Contributed by Damien
Gruson, IFCC News Working Group
"Time is muscle", these are the most important words that I
remember from my cardiology lessons at the medicine faculty. These
words are related to the benefit for patients of an early diagnosis
of acute myocardial infarction.
Nowadays, 1/3 of the deaths worldwide are due to cardiovascular
diseases (CVD). Beginning this year, a part of public awareness is
on CVD and CVD prevention. Popular attention in Belgium and France
is focused on the quest of "pushing out" from public places the
smokers and limit the exposition to tobacco, an important risk
factor for cardiovascular diseases. Professionally there is a real
challenge for the diagnosis industry to develop early markers of
cardiovascular diseases detection. Some markers (Myeloperoxydase,
Choline, CD40L, protein S100B...) will be available on automated
analyzers by the end of the year and will give us new diagnosis
possibilities for the early diagnosis of CVD and stroke.
This concern gives us the opportunity to have a short overview
about CVD nowadays and to underline the actual campaign of WHO
against CVD. The WHO Programme 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 reducing CVD risk factors and their determinants,
developing cost effective and equitable health care innovations for
management of CVD and monitoring trends of CVD and their risk
CVD family members included hypertension, coronary heart
disease, cerebrovascular disease (stroke), peripheral vascular
disease, heart failure, rheumatic heart disease, congenital heart
disease and cardiomyopathies.
CVD made up 16.7 million, or 29.2% of total global deaths
according to World Health Report 2003. 7.2 million are due to
ischaemic heart disease, 5.5 million to cerebrovascular disease,
and an additional 3.9 million to hypertensive and other heart
conditions. More than 50% of the deaths and disability came from
heart disease and strokes, which together kill more than 12 million
people each year. According to the American Heart Association
(AHA), stroke is the third leading cause of death in the United
States, resulting in 275,000 deaths annually, and is a leading
cause of adult disability. The AHA estimates that in 2005, the
direct and indirect costs associated with stroke in the United
States will exceed $56 billion. At least 20 million people survive
heart attacks and strokes every year; many require continuing
costly clinical care and are candidates to develop heart
Around 80% of CVD deaths took place in low and middle-income
countries. Economic transition urbanisation, industrialisation and
globalisation bring about lifestyle changes that promote heart
disease. 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 countries. By 2010, CVD will be the
leading cause of death in developing countries.
The rise in CVDs.
The rise in CVDs reflects a significant change in diet habits,
physical activity levels, and tobacco consumption worldwide as a
result of industrialization, urbanization, economic development and
food market globalization. People are consuming a more
energy-dense, nutrient-poor diet and are less physically active.
Imbalanced nutrition, reduced physical activity and increased
tobacco consumption are the key lifestyle factors. High blood
pressure, high blood cholesterol, overweight and obesity - and the
chronic disease of type 2 diabetes - are among the major biological
risk factors. Unhealthy dietary practices include the high
consumption of saturated fats, salt and refined carbohydrates, as
well as low consumption of fruit and vegetables. These risk factors
tend to cluster.
In many countries, too much focus is being placed on one-on-one
interventions among people at medium risk for CVD. A better use of
resources would be to focus on those at elevated risk and to use
other resources to introduce population-wide efforts to reduce risk
factors through multiple economic and educational policies and
programs. These risk factors include diet and physical activity.
The dietary intake of fats, especially their quality, strongly
influences the risk of CVD like coronary heart disease and stroke,
through effects on blood lipids, thrombosis, blood pressure,
arterial function, arthrogenesis and inflammation. Excess salt has
a significant impact on blood pressure levels.
Some simple strategies are effective in preventing CVD, and in
helping manage the disease:
- Substitute nonhydrogenated unsaturated fats (especially
polyunsaturated fat) for saturated and trans-fats;
- Increase consumption of omega-3 fatty acids from fish oil or
- Consume a diet high in fruits vegetables, nuts and whole
grains, and low in refined grains.
- Avoid excessively salty or sugary foods.
- At least 30 minutes of regular physical activity daily
- Avoid smoking
- Maintain a healthy weight.
The WHO strategic plan for CVDs.
WHO have developed a strategic plan to reduce the impact of CVD
and the major items of the plan are the following:
- Reduce major CVD risk factors and their social and economic
determinants through community-based programmes for integrated
- Development of standards of care and cost-effective 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.
- Developing effective inter-country, interregional and global
networks and partnerships for concerted global action.