Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisector...al population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
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Development of cardiovascular disease (CVD) is influenced by risk factors such as:
tobacco use, an unhealthy diet, physical inactivity, obesity (which can result from
a combination of unhealthy diet, physical inactivity, and other factors), elevated
blood pressure (hypertension), abnormal blood l...ipids (dyslipidaemia) and elevated blood glucose (diabetes mellitus). Continuing exposure to these risk factors leads
to further progression of atherosclerosis, resulting in clinical manifestations of these diseases, including angina pectoris, myocardial infarction, heart failure and stroke. Total CVD risk depends on the individual’s overall risk-factor profile.
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Almost all populations are consuming too much sodium. The global mean intake of adults is 4310 mg/day sodium (equivalent to 10.78 g/day salt). This is more than double the World Health Organization recommendation for adults of less than 2000 mg/day sodium (equivalent to < 5 g/day salt).
- The prima...ry health effect associated with diets high in sodium is raised blood pressure, increasing the risk of cardiovascular diseases, gastric cancer, obesity, osteoporosis, Meniere’s disease, and kidney disease.
- An estimated 1.89 million deaths each year are associated with consuming too much sodium
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Each year, ≈795 000 individuals in the United States experience a stroke, of which 87% (690 000) are ischemic and 185 000 are recurrent.1 Approximately 240 000 individuals experience a transient ischemic attack (TIA) each year.2 The risk of recurrent stroke or TIA is high but can be mitiga...ted with appropriate secondary stroke prevention. In fact, cohort studies have shown a reduction in recurrent stroke and TIA rates in recent years as secondary stroke prevention strategies have improved.3,4 A meta-analysis of randomized controlled trials (RCTs) of secondary stroke prevention therapies published from 1960 to 2009 showed a reduction in annual stroke recurrence from 8.7% in the 1960s to 5.0% in the 2000s, with the reduction driven largely by improved blood pressure (BP) control and use of antiplatelet therapy.5 The changes may have been influenced by changes in diagnostic criteria and differing sensitivities of diagnostic tests over the years.
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Hypertension is referred to as a “silent killer”. Most people with hypertension are unaware of their condition as in most cases, they experience no warning signs or symptoms hence they are not identified or treated. Hypertention is associated with a number of conditions, disability, and causes o...f death. These include: strokes; myocardial infarction; end-stage renal disease; congestive heart failure; peripheral vascular disease and blindness. According to Stats SA, in 2017, hypertensive disorders resulted in 19 900 deaths with a further 44 357 deaths associated with cerebrovascular diseases and other heart diseases. This means around 30% of all deaths in 2017 were associated with increased blood pressure.
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The incidence of circulatory disorders is increasing worldwide, affecting both low- and middle-income countries and some high-income countries. There is evidence of rising incidence and prevalence rates, even among younger individuals, along with an increasing prevalence of risk factors such as high... blood pressure, diabetes, and obesity. These indicators suggest that current approaches are not
effective in managing and reducing the burden of conditions affecting circulatory health.
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Age-standardized cardiovascular disease (CVD) mortality rates by region ranged from 73.6 per 100,000 in High-income Asia Pacific to 432.3 per 100,000 in Eastern Europe in 2022. Global CVD mortality decreased by 34.9% from 1990 to 2022. Ischemic heart disease had the highest global age-standardized D...ALYs of all diseases at 2,275.9 per 100,000. Intracerebral hemorrhage and ischemic stroke were the next highest CVD causes for age-standardized DALYs. Age-standardized CVD prevalence ranged from 5,881.0 per 100,000 in South Asia to 11,342.6 per 100,000 in Central Asia. High systolic blood pressure accounted for the largest number of attributable age-standardized CVD DALYs at 2,564.9 per 100,000 globally. Of all risks, household air pollution from solid fuels had the largest change in attributable age-standardized DALYs from 1990 to 2022 with a 65.1% decrease.
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Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity a...t a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
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The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors ...(cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
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The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014.
Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
Dia...betes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose.
Almost half of all deaths attributable to high blood glucose occur before the age of 70 years.
WHO projects that diabetes will be the 7th leading cause of death in 2030
Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
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If you’re interested in preventing type 2 diabetes, this guide can help you get started. Congratulations on taking the first step! By reading this, you’re already on your way. Prediabetes puts you on the road to possibly getting type 2 diabetes. Find out now, in less than 1 minute, if you may ha...ve prediabetes by taking the Prediabetes Risk Test. If your result shows you’re at high risk for type 2 diabetes, talk to your doctor about getting a simple blood sugar test to confirm it. Then, if you’re diagnosed with prediabetes, consider joining a lifestyle change program offered by the National Diabetes Prevention Program (National DPP). This program is proven to cut the risk for type 2 diabetes in half.
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The website "Learning About Diabetes" provides easy-to-understand educational materials for people with diabetes and their families. It focuses on improving diabetes self-management through visually engaging resources, such as illustrated guides, videos, and tools. The content covers topics like blo...od sugar monitoring, healthy eating, medication management, and lifestyle changes, making diabetes education accessible for all literacy levels. - Chinese documents
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The website "Learning About Diabetes" provides easy-to-understand educational materials for people with diabetes and their families. It focuses on improving diabetes self-management through visually engaging resources, such as illustrated guides, videos, and tools. The content covers topics like blo...od sugar monitoring, healthy eating, medication management, and lifestyle changes, making diabetes education accessible for all literacy levels. - Documents in hindi
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The website "Learning About Diabetes" provides easy-to-understand educational materials for people with diabetes and their families. It focuses on improving diabetes self-management through visually engaging resources, such as illustrated guides, videos, and tools. The content covers topics like blo...od sugar monitoring, healthy eating, medication management, and lifestyle changes, making diabetes education accessible for all literacy levels.
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The article "Best (and Worst) Oatmeal for Type 2 Diabetes" from Everyday Health discusses the benefits of incorporating oatmeal into a diabetes-friendly diet. It emphasizes that oatmeal, being rich in fiber and essential minerals like magnesium, potassium, and iron, can aid in blood sugar control, s...upport heart health, and assist with weight management.
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The CDC webpage "Types of Insulin" provides an overview of the various insulin types used in diabetes management, categorized by their onset, peak time, and duration of action. It explains terms like onset (how quickly insulin lowers blood sugar), peak time (when insulin is at maximum strength), and... duration (how long insulin works to lower blood sugar). The page also discusses factors influencing insulin prescriptions, such as activity level, diet, blood sugar management, age, and individual insulin absorption rates.
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The document "Management of Type 2 Diabetes Mellitus" provides comprehensive guidelines for the diagnosis, prevention, and treatment of type 2 diabetes in adults. It emphasizes the importance of individualized glycemic targets, lifestyle interventions like diet and exercise, and the use of medicatio...ns such as metformin, SGLT2 inhibitors, and GLP1 receptor agonists to manage blood sugar levels and reduce long-term complications. The document also discusses the screening and management of comorbidities such as hypertension, hyperlipidemia, and diabetic complications like retinopathy, neuropathy, and nephropathy. It highlights the role of diabetes self-management education and support in improving adherence to treatment and patient outcomes. The guidelines are evidence-based and aim to reduce morbidity and mortality associated with type 2 diabetes.
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The document "Pocketbook for Management of Diabetes in Childhood and Adolescence in Under-Resourced Countries" (2nd Edition) provides practical guidelines for managing diabetes in children and adolescents, particularly in resource-limited settings. It covers key topics like diagnosing and treating d...iabetes, managing diabetic ketoacidosis (DKA), insulin therapy, blood glucose monitoring, nutritional management, and dealing with complications. The pocketbook aims to support healthcare professionals in delivering effective diabetes care and improving outcomes for young patients in under-resourced areas.
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The World Health Organization (WHO) launched the SAFER initiative in 2018 to address the global health and societal challenges posed by alcohol-related harm. The initiative outlines five key strategies aimed at reducing alcohol consumption and its associated consequences. These include strengthening... restrictions on alcohol availability by implementing and enforcing policies to limit its accessibility and advancing drink-driving countermeasures, such as low blood alcohol concentration limits and random breath testing, to reduce alcohol-impaired driving incidents.
Additionally, SAFER emphasizes facilitating access to screening, brief interventions, and treatment for individuals with alcohol use disorders, ensuring that healthcare systems are equipped to provide effective support. Another core strategy is enforcing comprehensive bans or restrictions on alcohol advertising, sponsorship, and promotion to minimize its influence, particularly on vulnerable populations such as youth. Finally, the initiative advocates raising alcohol prices through excise taxes and pricing policies to make it less affordable and thereby reduce consumption.
By implementing these evidence-based, cost-effective measures, the SAFER initiative aims to reduce the global burden of alcohol-related deaths and disabilities, fostering healthier societies worldwide.
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The document "Diabetes in Pregnancy" by NICE (National Institute for Health and Care Excellence) outlines quality standards for managing diabetes in women during pregnancy, with a focus on five key areas. First, it emphasizes the importance of preconception planning for women of childbearing age wit...h diabetes. These women should receive guidance on optimizing their health before pregnancy, including achieving target HbA1c levels and taking high-dose folic acid to minimize risks. Second, joint diabetes and antenatal care is recommended for pregnant women with pre-existing diabetes, who should be seen early in pregnancy (ideally by 10 weeks gestation) by a combined diabetes and antenatal team to ensure optimal care throughout their pregnancy.
The third focus area is continuous glucose monitoring (CGM), which should be offered to pregnant women with type 1 diabetes. This includes either real-time CGM or flash monitoring to help improve blood glucose control and reduce complications during pregnancy. Fourth, postnatal testing and referral are essential for women diagnosed with gestational diabetes, who should receive glucose testing after birth to detect any persistent diabetes. Those eligible are referred to the National Diabetes Prevention Programme to lower their risk of developing type 2 diabetes. Lastly, the document recommends annual HbA1c testing for women with a history of gestational diabetes to monitor for type 2 diabetes development.
These standards aim to improve pregnancy outcomes for women with diabetes by providing individualized, accessible, and culturally appropriate care.
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