Abstract
BackgroundTo assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: specifically the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions.MethodsAnalysis of data collected in national cross-sectional STEPS surveys in 2009 (Mongolia) and 2010 (Cambodia) involving participants aged 25-64 years: 5433 in Cambodia and 4539 in Mongolia.ResultsMongolia has higher prevalence of CVD risk factors than Cambodia --hypertension (36.5% versus 12.3%), diabetes (6.3% versus 3.1%), hypercholesterolemia (8.5% versus 3.2%), and overweight (52.5% versus 15.5%). The difference in tobacco smoking was less notable (32.1% versus 29.4%).Coverage with prior testing for blood glucose in the priority age group 35-64 years remains limited (16.5% in Cambodia and 21.7% in Mongolia). Coverage is higher for hypertension. A large burden of both hypertension and diabetes remains unidentified at current strategies for early identification: only 45.4% (Cambodia) to 65.8% (Mongolia) of all hypertensives and 22.8% (Mongolia) to 50.3% (Cambodia) of all diabetics in the age group 35-64 years had been previously diagnosed.Approximately half of all hypertensives and of all diabetics in both countries were untreated. 7.2% and 12.2% of total hypertensive population and 5.9% and 16.1% of total diabetic population in Cambodia and Mongolia, respectively, were untreated despite being previously diagnosed.Only 24.1% and 28.6% of all hypertensives and 15.9% and 23.9% of all diabetics in Mongolia and Cambodia, respectively were adequately controlled. Estimates suggest deficits in delivery of important advice for lifestyle interventions.ConclusionsMultifaceted strategies are required to improve early identification, initiation of treatment and improving quality of treatment for common CVD risk factors. Periodic population-based surveys including questions on medical and treatment history and the context of testing and treatment can facilitate monitoring of individual-based prevention strategies.
Highlights
To assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions
The increasing CVD burden largely results from the increased prevalence of modifiable risk factors such as tobacco use, unhealthy diets, limited physical activity, elevated blood cholesterol and glucose levels and hypertension, which in turn are associated with a range of inter-linked social trends: changing life-styles, dietary habits, occupations, increasing urbanization, globalization and demographic changes [3]
Using nationally representative and comparable data from two low- and middleincome countries (LMIC) in Asia, this study examines the prevalence of CVD risk factors and coverage of early detection and management of hypertension and diabetes mellitus through medical treatment, lifestyle modification interventions or both
Summary
To assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions. Non-communicable diseases (NCD) account for a growing proportion of morbidity and premature mortality worldwide. This public health problem is neither exclusively nor predominantly associated with high-income. Between 42% and 60% of the decline in CVD deaths has been attributed to changes in risk factors including reduction in total cholesterol, systolic blood pressure and smoking prevalence, while 23% to 47% was attributed to treatments and secondary preventive therapies [4,5,6,7,8,9]. Population-based and individual-based primary prevention strategies can complement one another, both contributing to changes in risk factors Their relative contribution is difficult to ascertain, and appears to vary in different settings. Population and individual changes in modifiable risk factors can result in relatively rapid declines in CVD mortality [11]
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