Several decades ago, cardiovascular disease (CVD) was considered an illness prevalent in affluent countries, with their populations eating more high-cholesterol food, smoking more and exercising less.
It appears that with the aggressive CVD public health education and control programs of first-world countries, CVD prevalence is going down, and the middle-income countries are now the hardest hit.
This was the alarming message of a major report published in the European Heart Journal. Although non-European countries were not included in the report, we can say the same trend is happening in the Philippines.
CVD, in the form of heart disease, stroke and other complications of elevated blood pressure (BP), has been the top killer for quite some time now.
In the report, 57 middle-income countries in Europe, with more or less similar health care infrastructure and human resources as the Philippines, are now carrying the burden of hospitalization and long-term health care, and deaths from CVD.
Just like here, there are differences in the same country when it comes to access to modern diagnostics and therapies, which can play a crucial role in early diagnosis and prevention of complications of CVD.
Generally, countries with universal health care (UHC)— where everyone, rich or poor, has access to adequate health care—have marked health care advantages. The Philippines now has the UHC law, but its implementation remains a big question mark, much more so its long-term sustainability.
Legislators, health officials and the health care community must get their act together.
Bang for the buck
To get the biggest bang for the buck, there must be a focused plan on more cost-effective CVD prevention and control, since it’s the top killer, taking a huge toll on the country’s health care budget and resources.
By focusing on optimal hypertension control, we can significantly reduce CVD in the country, since elevated BP is the major culprit causing CVD.
A senator and his staff requested a meeting recently, and asked for inputs on hypertension control.
I emphasized that if we could tailor-fit strategies to specific needs, resources should be sufficient. But government intervention, in terms of legislation or policy-making, may be necessary.
Salt reduction in all processed foods is doable and can have a tremendous impact on hypertension control, since around 80 percent of salt intake really comes from them. Food products with excessive salt content should be identified and their manufacturers “convinced” to reduce salt content, even gradually over a three- to five-year period.
The government is giving free antihypertensive treatments based on so-called modern treatment for hypertension. However, I pointed out in a paper I wrote recently for the European Journal of Cardiovascular Medicine that Asians, including Filipinos, have a different type of hypertension, because of relatively increased salt sensitivity and fondness for salty foods.
Medicine to address high BP should contain a low dose of long-acting diuretic, which is a lot cheaper than the meds the government is giving for free.
If we “customize” treatment by mandating the local production of pills containing a long-acting diuretic, we can produce more tablets, treat more hypertensive Filipinos and save tens of thousands of lives yearly.
Going back to the European report, CVD accounts for 47 percent of deaths among women and 39 percent of deaths among men in middle-income European countries in the study. Just like in the Philippines, there has been only a modest decline in CVD or none at all in many countries.
In major CVD components like coronary heart disease (where there’s narrowing of arteries supplying the heart with blood) and stroke, there were only minor reductions despite all efforts.
According to the authors of the report, middle-income countries, compared to high-income countries, have:
• Higher premature death (before 70 years) due to CVD;
• More potential years of life lost due to CVD;
• Higher age-standardized incidence and prevalence of coronary heart disease and stroke; and
• Three times more years lost, including lower quality of life due to CVD ill health, disability, or early death.
Panos Vardas, a professor and past president of the European Society of Cardiology (ESC) and chief strategy officer of the ESC’s European Heart Agency in Brussels, says of the report: “The statistics emphasize the need for concerted application of CVD prevention policies, particularly in middle-income countries where the need is greatest. Middle-income countries are less able to meet the costs of contemporary health care than high-income countries leaving patients with no access to modern cardiovascular facilities.”
Vardas also noted in our previous conversations that many countries in Asia-Pacific share the predicament. I told him that, perhaps, just like in the Philippines, it’s because many of these countries have been barking up the wrong tree.