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54.1 Global perspectives of hypertension and cardiovascular disease
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Published:July 2018
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Abstract
This chapter considers the overall global burden of cardiovascular disease (CVD) and its far-reaching implications. The Global Burden of Disease study has highlighted the mortality and morbidity from CVD in total, as well as individual diseases, allowing cross-country comparisons. In Europe, the European Observational Registry Programme has enabled surveillance of CVD and its management across Europe. Better data have enabled global inequalities in CVD to be uncovered, whether in terms of incidence and prevalence of risk factors or diseases, access to treatments, or long-term outcomes. Particular diseases and risk factors are highlighted from a global perspective. Variation in access to drugs, access to intervention/surgery, and health system barriers are discussed in more detail. Better data has also fuelled better advocacy and awareness for CVD, as well as galvanizing international efforts, whether in the form of the United Nations 2011 High-Level Meeting for Non-Communicable Diseases or specific roadmaps, guidelines, and action plans. In cardiovascular medicine, the evidence base, both in trials and observational studies, has been an exemplar to other areas of medicine, but the evidence base for CVD and its management in low- and middle-income countries still lags, and there is a great need for capacity-building, both in terms of training cardiologists and task-shifting to other non-physician health workers. As well as local capacity, global health can and should be part of the training curricula for cardiologists in Europe and other high-income settings in order to further develop clinical and academic resources. Finally, global disease targets for CVD are now embedded and prioritized in international health policy, which must now be operationalized.
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