Cardiovascular diseases (CVD) are increasing in epidemic proportions in developing countries. CVD already accounts for almost 10 percent of the developing world's burden of disease and is likely to become the developing world's leading cause of death. There is reason for hope, however, given that huge potential exists for applying R&D to control this emerging epidemic—both in creating powerful new interventions such as vaccines and dietary supplements and in guiding behavior. In addition, a considerable body of evidence suggests that current risk-factor prevention programs and low-cost case management of CVD offer feasible, cost-effective ways to reduce CVD mortality and disability in developing country populations. Large-scale CVD control efforts are lacking, however, and thus governments and individuals are left to make choices about health and health care services without the benefit of appropriate knowledge. This report was designed to promote a policy dialogue on CVD based on informed knowledge of R&D opportunities that offer effective, affordable, and widely applicable responses in developing countries. The report examines (a) the emerging burden of CVD in developing countries, (b) the future worldwide burden of CVD, (c) current prevention and treatment of CVD in developing countries, (d) R&D to support CVD control, (e) opportunities and priorities for R&D, and the need for institutional arrangements for collaboration in facing the epidemic.
- Control of Cardiovascular Diseases in Developing Countries
- Copyright
- Preface
- PROJECT CHARGE
- ORGANIZATION OF THE REPORT
- Acknowledgments
- Contents
- Control of Cardiovascular Diseases in Developing Countries
- Executive Summary
- RECOMMENDATIONS
- Determine the Magnitude of the CVD Burden in Developing Countries
- Develop Targeted, Effective Primordial and Primary Prevention StrategiesUsing Case-Control Studies
- Reduce Tobacco Use
- Detect and Treat High Blood Pressure
- Initiate Pilot Studies to Evaluate Essential Vascular Packages of Effective, Low-Cost Drugs
- Develop and Assess Algorithms of Affordable Clinical Care for CVD
- Build the Capacity to Conduct R&D Activities
- Develop Institutional Mechanisms for Facilitating CVD Prevention and Control
- 1 The Current Burden of Cardiovascular Diseases in Developing Countries
- ECONOMIC DEVELOPMENT BRINGS CHANGES
- ATHEROSCLEROSIS AS THE UNDERLYING DISEASE PROCESS
- Risk Factors for Atherosclerotic Disease
- THE GLOBAL BURDEN
- Cardiovascular Disease as the Leading Cause of Death
- Another Measure of Disease Burden
- Regional Differences
- Attributable Risk
- CONCLUSIONS
- 2 The Future Burden of Cardiovascular Diseases in Developing Countries
- PROJECTIONS OF THE FUTURE BURDEN
- Future Impact of Tobacco
- Future Effects of Other CVD Risk Factors
- CAN DEVELOPING COUNTRIES AVOID THE FUTURE BURDEN?
- Cardiovascular Disease Prevention Strategies
- Efficacy of Current Interventions
- ECONCOMIC CONSEQUENCES
- COST-EFFECTIVENESS OF PREVENTION AND TREATMENT
- 3 Prevention and Treatment of Cardiovascular Diseases in Developing Countries
- DIFFICULTIES IN ASSESSING PATTERNS
- THE ROLE OF INTERNATIONALLY SPONSORED PROGRAMS
- THE ROLE OF THE PRIVATE SECTOR
- ZAMBIA: A CASE STUDY
- FUTURE DIRECTIONS
- 4 Current Research and Development in Developing Countries
- 5 Priorities for Global Research and Development
- CONTEXT
- RESEARCH PRIORITIES
- Improve Knowledge of the Size of the CVD Burden in Developing Countries
- Vital Registration
- Cause-of-Death Statistics
- Disability Estimates
- Establishing the Levels, Determinants, and Consequences of Risk Factors
- Cross-Sectional Surveys
- Analytic Studies
- Public Health Interventions
- Clinical Interventions
- Essential Vascular Package
- Algorithms for Effective Diagnosis and Clinical Management
- Randomized Trials of Other Low-Cost Treatments
- Inclusion of Developing Countries in International Collaborative Clinical Trials
- Other Public Health Interventions
- RESEARCH TO CONTROL SPECIFIC RISK FACTORS
- Tobacco Use
- Hypertension
- Diet and Physical Activity
- HEALTH SERVICES RESEARCH
- Review of Patterns of Clinical Practice
- The Economic Burden and Cost-Effectiveness of Interventions
- GOVERNMENT'S POLICY ROLE
- Tobacco Control Policy
- Food and Nutrition Policy
- Pharmaceutical Policy
- Private-Sector Participation
- BUILDING CAPACITY FOR RESEARCH AND DEVELOPMENT
- 6 Institutional Arrangements for Research and Development
- EFFECTIVE RESEARCH AND DEVELOPMENT AT LOCAL OR NATIONAL, REGIONAL, AND GLOBAL LEVELS
- MODELS OF INTERNATIONAL COLLABORATION
- The Special Programme for Research and Training in Tropical Diseases
- The MONICA Project
- DEVELOPMENT OF AN INSTITUTIONAL MECHANISM FOR CARDIOVASCULAR RESEARCH AND DEVELOPMENT
- Epilogue
- ECONOMIC IMPACT
- ETHICAL CONCERN: THE CONCEPT OF HEALTH FOR ALL
- NATIONAL RELEVANCE
- SCIENTIFIC DISCOVERY
- GLOBAL HEALTH ISSUES
- References
- Appendix A Five Steps for Setting Research Priorities
- STEP 1: DETERMINE THE SIZE OF THE CVD BURDEN
- STEP 2: IDENTIFY THE REASONS FOR THE CVD BURDEN
- STEP 3: EVALUATE THE ADEQUACY OF THE CURRENT KNOWLEDGE BASE
- STEP 4: EVALUATE THE PROMISE OF R&D EFFORTS
- STEP 5: ASSESS THE ADEQUACY OF THE CURRENT LEVEL OF EFFORT
- Appendix B Glossary of Cardiologic and Epidemiologic Terms
- CLINICAL MANIFESTATIONS OF ATHEROSCLEROTIC CARIOVASCULAR DISEASE
- Diseases That May Be Due to Effects of Hypertension on the Cardiovascular System
- CARIOVASCULAR RISK FACTORS
- EPIDEMIOLOGIC TERMS AND CONCEPTS
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