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Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition
Open accessAbstract
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
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Metadata
- Authors
- Prabhakaran, D., Anand, S., Watkins, D., Gaziano, T., Wu, Y., Mbanya, J. C., Nugent, R., Ajay, V. S., Afshin, A., Adler, A., Ali, M. K., Bateman, E., Bettger, J., Bonow, R. O., Brouwer, E., Bukhman, G., Bull, F., Burney, P., Capewell, S., Chan, J., Chandrasekar, E. K., Chen, J., Criqui, M. H., Dirks, J., Dugani, S. B., Engelgau, M., El Nahas, M., Fall, C. H., Feigin, V., Fowkes, F. G. R., Glassman, A., Goenka, S., Gupta, R., Hasan, B., Hersch, F., Hu, F., Huffman, M. D., Jabbour, S., Jarvis, D., Jeemon, P., Joshi, R., Kamano, J. H., Kengne, A. P., Kudesia, P., Kumar, R. K., Kumaran, K., Lambert, E. V., Lee, E. S., Li, C., Luo, R., Magee, M., Malik, V. S., Marin-Neto, J. A., Marks, G., Mayosi, B., McGuire, H., Micha, R., Miranda, J. J., Montoya, P. A., Moran, A. E., Mozaffarian, D., Naicker, S., Naidoo, N. G., Narayan, K. V., Nikolic, I., O'Donnell, M., Onen, C., Osmond, C., Patel, A., Perez-Padilla, R., Poulter, N., Pratt, M., Rabkin, M., Rajan, V., Rassi, A., Rassi, A., Rawal, I., Remuzzi, G., Riella, M., Roth, G. A., Roy, A., Rubinstein, A., Sakuma, Y., Sampson, U. K., Siegel, K. R., Sliwa, K., Suhrcke, M., Tandon, N., Thomas, B., Vaca, C., Vedanthan, R., Verguet, S., Webb, M., Weber, M. B., Whitsel, L., Wong, G., Yan, L. L., Yancy, C. W., Zhang, P., Zhao, D., & Zhu, Y.
- Affiliations
- Emory University (US)
- Stanford Medicine (US)
- University of Washington (US)
- Brigham and Women's Hospital (US)
- Peking University (CN)
- Université de Yaoundé I (CM)
- RTI International (US)
- The George Institute for Global Health (GB)
- Public Health Foundation of India (IN)
- Corresponding author
- Prabhakaran, Dorairaj
- ORCID
- Prabhakaran, Dorairaj
- Anand, Shuchi
- Watkins, David
- Gaziano, Thomas
- Wu, Yangfeng
- Mbanya, Jean Claude
- Nugent, Rachel
- Ajay, Vamadevan S
- Afshin, Ashkan
- Adler, Alma
- Ali, Mohammed K
- Bettger, Janet
- Bonow, Robert O
- Brouwer, Elizabeth
- Bukhman, Gene
- Bull, Fiona
- Burney, Peter
- Chan, Juliana
- Chandrasekar, Eeshwar K
- Chen, Jie
- Criqui, Michael H
- Dugani, Sagar B
- Fall, Caroline HD
- Feigin, Valery
- Goenka, Shifalika
- Gupta, Rajeev
- Hasan, Babar
- Hersch, Fred
- Hu, Frank
- Huffman, Mark D
- Jabbour, Samer
- Jarvis, Deborah
- Jeemon, Panniyammakal
- Joshi, Rohina
- Kamano, Jemima H
- Kumaran, Kalyanaraman
- Lambert, Estelle V
- Lee, Edward S
- Li, Chaoyun
- Luo, Rong
- Magee, Matthew
- Malik, Vasanti S
- Marks, Guy
- Mayosi, Bongani
- McGuire, Helen
- Micha, Renata
- Miranda, J Jaime
- Montoya, Pablo Aschner
- Moran, Andrew E
- Mozaffarian, Dariush
- Naicker, Saraladevi
- O'Donnell, Martin
- Osmond, Clive
- Patel, Anushka
- Poulter, Neil
- Pratt, Michael
- Rabkin, Miriam
- Remuzzi, Giuseppe
- Riella, Miguel
- Roy, Ambuj
- Rubinstein, Adolfo
- Siegel, Karen R
- Sliwa, Karen
- Suhrcke, Marc
- Tandon, Nikhil
- Vaca, Claudia
- Vedanthan, Rajesh
- Verguet, Stéphane
- Weber, Mary Beth
- Whitsel, Laurie
- Wong, Gary
- Yan, Lijing L
- Yancy, Clyde W
- Zhang, Ping
- Zhao, Dong
- Zhu, Yishan
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 391
- Issue
- 10126
- Pages
- 1224-1236
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5996970
- OpenAlex
- W2765097496
- Cited by
- 162
- References
- 86
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 23 · 2023: 34 · 2022: 18 · 2021: 17 · 2020: 16 · 2019: 15 · 2018: 16
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- ePrints Soton (University of Southampton) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- CONICET Digital (CONICET) (submittedVersion, cc-by-nc-nd)
- Funders
- Bill and Melinda Gates Foundation
- American Heart Association
- National Institute of Diabetes and Digestive and Kidney Diseases (K-23 5K23DK101826-03)
- Medtronic Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- disease control priorities, cost-effectiveness, tobacco taxation, trans fat ban, primary care, health policy, universal health coverage, Sustainable Development Goal 3, premature mortality, low- and middle-income countries, health disparities, financial protection
- MeSH terms
- Cardiovascular Diseases, Developing Countries, Health Priorities, Humans, Respiratory Tract Diseases
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