Prevention and control : the official journal of the World Heart Federation最新文献

The tobacco epidemic continues to spread through Latin America and the Caribbean. Philip Morris and British American Tobacco Company control the market through their subsidiaries. In the past, governments in this region have shown little or no commitment to tobacco control. This, however, has changed in recent years as the World Health Organization (WHO) Framework Convention on Tobacco Control has been signed by most and ratified by several countries in the region. Non-governmental organizations, sometimes rallied by the InterAmerican Heart Foundation, have played a crucial role in supporting Treaty ratification. Latin America and the Caribbean have the momentum to move forward in tobacco control and also the support to approve the necessary legislation to halt the tobacco epidemic.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States and other developed countries. While therapeutic lifestyle changes are integral to general risk reduction, drug therapy proves necessary for patients whose cardiovascular risk is above critical thresholds. Among proven medical treatments, antiplatelet therapy (mainly aspirin) and cholesterol-lowering therapy (mainly statins) are unequivocally recommended for the reduction of cardiovascular risk. Therapeutic indications for both therapies share great similarities, while critical differences are identifiable. Despite the compelling evidence, the gap between recommended practice and actualized practice is large. Between the two therapies, aspirin tends to be more underused than statins despite its more favorable cost-effectiveness. Admittedly, barriers to optimal translation and implementation of science to practice are considerable, but they are not insurmountable and effective interventions are available to overcome a variety of commonly cited barriers. This article reviews current practice guidelines regarding antiplatelet therapy and cholesterol-lowering treatment for cardiovascular prevention, available data of treatment gaps, documented barriers to guideline adherence, and promising interventions for practice improvement.

This article is aimed to analyze the current situation of the tobacco epidemic in Mexico as well as progress in the struggle against tobacco. Mexico was the first country in the Americas to ratify the framework convention on tobacco control (FCTC). Currently, 36% of men over 18 are smokers and among women there is a prevalence of 13%. Besides this, 26% of the population is exposed to tobacco smoke from other smokers in the home. These figures vary slightly according to the source, and the definition used for smoker. Among adolescents, the initiation of tobacco consumption tends constantly towards an earlier age and no differences exist between men and women. In both cases, 19% had smoked in the month previous to the application of the Global Youth Tobacco Survey and 46% cohabit with other smokers. Among the principal challenges faced is the need to limit the access of minors to tobacco, as 37% of adolescent smokers buy cigarettes in the shops and 62% were not denied the purchase, because they were under age. Mortality attributable to tobacco in Mexico is estimated to be in the tens of thousands. Recently, a conservative estimate calculated that 25,383 deaths occur annually among those over 35 years of age, related to causes attributable to tobacco consumption.

Background

We investigated the economic efficiency of a one-year training program for patients with stable angina of effort and dyslipidemia.

Methods

We examined 117 patients with coronary heart disease (CHD) and dyslipidemia randomly divided into three groups. The first group of 39 participants was enrolled in an individual educational program (Group 1). The second group of 40 participants participated in group training (Group 2), while 38 participants served as the control group and did not receive either individual or group education (Group 3).

All participants were observed for two years. The outcome variables of interest were:

• (a)

  number of days of disability;

• (b)

  number of emergency ambulance calls due to a worsening of CHD;

• (c)

  lipid parameters including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HLD-C) and triglycerides (TG).

A special methodology was applied to evaluate the economic efficiency of the educational program.

Results

The one-year educational program led to a decrease in both the number of disability days and emergency calls among participants in Groups 1 and 2. These decreases translated into an overall economic efficiency of US $8235.10 for the two groups. Group 3, which did not receive any specific education, suffered economic losses caused by increased disability days and emergency calls. These losses totaled US $530.08 for Group 3. Lipid levels improved significantly for those who participated in the educational programs.

Conclusion

Educational programs have a positive economic effect. They lead to a decrease in the number of disability days and emergency calls while significantly improving lipid levels.

Intensive study of peripartum cardiomyopathy in the Hôpital Albert Schweitzer district of Haiti has led to two possible prevention and control measures:

• (1)

  Promotion of family planning measures to assist women who wish to avoid the higher risk of disease and/or relapse seen with grand multiparity (defined as 5 or more pregnancies).

• (2)

  focused non-invasive cardiac ultrasound screening of higher risk women in the peripartum period to identify and treat asymptomatic left ventricular dysfunction.

Hypertension is one of the most important risk factors for cardiovascular morbidity and mortality. More than a quarter of the global adult population (972 million) is currently hypertensive and almost three quarters (639 million) live in developing countries. Hypertension management therefore is of great public health importance in the developing world. In this paper, we review screening, diagnosis and management using lifestyle measures and pharmacotherapy given the resources of developed nations. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in developing countries. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt additives and rich in fruits and vegetables), increased physical activity, and a smoke free environment, properly balanced with a high risk approach of cost effective clinical care, developing countries can effectively control hypertension and improve public health. Existing scientific knowledge regarding prevention, treatment and management should be harnessed as a health priority to reduce the disease burden associated with uncontrolled hypertension.