(24-05-14) Control of Six Risk Factors Would Reduce CVD Mortality by One-Third: 25x25

Global Road Map

Michael O'Riordan
May 04, 2014

ELBOURNE, AUSTRALIA - By adopting a comprehensive plan to reduce tobacco
use, harmful alcohol use, salt intake, physical inactivity, and elevated
blood pressure and glucose levels, countries can a go a long way toward
reducing the risk of premature mortality from noncommunicable diseases
(NCDs), including CVD, according to a new report[1].

In fact, if countries achieved the goals set out by the 25x25 World Health
Assembly (WHA) road map, there would be a 22% reduction in premature deaths
from CVD, cancer, diabetes, and chronic respiratory disease in men and a 19%
reduction in women. Overall, controlling these six risk factors would reduce
CV morality by more than one-third.

If it's just business as usual and risk factors aren't reduced, there would
only be an 11% reduction in NCDs in men and a 10% reduction in women,
according to investigators.

The NCD road map, which aims to reduce premature mortality from NCDs by 25%
by 2025-the so-called 25x25 target-has been adopted by the WHA and was the
focus of the first session on day one of the World Congress of Cardiology
(WCC) 2014 Scientific Sessions in Melbourne, Australia.

Dr Majid Ezzati (Imperial College London, UK), who led the study of the
effects of risk-factor control on premature NCD mortality, said the largest
driver of the overall reduction is the decrease in CVD deaths. "In some
sense, if you put aside tobacco, which obviously has large effects on cancer
and CVD, these are really CV targets we're looking at rather than NCD
targets," he told heartwire . "We don't have targets for a lot of the
drivers of big cancers."

The article by Ezzati, first author Dr Vasilis Kontis (Imperial College
London), and colleagues was published online May 3, 2014 in the Lancet to
coincide with the WCC meeting.

High-Level UN Meeting on NCDs

The 25x25 goal is part of a United Nations political declaration to prevent
and control NCDs; the declaration was developed after a high-level meeting
among member countries three years ago. Back in 2011, CVD was identified as
the number-one killer worldwide, with more than 80% of deaths occurring in
low- and middle-income countries.

As part of their commitment to combat the problem, the countries adopted
nine global targets, one of which is the 25% reduction in premature
mortality from NCDs by 2025 (relative to 2010 levels). The World Heart
Federation (WHF) has since set a goal to achieve a 25% reduction in
premature CVD mortality given the recognition that a large focus on CVD
would be necessary to achieve the WHA targets.

To achieve a 25% reduction in premature deaths from NCDs, participating
countries agreed to reduce tobacco use by 30%, harmful alcohol intake by
10%, salt consumption by 30%, and hypertension by 25%, stem the rising
obesity tide, and halt the rise in diabetes.

Speaking during the WCC session about the 25x25 plan, Dr Robert Beaglehole
(University of Auckland, New Zealand), Lancet NCD Action Group member and
study author, said that population interventions are "absolutely key" to
dealing with the preventable burden of NCDs. "They are cost-effective,
they're the best buy, and they're easy," said Beaglehole. "There is no need
to muck around with population interventions. We just have to get on and do
it. And of particular priority is the importance of tobacco control."

Regarding tobacco control, banning smoking in public places, raising taxes
on tobacco, banning tobacco advertising, using plain packaging, and helping
people quit smoking with the help of their primary caregiver are all ways to
achieve the 30% to 50% reduction in tobacco use, especially in lower- and
middle-income countries, say the researchers.

Beaglehole noted their model showed that by improving control of the six
risk factors, countries will come close to achieving the 25% reduction in
premature mortality from NCDs by 2025. Teasing out four NCDs, the
risk-factor intervention reduces premature mortality from all CVD by 34%,
chronic respiratory diseases by 24%, all cancers by 7%, and diabetes by 5%.

Although the model predicts an overall 21% reduction in premature deaths
from NCDs if the six variables are controlled, Ezzati told heartwire that if
countries adopt a more aggressive reduction in tobacco use-say 50% instead
of the recommended 30%-the 25% reduction in premature mortality from NCDs
could be achieved in men and would come close in women (mainly because more
men smoke than women globally).

Burden of Disease in Low- and Middle-Income Countries

Over 15 years, the 25x25 plan would delay or prevent 37 million deaths, with
16 million deaths prevented in people aged 30 to 69 years. In those younger
than 70 years, approximately 11 million deaths from CVD could be averted
between now and 2025. In terms of delayed and prevented deaths, most occur
in low- and middle-income countries, and most are preventable CVD deaths. To
heartwire , Ezzati said that high-income countries already do a good job
treating CVD and have seen reductions in blood pressure, tobacco use,
alcohol use, and cholesterol levels.

"The vast majority of these deaths averted are in low- and middle-income
countries," added Beaglehole. "Achieving these targets will do a lot for
reducing the inequalities in CVD death rates between high-income countries
and low- and middle-income countries. This agenda can be seen to be part of
a grand convergence in global health."

Dr Shanthi Mendis (World Health Organization, Geneva, Switzerland), who also
spoke during the WCC session, said the recommendations on risk-factor
control are extremely cost-effective when implemented at the population
level, costing less than 50 cents per person. However, she acknowledged that
accountability remains problematic, as member countries are not legally
bound to fulfill their obligations and targets. In an accompanying
editorial, Dr Rifat Atun (Harvard University, Boston, MA) makes the same
point, noting that the "challenge of NCDs is less technical than
political"[2]. However, Atun points to the HIV response and recent maternal
and child health movement, which show what is possible when political will
is mobilized.

Dr Mariell Jessup (University of Pennsylvania School of Medicine,
Philadelphia), president of the American Heart Association (AHA), said the
AHA supports the global initiative and has adopted their own strategic goal
to improve the CV health of all Americans by 20% and reduce deaths from CVD
and stroke by 20% by 2020.

The study authors and Atun report no conflicts of interest.

References

    Kontis V, Mathers CD, Rehm J, et al. Contribution of six risk factors to
achieving the 25x25 noncommunicable disease mortality reduction target: a
modelling study. Lancet 2014; DOI: 10.1016/S0140-6736(14)60616-4. Summary

    Atun R. Decisive action to end apathy and achieve 25x25 NCD targets.
Lancet 2014; DOI: 10.1016/S0140-6736(14)60728-5 Extract

SOURCE: Medscape Medical News from the

World Congress of Cardiology (WCC) Scientific Sessions 2014

News

---

In evidenza

"L'informazione presente nel sito serve a migliorare, e non a sostituire, il rapporto medico-paziente."

Per coloro che hanno problemi di salute si consiglia di consultare sempre il proprio medico curante.