Accelerating progress on non-communicable diseases

Rl, Sacco; Sc, Smith; Holmes, David R.; Shurin, Susan B.; Brawley, Otis W.; Cazap, Eduardo; Glass, Roger I.; Komajda, Michel; Koroshetz, Walter J.; Mayer‐Davis, Elizabeth J.; Mbanya, Jean Claude; Sledge, George W.; Varmus, Harold

doi:10.1016/s0140-6736(11)61477-3

Cited by 31 publications

(26 citation statements)

References 4 publications

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“…22, 23 Initiatives such as the Million Hearts program and follow-up to the United Nations Political declaration on Non-communicable disease that target tobacco control, obesity, and diet will be essential to the future reduction of cardiovascular diseases and stroke. 24, 25 …”

Section: Discussionmentioning

confidence: 99%

Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

et al. 2012

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Background Evidence regarding the relationship of cardiovascular health (CVH) defined by the American Heart Association (AHA) and specific cardiovascular outcomes is lacking, particularly among Hispanics. This study sought to evaluate the relationship between the number of ideal CVH metrics and cardiovascular risk, overall and by event subtype, in a multiethnic community-based prospective cohort. Methods and Results 2981 subjects (mean age 69±10 years, 54% Caribbean Hispanic, 25% black, 21% white) free of myocardial infarction (MI) and stroke at baseline in the Northern Manhattan Study were prospectively followed (median follow-up 11 years). The relationship between the number of ideal CVH metrics and the risk of cardiovascular disease (CVD), including MI, stroke and vascular death was investigated. Overall, a strong gradient relationship was observed between the adjusted hazard ratios for CVD and the number of ideal CVH metrics: 0.73 (95% CI: 0.60–0.89), 0.61 (0.50–0.76), 0.49 (0.38–0.63) and 0.41 (0.26–0.63), respectively, for those having 2, 3, 4, and 5–6 ideal CVH metrics compared with those having 0–1 ideal CVH metrics (P for trend <0.0001). Similar graded relationships were found between the number of ideal CVH metrics and the adjusted incidence rate for each specific outcome and among whites, blacks, and Caribbean Hispanics. Conclusions Our findings demonstrated a steep gradient relationship between ideal CVH and individual CVD endpoints, including stroke, which was similar for whites, blacks and Caribbean Hispanics. This evidence supports the application of the AHA ideal cardiovascular health metrics for CVD risk assessment and health promotion for all Americans regardless of race-ethnic background.

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Section: Discussionmentioning

confidence: 99%

Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

et al. 2012

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“…The broad package of prevention and screening strategies implemented by the main Scientific Societies is thus mainly focused to cope with the effects of globalization (urbanization) on hypertension, diabetes and metabolic disease. 5, 26 …”

Section: Discussionmentioning

confidence: 99%

Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

et al. 2013

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Little information is available on the meanings of proteinuria in low-resource settings. A population-based, cross-sectional survey was performed in Yemen on 10 242 subjects aged 15–69 years, stratified by age, gender and urban/rural residency. Hypertension is defined as systolic blood pressure (BP) of ⩾140 mm Hg and/or diastolic BP of ⩾90 mm Hg, and/or self-reported use of antihypertensive drugs; diabetes is diagnosed as fasting glucose of ⩾126 mg dl−1 or self-reported use of hypoglycaemic medications; proteinuria is defined as ⩾+1 at dipstick urinalysis. Odds ratios (ORs) for associations were determined by multivariable logistic regression models. Prevalence (weighted to the Yemen population aged 15–69 years) of hypertension, diabetes and proteinuria were 7.5, 3.7 and 5.1% in urban, and 7.8, 2.6 and 7.3% in rural locations, respectively. Proteinuria and hypertension were more prevalent among rural dwellers (adjusted ORs 1.56; 95% confidence limit (Cl) 1.31–1.86, and 1.23; 1.08–1.41, respectively), diabetes being less prevalent in rural areas (0.70; 0.58–0.85). Differently from hypertension and diabetes, proteinuria was inversely related with age. Most importantly, 4.6 and 6.1% of urban and rural dwellers, respectively, had proteinuria in the absence of hypertension and diabetes. The approach of considering kidney damage as a consequence of hypertension and diabetes might limit the effectiveness of prevention strategies in low-income countries.

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“…11 These factors, coupled with underuse of strategies for primary prevention of stroke/NCDs on an individual level and the lack of accurate data on the prevalence and effect of risk factors in different countries and populations have been implicated in the ever-increasing worldwide burden of the NCDs. [12][13][14][15] Of particular concern is a significant increase in the number of young adults (aged <65 years) affected by stroke, 16 and the increasing epidemic of overweight/obesity 17 and diabetes mellitus worldwide. 18 If these trends continue, the burden of stroke and other major NCDs will increase even faster.…”

Section: Increasing Global Stroke Burdenmentioning

confidence: 99%

“…[12][13][14][15] Of particular concern is a significant increase in the number of young adults (aged <65 years) affected by stroke, 16 and the increasing epidemic of overweight/obesity 17 and diabetes mellitus worldwide. 18 If these trends continue, the burden of stroke and other major NCDs will increase even faster.…”

mentioning

confidence: 99%

New Strategy to Reduce the Global Burden of Stroke

Feigin

Krishnamurthi

Bhattacharjee

et al. 2015

Stroke

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The socioeconomic and health effect of stroke and other noncommunicable disorders (NCDs) that share many of the same risk factors with stroke, such as heart attack, dementia, and diabetes mellitus, is huge and increasing. [1][2][3][4] Collectively, NCDs account for 34.5 million deaths (66% of deaths from all causes) 3 and 1344 million disability-adjusted life years lost worldwide in 2010. 2 The burden of NCDs is likely to burgeon given the aging of the world's population and the epidemiological transition currently observed in many low-to middle-income countries (LMICs). 5,6 In addition, there is low awareness in the population about these NCDs and their risk factors, 7-10 particularly in LMICs.11 These factors, coupled with underuse of strategies for primary prevention of stroke/NCDs on an individual level and the lack of accurate data on the prevalence and effect of risk factors in different countries and populations have been implicated in the ever-increasing worldwide burden of the NCDs. [12][13][14][15] Of particular concern is a significant increase in the number of young adults (aged <65 years) affected by stroke, 16 and the increasing epidemic of overweight/obesity 17 and diabetes mellitus worldwide. 18 If these trends continue, the burden of stroke and other major NCDs will increase even faster. The increasing burden of stroke and other major NCDs provide strong support for the notion that the currently used primary prevention strategies for stroke and other major NCDs (business as usual) are not sufficiently effective. The most pertinent solution to this problem is the implementation of new, effective, widely available, and cost-effective prevention and treatment strategies to reduce the incidence and severity distribution of stroke and other major NCDs. Issues With Population-Wide Prevention StrategiesThe recent INTERSTROKE case-control study, conducted in 22 countries worldwide, provided evidence that, collectively, 10 risk factors accounted for 88.1% (99% confidence interval, 82.3%-92.2%) of the population-attributable risk for all stroke. 19 Because many (but not all) of these risk factors are modifiable, the INTERSTROKE data suggest that interventions that reduce blood pressure, promote physical activity, smoking cessation, and a healthy diet, could substantially reduce the burden of stroke. Although a combination of population-wide and individual high-risk prevention strategies were initially advocated >30 years ago, 20 and have since been repeatedly recommended as the most promising strategies to reduce stroke and NCDs burden, there is still no country in the world where both these prevention strategies have been implemented in full. There are major hurdles to implementing population-wide primary prevention strategies, including the need for policy and legislative changes that are often not supported by major industries (such as salt reduction in processed food, reduction of exposure to cigarette smoking, alcohol, and fast food). In addition, there are significant costs associated with the imple...

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Accelerating progress on non-communicable diseases

Cited by 31 publications

References 4 publications

Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics

Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

New Strategy to Reduce the Global Burden of Stroke

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