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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!