Principles for national and regional guidelines on cardiovascular disease prevention: a scientific statement from the World Heart and Stroke Forum.

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In the global effort to reduce suffering and death from CVD, the World Heart and Stroke Forum (WHSF) Guidelines Task Force of the World Heart Federation (WHF) recommends that every country develop a policy on CVD prevention. National policy should grow out of systematic and ongoing dialogue among governmental, public health, and professional clinical groups. National policy should set priorities for public health and clinical interventions appropriate to the country. It should also be the foundation for the development of national guidelines on CVD prevention, which are the focus of the present document. Cardiovascular disease (CVD) is a leading cause of global mortality, accounting for almost 17 million deaths annually. Nearly 80% of this global mortality and disease burden occurs in developing countries. In 2001, CVD was the leading cause of mortality in 5 of the 6 World Health Organization (WHO) worldwide regions. Of concern in developing countries is the projected increase in both proportional and absolute CVD mortality. This can be related to an increase in life expectancy due to public health advances, which reduce perinatal infections and nutritional deficiencies in infancy, childhood, and adolescence, and in some countries to improved economic conditions. This increasing longevity provides longer periods of exposure to CVD risk factors and thus a greater probability of clinically manifest CVD. The concomitant decline of infections and nutritional disorders (competing causes of death) also increases the proportional burden due to CVD. Adverse lifestyle changes accompanying industrialization, urbanization, and increased discretionary income increase the degree of exposure to CVD risk factors. Altered diet with increased fat and total caloric consumption and increased tobacco use are prevalent lifestyle trends. Demographic changes coupled with adverse lifestyle changes will accelerate the number of deaths due to CVD worldwide, many of which will be premature in the developing countries. Although continuation of this adverse trend is not inevitable, the CVD disease patterns now present in the economically developed countries are, in fact, becoming established in developing countries, as noted in the World Health Report 2002 1 (Data Supplement Figure I). Whereas the causes of CVD are common to all parts of the world, the approaches to its prevention at a societal or individual level will differ between countries for cultural, social, medical, and economic reasons. Although national guidelines will embrace the principles of CVD prevention recommended in this report, they may differ in terms of the organization of preventive cardiology, risk factor treatment thresholds and goals, and the use of medical therapies. The recommendations in this report focus on clinical management of patients with established CVD and those at high risk; however, it is essential that each country include a societal approach to CVD prevention. As stated in the WHO publication Integrated Management of Cardiovascular Risk, 2 “Epidemiological theory indicates that, compared with intensive individual treatment of high-risk patients, small improvements in the overall distribution of risk in a population will yield larger gains in disease reduction, when the underlying conditions that confer risk are widespread in the population.” Each country should seek to implement national clinical guidelines directed toward high-risk individuals and give equal importance to developing low-risk population strategies.