The factors described in Chapters 2 and 3 that contribute to the burden of CVD and related chronic diseases are the targets for change in the quest to promote global cardiovascular health. These can be divided into behavioral factors (such as tobacco use, diet, and physical activity); biological factors (such as blood pressure, cholesterol, and blood glucose); psychosocial factors (such as depression, anxiety, acute and chronic life stressors, and lack of social support); health systems factors (such as access to care, screening, diagnosis, and quality of care); and intersectoral factors (such as tobacco control policies and agricultural policies). The evidence describing the interrelated determinants of CVD provides a strong conceptual basis for a strategy that coordinates across multiple sectors and integrates health promotion, prevention, and disease management as part of a long-term, comprehensive approach. This approach would employ multiple intervention strategies in a mix of programs and policies that accomodate variations in need according to context and locale.
The ideal approach would take advantage of opportunities for intervention at all stages of the life course in order to promote cardiovascular health by preventing acquisition and augmentation of risk, detecting and reducing risk, managing CVD events, and preventing the progression of disease and recurrence of CVD events. Policies and programs to change the factors that contribute to CVD would be designed to work through population-wide approaches; through interventions within health systems; and through community-based programs with components in schools, worksites, and other community settings. A comprehensive strategy of this kind that takes into account the full range of complex determinants of CVD, illustrated in Figure 5.1, would have the theoretical potential to produce a synergistic interaction among approaches at individual and population levels. Concurrent modalities could include policy and regulatory changes, health promotion campaigns, innovative applications of communications technologies, efficient use of medical therapies and technologies, and integrated clinical programs. For individuals already at high risk or with existing disease, this approach would combine education, support, and incentives to both address behavioral risk factors and improve adherence to clinical interventions. Participation in this approach extends beyond clinical providers and public health approaches to also include public media outlets, community leaders, and related sectors, especially food and agriculture policy, transportation and urban planning, and private-sector entities such as the food and pharmaceutical industries. All these players are potential partners both in assessing needs and capacity and in developing and implementing solutions.