What are cardiovascular diseases?
Cardiovascular diseases (CVDs) are conditions that affect the heart and blood vessels. They include diseases of the heart (coronary arteries, heart valves, myocardium), cerebrovascular and peripheral arteries diseases, congenital heart diseases and deep vein thrombosis and pulmonary embolism.
CVDS are the leading cause of death worldwide. In 2012, 17.5 million people died from CVDs, one-third of all deaths. Of these deaths, over seven million were due to coronary heart disease and almost seven million were due to stroke.
People in low- and middle-income countries represent over three quarters of these CVD deaths. Compared to people in high-income countries, these populations often do not benefit from early detection and treatment of CVD risk factors and have less access to effective health care services. CVDs also contribute to poverty in population that do not benefit from social security and represent heavy expenditure for low- and middle-income countries.
Ischemic heart diseases and strokes are related to atheromatous obstruction of heart and brain arteries. Stroke can also result from bleeding of a cerebral blood vessel or hemorrhagic transformation of an ischemic stroke.
Risk factors of heart attacks and stroke include hypertension, diabetes, hypercholesterolemia tobacco use, and behavioral risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and excessive alcohol intake.
Awareness and prevention
Raising awareness and control of cardiovascular risk factors at the individual and population-wide levels are major challenges to decrease CVDs morbidity and mortality in the next ten years. At the individual level, detection of hypertension, diabetes and hypercholesterolemia and incentives to alter behavioral risk factors such as cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of CVDs.
These measures are practicable in the primary care setting, even in low-resource settings. For patients who already have developed ischemic heart diseases and strokes, secondary prevention should have recourse to generic drugs that have been associated with a strong benefit such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, statins and diabetes treatment.
Therapies associated with smoking cessation, weight reduction and increased physical activity can prevent up to 75% of recurrent cardiovascular events.
These therapies associated with smoking cessation, weight reduction and increased physical activity can prevent up to 75% of recurrent cardiovascular events. At the population-wide level, policies to reduce CVDs might include discouraging use and raising taxes on tobacco, alcohol and foods that are rich in fat, sugar and salt, promoting physical activity, and providing healthy food to children and teenagers at school.
These measures are included in a nine target action plan of the WHO for the prevention and control of non-communicable disease burden (NCDs 2013-2020), which aims to reduce the number of premature deaths by 25% by 2025.
The sixth target of this plan aims at a 25% reduction in the prevalence of hypertension while the eighth target recommend that >50% of eligible patients should be prescribed medications and health recommendations for the primary and secondary prevention of CVDs.
An international convention will be organized by the UN General Assembly in 2018 to assess the situation and focus on the progresses needed to attain the global targets by 2025.
Preparing for the future
In the cardiac surgery field, the next ten years will see the development of less invasive procedures, with transcatheter aortic valve implantation (TAVI) becoming the dominant therapy for aortic stenosis.
Major technological improvement in battery technology and pump miniaturization will also make the surgical treatment of chronic heart-failure with fully implantable partial or total circulatory support device feasible for an increasing number of patients.