Tracing the steps to better cardiovascular health

Daniel José Piñeiro

President, World Heart Federation

It is preventable and treatable, so it might surprise people that cardiovascular disease claims more lives every year than even cancer — more than 18 million.

Cardiovascular disease (CVD) can strike anyone, manifest in different ways and have varying causes. High cholesterol, tobacco, physical inactivity and harmful use of alcohol are factors that can compromise cardiovascular health. Additionally, air pollution is a growing risk that complicates cardiovascular conditions.

Working towards better cardiovascular health

As for all diseases, habits and genetics play a role. For some, the hereditary (genetic) component is the most important. For example, Familial hypercholesterolemia (FH) is an inherited, metabolic disorder. Individuals with FH have high levels of low-density lipoprotein (LDL) cholesterol — sometimes called ‘bad’ cholesterol — due to a mutation in one of several genes that help regulate and eliminate it.

Guidance in a series of WHF Roadmaps can be a timesaver. They help map challenges, stakeholders and options across systems to support responses that might not always be considered or obvious. With case studies and examples, the series synthesises challenges and solutions and makes practical recommendations.

A closer look at cholesterol for cardiovascular health

High cholesterol is a factor in the deaths of more than 4 million people every year. Elevated levels of unhealthy cholesterol (low-density lipoproteins or LDL-C) can lead to plaque build-up or atherosclerosis that causes arteries to narrow and increases the person’s risk of heart attack and stroke.     

Obstacles to managing cholesterol often include a lack of health awareness and education, insufficient or delayed screening or poor access to health facilities and treatments.

As the Roadmap on Cholesterol shows, food labelling and regulation plus taxes on unhealthy commodities are some concrete steps to prevent unhealthy cholesterol levels. Timing matters, too; population-level screening can identify at-risk individuals. Equitable policies are a must: knowledge and evidence, effective drug treatment and supporting modified lifestyles can ensure people access care.

Hypertension: common yet manageable

Often causing no overt symptoms, raised blood pressure or hypertension can impair the functioning of the brain, heart and kidneys. An estimated 1.3 billion people live with hypertension with only one in five having it under control.

With ageing and certain lifestyle habits, maintaining blood pressure at an ideal level can be challenging. According to The Roadmap on Hypertension, government health policies that emphasise initial screening for hypertension from 18 years of age — and repeated regularly — can identify problems as part of primary prevention or treatment.

Combination therapies — for example, via a single pill in some cases — can improve patients’ adherence to treatment and help simplify processes in primary care.

High cholesterol is a factor in the deaths of
more than 4 million people every year.

Arrhythmia awareness

Atrial Fibrillation (AF or AFib), is the most common arrhythmia, affecting more than 33 million people worldwide. In AF, the atria beat out of normal rhythm, causing blood to be pumped less efficiently.

Surveys suggest that more than 50% of AF patients are minimally aware of the risks or unaware they have AF. The WHF Roadmap on Atrial Fibrillation emphasises the issues and opportunities for addressing AF. Challenges encompass access to clinics, especially for those in rural areas.

One important impetus for the updated Roadmap has been the addition of treatments to the World Health Organization’s Model List of Essential Medicines vetted for their safety and effectiveness in meeting global health needs.

Tech for better cardiovascular health

There are digital health interventions (DHIs) including text messaging platforms, mobile (mHealth) apps, wearable devices and more. The Roadmap for Digital Health in Cardiology assesses the opportunities for DHIs to tackle cardiovascular disease.

Healthcare secured this way can expand equitable access to help reduce the incidence and mortality of cardiovascular disease. DHIs can take the strain off workforce capacity and support tasks that can be undertaken virtually.

From the shelf to life

Over 500 million people live with some form of heart disease. Taken together, the Roadmaps can drive a holistic care approach. Therefore, sectors should collaborate, take action and secure everyone’s right to proper care.