Publication Type:

Journal Article


Dorairaj Prabhakaran; Shuchi Anand; David Watkins; Thomas Gaziano; Yangfeng Wu; Jean Claude Mbanya; Rachel Nugent; Vamadevan S Ajay; Ashkan Afshin; Alma Adler; Mohammed K Ali; Eric Bateman; Janet Bettger; Robert O Bonow; Elizabeth Brouwer; Gene Bukhman; Fiona Bull; Peter Burney; Simon Capewell; Juliana Chan; Eeshwar K Chandrasekar; Jie Chen; Michael H Criqui; John Dirks; Sagar B Dugani; Michael Engelgau; Meguid El Nahas; Caroline HD Fall; Valery Feigin; F Gerald R Fowkes; Amanda Glassman; Shifalika Goenka; Rajeev Gupta; Babar Hasan; Fred Hersch; Frank Hu; Mark D Huffman; Samer Jabbour; Deborah Jarvis; Panniyammakal Jeemon; Rohina Joshi; Jemima H Kamano; Andre Pascal Kengne; Preeti Kudesia; R Krishna Kumar; Kalyanaraman Kumaran; Estelle V Lambert; Edward S Lee; Chaoyun Li; Rong Luo; Matthew Magee; Vasanti S Malik; J Antonio Marin-Neto; Guy Marks; Bongani Mayosi; Helen McGuire; Renata Micha; J Jaime Miranda; Pablo Aschner Montoya; Andrew E Moran; Dariush Mozaffarian; Saraladevi Naicker; Nadraj G Naidoo; KM Venkat Narayan; Irina Nikolic; Martin O'Donnell; Churchill Onen; Clive Osmond; Anushka Patel; Rogelio Perez-Padilla; Neil Poulter; Michael Pratt; Miriam Rabkin; Vikram Rajan; Anis Rassi; Anis Rassi; Ishita Rawal; Giuseppe Remuzzi; Miguel Riella; Greg A Roth; Ambuj Roy; Adolfo Rubinstein; Yuna Sakuma; Uchechukwu KA Sampson; Karen R Siegel; Karen Sliwa; Marc Suhrcke; Nikhil Tandon; Bernadette Thomas; Claudia Vaca; Rajesh Vedanthan; Stéphane Verguet; Michael Webb; Mary Beth Weber; Laurie Whitsel; Gary Wong; Lijing L Yan; Clyde W Yancy; Ping Zhang; Dong Zhao; Yishan Zhu


The Lancet, Volume 391, Number 10126, p.1224 - 1236 (2017)



Summary 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.

Cite this Research Publication

D. Prabhakaran, Anand, S., Watkins, D., Gaziano, T., Wu, Y., Mbanya, J. Claude, 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., Nahas, M. El, Fall, C. H. D., Feigin, V., F Fowkes, 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. Pascal, Kudesia, P., R Krishna Kumar, Kumaran, K., Lambert, E. V., Lee, E. S., Li, C., Luo, R., Magee, M., Malik, V. S., J Marin-Neto, A., Marks, G., Mayosi, B., McGuire, H., Micha, R., J Miranda, J., Montoya, P. Aschner, Moran, A. E., Mozaffarian, D., Naicker, S., Naidoo, N. G., Narayan, K. M. Venkat, 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. A., Siegel, K. R., Sliwa, K., Suhrcke, M., Tandon, N., Thomas, B., Vaca, C., Vedanthan, R., Verguet, S., Webb, M., Weber, M. Beth, Whitsel, L., Wong, G., Yan, L. L., Yancy, C. W., Zhang, P., Zhao, D., and Zhu, Y., “Cardiovascular, Respiratory, and Related Disorders: key Messages from Disease Control Priorities, 3rd edition”, The Lancet, vol. 391, pp. 1224 - 1236, 2017.