The World Heart Federation roadmap for reducing ... · The World Heart Federation roadmap for...

The World Heart Federation

roadmap for reducing

cardiovascular morbidity

and mortality through

prevention and control

of Cholesterol

Professor David A Wood

WHF President Elect

WHF Roadmaps to achieve "25 by 25"

CVD Roadmaps – Cholesterol

CVD Roadmaps – Cholesterol

International expert writing group from 12 countries

• Gerald Watts (Australia) – co-chair

• David Wood (UK) – co-chair

• Khalid Al Rasadi (Oman)

• Phil Barter (Australia)

• Dirk Blom (South Africa)

• Alberico Catapano (Italy)

• Ada Cuevas (Chile)

• Michael Davidson (USA)

• Jose Rocha Faria Neto (Brazil)-WHF

Emerging Leader-

• Francisco Lopez-Jimenez (USA)

• Raul Santos (Brazil)

• Allan Sniderman (Canada)

• Rody Sy (Philippines)

• Dong Zhao (China)

• Salim Yusuf (Canada)

World Heart Federation staff

• Adrianna Murphy (UK)

• Pablo Perel (Switzerland)

Relevance of cholesterol to CVD mortality

Worldwide, there are about 17 million deaths due

to CVD each year.

Elevated Apo B/Apo A1 is among the most

important risk factors for MI.

Rising concentrations of total cholesterol in low-

and middle-income countries (east and southeast

Asia and Pacific)

Secondary prevention

Patients with established CVD to be put on

treatment with a high intensity statin

Depending on resources for follow up, either

maintain same dose or monitor targets and adjust

dose/statin accordingly

Support patient with life-long adherence to lifestyle

modification and drug therapy

Secondary Prevention

Primary prevention

Total Risk Approach to measure CVD risk in

asymptomatic individuals

Risk score charts adapted to local contexts

Treatment thresholds based on local policy &

resources

Groups automatically eligible for treatment (LDL-

C>190 mg/dL (4.9 mmol/L), FH, DM with target organ

damage, CKD

Total Risk Approach

Total Risk Approach

Primary prevention

Total Risk Approach to measure CVD risk (with new

approaches emerging)

Risk score charts adapted to local contexts

Treatment thresholds based on local policy &

resources

Groups automatically eligible for treatment (LDL-

C>190 mg/dL (4.9 mmol/L), FH, DM, target organ

damage, CKD

Statin efficacy and safety

Collins, et al; Lancet 2016

Proportional major vascular event reductions versus absolute LDL cholesterol reductions in randomised trials of

routine statin therapy versus no routine statin use and of more intensive versus less intensive regimens

Primary Prevention

Familial hypercholesterolemia

Diagnosed using Dutch Clinic Network or other

criteria, followed by cascade screening and

genetic testing and counselling

Treated with high-intensity statin at maximum

tolerable dose, plus ezetimibe and, if appropriate,

bile acid binding resins

Newly emerging therapies (PCSK9) should be

considered but more evidence needed on CVD

outcomes

Familial Hypercholesterolaemia

Knowledge practice gaps

Low rates of awareness and treatment of

cholesterol globally

In secondary prevention, large treatment gaps in

cholesterol management with patients not

achieving guideline targets (PURE and

EUROASPIRE)

Large proportion of FH cases under-detected and

and not effectively treated worldwide

Existing roadblocks - examples

Patient-level roadblocks

• Low access to health facilities among poor or remote populations.

• Statins unaffordable for many patients

• Undue patient fear of side effects of statin treatment

Physician-level roadblocks

• Low capacity for monitoring treatment, especially with competing

disease priorities

• Low capacity for diagnosing and managing statin treatment among

FH patients

Health system-level roadblocks

• Insufficient resources to manage screening

• Shortage of facilities for large-scale measurement of cholesterol

levels, especially in rural areas

Potential solutions - examplesScreening and risk stratification

• Campaigns to raise awareness among health professionals and

public of importance of screening for CVD risk

• Development of simplified national screening guidelines with risk

charts

Initiation of statin treatment

• Development of simplified treatment guidelines for secondary and

primary prevention of CVD

• Campaigns to provide balanced information of statin safety and

efficacy

Health system-level roadblocks

• Free or subsidized drug provision, elimination of taxes on

pharmaceuticals, local generic drug production

• Novel interventions using mobile technology to remind and support

patients toward treatment adherence

Adapting the WHF Roadmaps at the

national level

Adapting the WHF Roadmaps

at the national level

Objectives

• National Roadmap

• Situation analysis

• Policy dialogues

• Action plan for implementation

Next steps

• Situation analysis • Epidemiological profile (CVD, risk factors)

• Health system assessment (resources,

financing, governance, delivery)

• Policy mapping (national plans, laws)

• Rapid reviews, secondary data analysis

and interviews

• Produce a situation analysis report

Next steps

• Policy dialogues• Stakeholders mapping

• Discuss roadmaps solutions (in the context

of situation analysis)

• Produce a plan of action for secondary

and primary prevention of CVD

“National Roadmap”

WHF Roadmaps to achieve "25 by 25"

WHF www.cvdroadmaps.orgcvd25 by 25"

Next steps

• Consultation with our partners

• Final publication in Global Heart

• Communication to continental and

national societies of cardiology and

heart foundations

• Advocacy toolkit for cholesterol

• WHO Global Hearts Initiative

United Nations General Assembly 2016

WHO Global

Hearts

Initiative 2016

WHF WSO WHL

Thank You!