case management for CVD.

Global action to enhance the capacity of

countries to meet the health care needs of
CVD.

Developing feasible surveillance methods to

assess the pattern and trends of major CVDs
and risk factors and to monitor prevention and
control initiatives.

Integrated Management
of Cardiovascular Risk

Cardiovascular disease (CVD) is a leading cause

of mortality and is responsible for one-third of all
global deaths. Nearly 85% of the global mortality
and disease burden from CVD is borne by lowand middle-income countries.

In India, for example, approximately 53% of CVD

deaths are in people younger than 70 years of
age; in China, the corresponding figure is 35%.
The majority of the estimated 32 million heart
attacks and strokes that occur every year are
caused by one or more cardiovascular risk
factors hypertension, diabetes, smoking, high
levels of blood lipids, and physical inactivity
and most of these CVD events are preventable if

CVD is an important cause of global

morbidity and in five of the six WHO
Regions it is the leading cause of
mortality.

Cardiovascular Risk

Risk factors i.e. smoking, unhealthy

diet and physical inactivity are
expressed as hypertension, diabetes,
obesity and high blood lipid levels,
and together contribute to the total
cardiovascular risk and are the root
causes of the global CVD epidemic

Risk factors account for 75% of the

CVD epidemic worldwide

Heart attacks and strokes are leading

causes of death and disability, they
represent only the tip of an iceberg.

CVDs are responsible for the deaths

of 17 million people each year, or
approximately onethird of global
deaths annually.
Hypertension is the most prevalent
CVD, affecting at least 600 million
people, and is an important
contributor to cardiovascular
mortality and morbidity

Hypertension as an entry point to

cardiovascular risk management

About 15%37% of the adult population

worldwide is afflicted with hypertension
In general, hypertension prevalence is higher
in urban settings compared to rural settings
Data from World Health Report 2002 indicate
that hypertension is the third most important
contributor to the global disease burden
among the six risk factors: underweight,
unsafe sex, hypertension, unsafe water,
tobacco and alcohol.
treating hypertension has been associated
with a 35%40% reduction in the risk of stroke
and a reduction of at least 15% in the risk of
myocardial infarction.

a paradigm shift from treatment of

hypertension to management of
comprehensive cardiovascular risk.
Cost-effectiveness of treating
hypertension is also determined by the
overall cardiovascular risk and not by
blood pressure alone

Barriers to cardiovascular risk

management

Health policy

The overriding barrier to CVD risk-management

programmes in low- and middle-income countries is
that there are no formal policies that target CVD as a
major health issue.
In 2001, a survey of 167 countries in the six WHO
Regions found that 57% of the countries lacked a
noncommunicable disease policy, and 65% had no CVD
plan

Health-care systems

under equipped health facilities; a lack of continuity

between primary health care and the secondary- and
tertiary-care sectors; poorly-developed information
systems; a lack of awareness of the potential health
benefits and cost savings of CVD programmes; and the
influence of commercial interests on resource

Barriers to cardiovascular risk

management

Health-care providers

the lack of personnel with appropriate training and

skills, and an already overburdened workforce.
In the WHO global capacity assessment survey,
healthcare professionals received no training in the
management of noncommunicable diseases in about
one-half of the 167 countries surveyed.

Patients, families and the community

A comprehensive CVD risk-management programme

relies upon individual patients adhering to daily drug
treatments, accepting lifestyle advice, and returning for
follow-up assessments
Patient adherence needs to be enhanced through the
support of family members and the community
Families and communities need to be empowered to
actively participate in patient care, through health
education and through community mobilization

Menurut Menkes CVD telah menjadi

salah satu masalah penting
kesehatan masyarakat dan penyebab
kematian utama
WHO, memperkirakan pa tahun
2030, 23,6 juta orang meninggal
karena CVD
Riskesdas (2007), menunjukkan
prevalensi penyakit jantung 7,2%
Penyakit jantung Iskemik : 5,1% dari
seluruh penyebab kematian dan
penyakit jantung 4,6% dari seluruh