Cardiovascular disease (CVD) is the most common cause of death across the globe, and people living in resource-limited settings are disproportionately affected; more than 80% of CVD deaths occur in low- and middle-income countries (LMICs). Individuals in these settings have less access to CVD treatment than those in high-income countries, meaning that they die younger. It is therefore essential to identify those at high risk for CVD as early as possible, in order to reduce the possibility of disease development. In the industrialized world, CVD risk is assessed using tools such as the Framingham Risk Score, which takes blood pressure and cholesterol measurements into account. Such risk calculators are impractical to use in LMICs because they require laboratory testing, which is not always possible in these settings.
New research by Thomas Gaziano and colleagues published in BMC Medicine as part of our Medicine for Global Health series has tested the ability of a non-laboratory-based risk score to predict 10-year CVD risk in South African populations. The study shows that this simple score, which takes into account body mass index, blood pressure and smoking status, has similar performance for predicting CVD compared with laboratory-based tools. These results suggest that following further validation, the score could be used for early and inexpensive identification of people at risk of CVD in resource-limited settings, and could allow treatment decisions to be made in a single clinic visit. Importantly, this would make diagnosis more efficient, allowing for earlier treatment, which in turn could help reduce CVD deaths.
While CVD risk is particularly high in resource-limited settings, the alarming rise in obesity in many countries has led to concerns about dramatic increases in CVD mortality. Research by the IDEFICS consortium published this week in BMC Medicine finds that clustering of CVD risk factors occurs in inactive children as young as 2–6 years old. The authors recommend that children should be doing 60–85 minutes of exercise per day, including 20 minutes of vigorous activity, to reduce CVD risk. In a commentary accompanying this study, Robert McMurray from UNC Chapel Hill emphasizes that CVD risk develops at a very early age, and childhood prevention is key to reducing CVD deaths in the future.
Hypertension is a key risk factor for developing CVD, and it is recommended that adults should have their blood pressure checked every 5 years to monitor the risk of having a heart attack. A meta-analysis published in BMC Medicine evaluated the association between prehypertension – slightly elevated blood pressure – and CVD morbidity, showing that even low range prehypertension is associated with CVD. These results suggest that the prehypertension category should be separated into low and high levels, and lifestyle interventions to lower blood pressure and reduce CVD risk should be encouraged in the early stages of prehypertension.
Together, these articles highlight the importance of prompt identification of adults and children at risk of CVD across the globe, along with targeted interventions to decrease the risk of disease development. Combining early risk assessment with specific exercise and diet recommendations should help to reduce the global burden of CVD and reduce deaths.