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Focus On The Prevention Of Heart Disease And Stroke During The Clinton Global Initiative

The World Heart Federation, a nongovernmental organisation dedicated to the prevention and control of heart disease and stroke, with a focus on low- and middle-income countries, is taking an active part in the second annual meeting of the Clinton Global Initiative (CGI).

The event, taking place in New York between 20 - 22 September will bring together over 1,000 global leaders from business, politics, academia, science, religion, and non-governmental organizations, including numerous Heads of State and CEOs from major international corporations. CGI is a forum for participants to discuss and develop workable solutions to some of the world's most pressing challenges, including the prevention of heart disease and stroke which claims 17.5 million lives a year, 80% of these in low and middle income countries.

The World Heart Federation will announce two major new commitments for which partial funding has already been committed but needs to be met by pledges of additional support by the global leaders during or after the CGI.

Prevention of Rheumatic Fever / Rheumatic Heart Disease in Africa

The World Heart Federation will set up four demonstration projects, one in each of Egypt, Ethiopia, Ghana and South Africa, that will grow into sustainable, long-term, government-run national rheumatic heart disease-control programmes. The projects will raise awareness through public and professional education, establish surveillance systems, advocate improving health services, and promote effective prevention measures.

Rheumatic fever (RF) can develop after an infection by the group A streptococcus bacterium. The resulting inflammatory illness can damage heart valves; this is called rheumatic heart disease (RHD) and can lead to disability or death. RF and RHD affects 15.6 million people worldwide, including 2.4 million children, and is the most common cardiovascular disease of children and young adults. There are nearly half a million new cases every year, 300,000 of them in Africa. Hundreds of thousands of people are disabled by RHD and some 350,000 die from it each year. 233,000 of those deaths are in Africa.

The tragedy is that almost all of these deaths are easily preventable using regular injection of penicillin. Despite the wide availability and the proven effectiveness of penicillin for the prevention of RF and RHD, developing countries continue to face unacceptably high rates of RF and RHD, making RHD the most common cardiovascular disease affecting children and young adults in the world .

“Our aim is to significantly reduce mortality, morbidity and disability from rheumatic fever/rheumatic heart disease among African children and young adults,” said Dr Jonathan Carapetis, chairman of the World Heart Federation’s Scientific Council on Rheumatic Fever and Rheumatic Heart Disease. “Rheumatic heart disease shortens people’s lives and aggravates human misery. We will train health workers in how to identify and treat patients, and public health officials in how to establish and maintain prevention programmes. But this is not enough. We will also advocate for guaranteed supplies of high-quality antibiotics and for rheumatic heart disease to be recognized as an international clinical, public health and political priority.”

The World Heart Federation is presently leading the global effort in RHD control. Its RHD control project in the South Pacific, which began in 2005, has a regional training programme and demonstration projects in Fiji and Samoa. So far, the project has screened 3,000 children and its first regional training workshop will be held this October. The WHO supports the programme and is co-sponsoring the workshop. Tools developed and experiences gained in the Pacific are being made available to the world through the World Heart Federation website, and will be adapted for the project in Africa.

Development, Production and Delivery of the Polypill

The World Heart Federation also intends to advocate for the development, production and delivery of the polypill for the secondary prevention of cardiovascular disease in post myocardial infarction patients by 2009/10. The initiative conducted in partnership with CNIC, the Spanish National Centre for Cardiovascular Research.

The aim is to save the lives of those severely affected by cardiovascular disease by successfully completing the development of a polypill or fixed dose combination of ace inhibitor, statin and aspirin therapies.

The aim is also to build knowledge and commitment among practicing physicians particularly in low- and middle-income countries to facilitate distribution as of 2010. Pilot countries are being identified but will probably include Spain and China.

The World Heart Federation’s primary contribution would be in the area of advocacy and education. The World Heart Federation would advocate for the polypill with the relevant authorities including the FDA and EMEA, and through its national member societies, journals and congresses encourage its inclusion in national guidelines and use by cardiologists in post myocardial infarction patients.

With chronic diseases including cardiovascular disease and diabetes accounting for 60% of global mortality, and 80% of that burden in low and middle-income countries, it is time to advance the prevention agenda as well as patient care. It is proven that appropriate stand-alone medications ranging from statins to aspirin have had very beneficial effects on premature mortality in Western populations. Many of these medications are now off patent and as such are available at lower generic prices. However, the complexity of three or more medications would strain developing country health systems both financially and logistically. Patient compliance would be another complicating factor.

A polypill is estimated to cost one-fifth of currently available therapies and save the lives of post-myocardial infarction patients as well as high risk individuals in low- and middle-income countries as well as low income patients in more developed economies who would otherwise have limited treatment options. The production of the polypill has been recommended in recent reports by the World Health Organization.

Michelle Roverelli | alfa
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