Doing Nothing About CVD Will Cost $47 Trillion

September 17, 2012 (Geneva, Switzerland) — One year after a United Nations (UN) High-Level Meeting on Non-Communicable Diseases (NCDs) that set a target of reducing premature mortality by 25% by the year 2025, the major cardiovascular societies across the globe have come together to publicize the important steps that now need to be taken to achieve this goal, given that CVD accounts for nearly half of all NCD deaths [1].

"What was agreed upon a year ago was a major step forward. This is a coming together, a coalescence--at least between the societies and foundations worldwide--looking at how we can work together and with the World Health Organization [WHO] to move beyond the 25% target, to see how we can actually get there," president of the World Heart Federation, Dr Sidney Smith (University of North Carolina, Chapel Hill), told heartwire in an interview. "We are putting some teeth into the jaws of what can happen," says Smith, who is lead author of a new paper outlining the main objectives in the fight to prevent deaths from heart disease and stroke, published simultaneously today in a number of journals, including Circulation, the European Heart Journal, the Journal of the American College of Cardiology, and Global Heart.

Doing nothing is going to cost the world $47 trillion in the next 25 years, including $500 billion a year in low- and middle-income countries, where 80% of deaths from CVD now occur.

"This statement reflects the desires of the leaders from the major CVD societies to say, 'We are on board, and these are the measures we think can really make a difference,' " he says.

And Smith notes that detailing how much it will cost countries if they fail to act on CVD prevention and treatment is vital. "Doing nothing is going to cost the world $47 trillion in the next 25 years, including $500 billion a year in low- and middle-income countries, where 80% of deaths from CVD now occur," Smith observes. In contrast, estimates by the WHO of how much it will cost to implement various measures they have recommended vary between just $11 billion and $13 billion a year, he says.

Look at "Best-Buy" Targets as a Menu; Effective Surveillance Is Key

The WHO has now identified a core set of 10 low-cost strategies called "best buys" to address NCDs, including, for example, a 25% relative reduction in prevalence of hypertension, 30% relative reduction in mean population intake of salt, and a 30% relative reduction in prevalence of tobacco smoking.

It's important to have all the best buys, but it's not necessary for each country to do all of them.

"But we have to balance several considerations," Smith notes. "The more people have to do, the less likely it is they are going to get everything done. It's important to have all the best buys, but it's not necessary for each country to do all of them. Let's have each country decide on specific areas," he says, although he urges that this still requires treading carefully. "If you eliminate targets on obesity, for example, do you send the wrong message?

"We have to look at the targets as a menu, and every country around the world will have to ask, 'What are the big problems in our country?' If you go to China, it's hypertension, sodium, and smoking. If we are going to choose three where we invest our money, let's choose the ones that are most appropriate."

It will also be important that any outcomes from the actions chosen can be effectively measured, he says. "Many countries just don't have the data, so getting good surveillance in place is critical."

Getting Everyone Involved Is Imperative

Also vital is the involvement of the right personnel in each place, he says, including physicians, who need to become more politically active to help achieve these aims. "And it's important to note that almost everywhere there have been successes, there has been a committed government leader. But it's not going to be just a minister of health you need to engage, it is agriculture and finance too," he observes.

Smith goes on to give one simple example of how revenue could be generated to achieve the aims laid out, citing a calculation made by Bill Gates [2]. "If we were to tax cigarettes 10¢ per pack in developed nations, 6¢ per pack in middle-income nations, and 2¢ per pack in those with a lower income, it would result in $10.8 billion a year that could be used to save millions of lives."

We do have a chance, and one that we cannot afford to miss. This is an epidemic that need not happen.

And lessons can be learned from other campaigns too, he notes--for example, with regard to availability of medications. "Statins are generic, aspirin is inexpensive, and there are cheap medicines for high blood pressure. In the same way we started talking about the ways we could get medications for HIV/AIDS available, let's do it for somebody who's had a stroke or heart attack or somebody who's at very high risk, and that ought to be a focus if we are really going to get a 25% reduction [in mortality] by 2025."

CVD is striking down people in their prime in developing nations, "in their 40s and 50s, people with jobs and families, resulting in crippling blows for countries that are trying to advance," Smith stresses. "With the UN behind this, reporting from every country in the world, we do have a chance, and one that we cannot afford to miss. This is an epidemic that need not happen."