1. and Prevent 100 Million Deaths from Cardiovascular Disease
Resolve to Save Lives – A Global Initiative to Partner with Communities
and Prevent 100 Million Deaths from Cardiovascular Disease
Tom Frieden, MD, MPH, Laura K Cobb*, PhD
Resolve to Save Lives, An Initiative of Vital Strategies
Background:
Cardiovascular disease (CVD) is the world’s leading cause of death, with 80% of deaths occurring in low and middle-income countries (LMIC). In LMICs, approximately 50% of CVD deaths occur in people under 70. (1) Other than the Bloomberg Initiative to Control Tobacco Use, which since 2007 has invested almost $1 billion in reducing tobacco use, there have been few large-scale investments in global CVD prevention to date. (2) To fill this gap, Resolve to Save Lives (RTSL) was launched in September 2017, with two focus areas: preventing cardiovascular disease (CVD) and preventing epidemics. In CVD prevention, RTSL focuses on three areas which can achieve large-scale impact: elimination of artificial trans fat, improved treatment of hypertension, and reduction of sodium intake. If implemented globally, we estimate these three interventions can save 100 million lives over 30 years (Figure 1).
Figure 1: Saving 100 million lives over the next 30 years
Sodium Reduction
The most challenging of the three goals is sodium reduction. Reducing sodium intake by 30% globally would save as many lives as hypertension treatment. (4) RTSL’s work is aligned with the WHO’s SHAKE technical package and supports interventions including:
Front of pack warning labels
Mandatory or voluntary targets for industry reformulation of packaged foods
Promotion of low-sodium salts
Government nutrition standards
Salt reduction in restaurant foods
Behavior change communication.
A 30% reduction can be achieved through a combination of these interventions, depending on the key sources of salt in a country.
Countries are trying different strategies; efforts need to be evaluated and effective strategies identified and scaled up. RTSL is currently working with China, Ethiopia, Vietnam, and the Philippines.
Trans Fat Elimination
Globally, artificial trans fat intake is estimated to cause 540,000 deaths every year. (5) Denmark, New York City, and other locations that banned artificial trans fat show that it can be eliminated and replaced with healthier alternatives without altering taste or increasing cost. (6) Elimination of artificial trans fat by 2023 is a key goal in the WHO’s five-year General Programme of Work.
In its first year, RTSL partnered with WHO to launch the REPLACE action package to eliminate artificial trans fat globally.
RTSL is working to eliminate trans fat in 20 countries. Countries around the world are taking steps to eliminate this toxic product (Fig 3).
Figure 3: The number of countries taking action on artificial trans fat is accelerating rapidly
Hypertension Treatment
Globally, 1.4 billion people have hypertension, but less than 200 million have it under control. (3) As a result, hypertension is responsible for more deaths than all infectious diseases combined. Treatment for hypertension is safe, effective, generic, once daily, and low cost, but requires a functioning primary healthcare system. A five-component approach can improve management of hypertension and increase hypertension control (Figure 2).
Figure 2: 5 Components of Hypertension Control
RTSL works at both the country level and with global policy makers, such as WHO, to improve hypertension treatment.
Country progress in the first year:
Supported hypertension treatment for more than 100,000 people in India using the HEARTS strategy
Developed a mobile app for hypertension treatment
Helped 5 countries and multiple provinces/states select drug and dose specific hypertension protocols, including China, India, Ethiopia, Turkey, and Vietnam
Global progress:
Partnered with WHO and others to develop the HEARTS technical package
Submitted application to include fixed-dose combination anti-hypertensive medications on the WHO Essential Medicines List
RTSL has partnered with WHO and the CDC Foundation to develop LINKS, a free, online community and resource sharing platform that connects people working to improve cardiovascular health around the world. In the 3 months since LINKS was launched, we have gained more than 300 members from more than 50 countries and have hosted 3 successful webinars. LINKS also provides catalytic support for organizations in LMICs through both one-time grants and technical assistance. Sign up at
Figure 4: Footprint of Resolve to Save Lives in its first year, 2018
Cardiovascular Health
REPLACE trans fat
HTN control, working with PAHO
Conclusions:
Reducing CVD is essential to achieve SDG 3.4 and make health systems responsive to the growing NCD epidemic. Through its global and country work, RTSL aims to partner with countries to spur action to prevent CVD worldwide.
References:
WHO CVD Fact Sheet:
Mills KT et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circ
Kontis et al. Contribution of six risk factors to achieving the 25×25 non-communicable disease mortality reduction target: a modelling study. Lancet. 2014
Wang Q et al. Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease. J Am Heart Assoc
Angell SY et al.. Change in trans fatty acid content of fast-food purchases associated with New York City’s restaurant regulation: a pre-post study. Ann Intern Med