Centre for Health and Social Change, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Glob Heart. 2017 Sep;12(3):179-197.e5. doi: 10.1016/j.gheart.2017.03.002. Epub 2017 Jul 29.
The World Heart Federation has undertaken an initiative to develop a series of Roadmaps.
The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease.
Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these.
Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders.
Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap may apply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.
世界心脏联合会已开展一项计划，以制定一系列路线图。
这些路线图旨在促进制定国家政策和卫生系统措施，并确定中低收入国家（LMIC）在有效预防、检测和治疗心血管疾病（CVD）方面可能存在的障碍，以及克服这些障碍的策略。本路线图重点关注升高的血胆固醇，这是心肌梗死、中风和外周动脉疾病的主要危险因素。
通过对已发表的指南和研究论文进行审查，并与一个由 LMIC 胆固醇临床管理和卫生系统研究专家组成的委员会进行协商，本路线图确定了（1）通过检测、治疗和管理升高的胆固醇和家族性高胆固醇血症（FH）来预防 CVD 的一级、二级和三级预防的关键干预措施；（2）实施这些干预措施方面的差距（知识-实践差距）；（3）LMIC 升高胆固醇治疗的卫生系统障碍；（4）克服这些障碍的潜在策略。
尽管有大量证据表明胆固醇水平在 CVD 的一级或二级预防中的重要性，以及他汀类药物治疗降低胆固醇和降低 CVD 风险的有效性，但全球在检测、治疗和管理高胆固醇方面仍存在差距。一些潜在的障碍包括胆固醇管理方面的实验室设施或训练有素的专业人员获取不足、普通人群和卫生专业人员对 FH 的认识较低、患者家庭负担不起他汀类药物的费用以及对坚持使用降脂药物重要性的认识不足。潜在的解决方案包括即时检测、提供免费或补贴的降脂药物以及使用短信提醒来提供治疗依从性支持。
针对升高的胆固醇和 FH 的检测、治疗和管理，已经存在有效的策略，但在许多资源匮乏的环境中，这些策略的实施存在障碍。应在国家层面确定卫生系统干预的优先事项，并评估特定环境下拟议解决方案的可行性和有效性。本路线图中提出的许多解决方案可能适用于其他心血管疾病，并为整合 LMIC 的 CVD 护理提供机会。
