Editorial original published in the Indian Journal of Medical Research.
Full list of authors: Piñeiro, Daniel José; Narula, Jagat; Pervan, Borjana; Hadeed, Lisa
That cardiovascular disease (CVD), the world’s topmost killer1, is not widely known among the general public, and even less so that it is often preventable and manageable.
Another startling fact is that as much as 80 per cent of deaths from CVD are premature, happening sometimes for reasons within our control including if the right infrastructure and policies are in place. The conditions of the heart or blood vessels such as heart attack, stroke and heart failure, kill 20.5 million every year, mostly in low- and middle-income countries2.
The World Heart Federation’s (WHF) three fold mission is to connect and lead the CVD community, translate science into policy and stimulate knowledge exchange. For more than two decades, WHF has been leading the World Heart Day (WHD) movement on September 29, a campaign that reaches across all walks of life, connecting and rallying people everywhere. This year, the focus is on the essential step of disseminating knowledge about CVDs such that one can take better care of this mostly preventable scourge. We highlight the vital actions that individuals, policymakers and health care providers must take throughout the year.
Knowledge is power
Environmental and behavioural risk factors for CVD require coordinated action across sectors, not just in health. In one informal online survey conducted by WHF across 25 countries, most respondents erroneously claimed cancer were the more important cause of mortality ahead of CVD (unpublished data). Few respondents ranked tobacco among the primary risk factors for CVD, even though three million people die of a heart disease every year attributable primarily to tobacco use (unpublished data). Curiously, only three per cent of respondents identified education as the key to mitigating heart disease.
With the motto ‘Use Heart, Know Heart’, WHD 2023 offers a unique disseminative strategy to encourage not only an individual to learn about their cardiovascular health but also that of their parents, children, friends and community, thus encouraging others to improve awareness. The campaign also promotes the importance of connection and community and cardiovascular health in a thriving, empathetic society.
With an estimated reach of more than two billion on mainstream and social media, WHD1 is a global, multicultural event, spanning across six continents with hundreds of member organizations taking part and mobilizing schools, universities, sports clubs and more3. Campaign activities have included initiatives to highlight monitoring of hypertension and heart rhythm, providing cardiovascular facts in schools and in the community and collaborating with media about dietary indiscretion, tobacco abuse, elevated blood cholesterol and sugar, physical inactivity and outdoor and indoor air pollution3.
India has become the third most frequent visitor to the WHD campaign action online and is active also on social media platforms. India’s campaign engagement increased by 30 per cent in 2022 exceeding well above 10 million on social media platforms, including message-sharing in Hindi as a close second to English out of all language posts. It is a tribute to the power of membership as WHF counts 10 members in India among which are more than 200 foundations, societies and associations.
Cardiovascular disease in the spotlight
Linked with the WHD theme of ‘knowing your heart’4, the World Heart Report 20232 is an in-depth analysis of global CVD risk and mortality data. The report highlights trends across regions, gender and risk factors and urges countries to take steps that save the lives and billions of dollars.
Even though globally the overall age-standardised death rate has decreased2 due to advances in disease management, the estimated deaths due to CVD has reportedly increased over the past three decades. However, this decline is reportedly slowing unevenly across all regions5.
CVD remains India’s leading cause of death. As noted in the Lancet Regional Health – Southeast Asia, “coronary disease in India is characterized by an earlier age of onset, a higher relative risk burden, higher case fatality and higher premature deaths. As of 2017, CVD was responsible for 26.6 per cent (25.3-27.4%) of total deaths and 13.6 per cent (12.5-14.6%) of DALY in India, compared with 15.2 per cent (13.7-16.2%) and 6.9 per cent (6.3-7.4%), respectively, in 1990”6.
The “State level statistic in India has witnessed a 2.3 fold increase in the prevalence of both ischaemic heart disease and stroke between 1990 and 2016” as reported by the Global Burden of Disease study6. A report of the World Economic Forum and Harvard School of Public Health in 2014 estimated India’s economic losses due to CVD between 2012 and 2030 at US$ 2.17 trillion7. A recent study from the southwestern State of India-Kerala indicated that “the health expenditure associated with acute myocardial infarction was very high among those without health insurance“6.
Investment and perception
The correlation between healthcare investment as a per cent gross domestic product (GDP) and lower death rates is well established. CVD death rates are higher in those countries where out-of-pocket expenditure is more on healthcare2. Overall, 97 per cent of high income countries spend at least five per cent of their GDP on health, compared with only 50 per cent of countries in southeast Asia, east Asia and Oceania and even lower in sub-Saharan African countries. These findings paint a concerning picture of persisting inequalities in access to care for CVD across the regions. In line with the WHO’s recommendations, at least five per cent of the GDP is to be invested by countries to help reduce CVD mortality. Universal Health Coverage with primary and secondary care will help contain CVD incidence, premature mortality and costs.
According to WHO, “of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2019, 38% were caused by CVDs”8. Even though hypertension is preventable, treatable and manageable in cost-effective ways, it is the most important modifiable risk factor, contributing to 10.8 million deaths from CVD, followed by air pollution and elevated plasma low density lipoprotein cholesterol levels, with 4.8 and 3.8 million deaths, respectively8. The countries in sub-Saharan Africa are among those with the highest prevalence of hypertension and air pollution levels are highest in countries of south Asia and again, lowest in the high income regions of the world.
Communicable diseases, such as HIV/AIDS, tuberculosis and malaria, have posed substantial global health challenges and generated much attention on the devastating impacts and efforts to control infection. “Interventions for communicable diseases, including vaccination programmes and disease specific treatments, have persistently been perceived as offering cost-effective health benefits, in turn influencing funding decisions, often in resource-constrained settings where immediate and measurable results are prioritized”5. In contrast, evidence for cost-effective interventions to reduce CVD prevalence and mortality and manage risk factors is largely available but that knowledge has not translated into national level policies and strategies; a “lack of integrated strategies across different sectors and a persisting siloed approach to CVD is slowing progress”9.
Socioeconomic inequalities remain an additional obstacle to reducing the CVD burden. Availability and uptake of new technologies to confront CVD are also uneven and impacted by issues such as digital health literacy, safety and internet access, and data privacy.
Making the world heart vision a reality
Year-round, collective efforts are helping to put tools in the hands of all those who can change the cardiovascular health landscape. The World Heart Observatory was launched in 202210 and is an example of an evolving hub where all disciplines share globally sourced data, case studies and policies. As a resource for educators, researchers, patients and policymakers, this observatory aims to address knowledge gaps and needs in cardiovascular health. Another is a series of roadmaps developed with the multidisciplinary expertise of peers, members, researchers and often reflecting insights of patients. The road maps focus on critical topics including cholesterol and hypertension and are directed for use by medical practitioners, policymakers and researchers.
WHF’s World Heart Vision 203011 is a sector-by-sector blueprint showing paths to cardiovascular health including equity, knowledge, digital tools and beneficial climate and environmental action.
The WHD campaign ‘walks the talk’ reflects the breadth of the vision that reaches across all sectors who must play their part, motivating everyone to get involved and reminding us to take care of our hearts. As one of the most successful health awareness days on the calendar, the WHD campaign is a celebration of the strides made in raising awareness, improving and expanding treatments, and using telemedicine and other digital interventions. WHD has grown into a global movement for health, wellbeing and productivity not just to be observed on. We urge everyone to join us on September 29 but beyond: Use Heart, Know Heart and dethrone CVD from the embarrassing distinction of numero uno killer of humanity.
Conflicts of Interest: None.
1. World Heart Federation. What is CVD. Available from: https://www.world-heart-federation.org/world-heart-day/cvd-causes-conditions/what-is-cvd/, accessed on August 2, 2023
2. World Heart Federation. World heart report 2023. Available from: https://www.world-heart-federation.org/resource/world-heart-report-2023/, accessed on August 2, 2023
3. World Heart Federation. About WHD. Available from: https://world-heart-federation.org/world-heart-day/about-whd/, accessed on July 27, 2023
4. World Heart Federation. World Heart Day 2023. Available from: https://world-heart-federation.org/world-heart-day/about-whd/world-heart-day-2023/, accessed on July 27, 2023
5. Piñeiro DJ, Codato E, Mwangi J, Eiselé JL, Narula J. Accelerated reduction in global cardiovascular disease is essential to achieve the sustainable development goals. Nat Rev Cardiol 2023; 20: 577–8
6. Kalra A, Jose AP, Prabhakaran P, Kumar A, Agrawal A, Roy A, et al. The burgeoning cardiovascular disease epidemic in Indians –Perspectives on contextual factors and potential solutions. Lancet Reg Health Southeast Asia 2023; 12: 100156
7. World Economic Forum, Harvard School of Public Health. Economics of non-communicable diseases in India: The costs and returns on investment of interventions to promote healthy living and prevent, treat, and manage NCDs. Available from: https://www3.weforum.org/docs/WEF_EconomicNonCommunicableDiseasesIndia_Report_2014.pdf, accessed on August 3, 2023
8. World Health Organization. Cardiovascular diseases (CVDs). Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds), accessed on September 25, 2023
9. World Heart Federation. Hypertention. Available from: https://world-heart-federation.org/what-we-do/hypertension/, accessed on August 2, 2023
10. World Heart Federation. World heart observatory. Available from: https://world-heart-federation.org/world-heart-observatory/, accessed on August 3, 2023
11. World Heart Federation. World heart vision 2030: Driving policy change. Available from: https://www.world-heart-federation.org/wp-content/uploads/World-Heart-Vision-2030.pdf, accessed on August 3, 2023