NCDI Poverty researchers release first key publication focused on CVD in poorest billion

Author: Maia Olsen, NCD Synergies
June 28, 2016

On June 14, 2016, “Endemic Cardiovascular Diseases of the Poorest Billion” was published in Circulation, the peer reviewed journal of the American Heart Association.


Nancy Ferguson / Partners In Health
Co-authors Jaime Miranda, center, and Gisela Robles, right, from Universidad Peruana Cayetano Heredia and Oxford Poverty and Human Development Initiative respectively, at the first Lancet NCDI Poverty meeting in London.

In this piece, co-authors investigate the burden of cardiovascular disease among the world’s poorest billion people. Through a review of existing data sources, including the 2013 Global Burden of Disease, facility-based CVD registries, verbal autopsy studies, and population-based risk factor surveys, co-authors provide evidence to suggest that –

  • In the world’s poorest countries, over one third of the burden of CVD and congenital heart anomalies occurs in people under age 30, compared to less than 3 percent in high-income countries;
  • Compared to high-income countries, substantially less of the CVD burden among the poorest billion is attributed to behavioral or metabolic risk factors; and
  • Environmental, infectious, and early life nutritional risk factors play a substantial role in the predominant CVD conditions of the poorest countries, such as rheumatic heart disease (RHD) and nonischemic and Chagas cardiomyopathies.

Given this analysis, the paper contends that while the current Global Monitoring Framework for the prevention and control of NCDs will help reduce premature CVD deaths among the world’s poorest populations, it is not sufficient. As a result, the co-authors conclude with the following call to action:

“We recommend a complementary strategy for the poorest populations that targets premature death at younger ages, addresses environmental and infectious risks, and introduces broader integrated health systems interventions, including cardiac surgery for congenital and rheumatic heart disease.”
Kwan et al., “Endemic Cardiovascular Diseases of the Poorest Billion”

Co-authors include a number of advisors and commissioners from the Lancet Commission on Reframing NCDs and Injuries in the Poorest Billion (NCDI Poverty), including Gene Kwan from Boston University School of Medicine and PIH, NCD Synergies director Gene Bukhman (NCDI Poverty co-chair, Harvard Medical School), Ana Mocumbi (NCDI Poverty co-chair), Majid Ezzati, Yogesh Jain, Bongani Mayosi, and Jaime Miranda. Investigators from Harvard T.H. Chan School of Public Health, Oxford Poverty and Human Development Initiative (OPHI), and Boston University School of Public Health were also a part of the collaboration.

The NCDI Poverty Commission will reconvene in Kigali, Rwanda, in late September 2016 for their second in-person meeting. Follow @NCDIpoverty on twitter to learn more about this work.