Fortnightly Medical Newspaper
published from Pakistan

Published by
Professional Medical Publications

March 15-31, 2011


ISSN: 1026-6828




Comprehensive measures discussed to promote prevention
of cardiovascular diseases at Preventive Cardiology
Council meeting at Islamabad
Preventive Cardiology departments to be established
in all major medical institutions in Pakistan

Establishment of Healthy Heart Clinics, Free Drug Bank for management
of Hypertension, high cholesterol, obesity centers, collaboration with
NGOs and Media to create awareness also discussed in detail


ISLAMABAD: Preventive Cardiology Council of Pakistan Cardiac Society met here on March 5th and after detailed deliberations, decided to initiate comprehensive measures to promote prevention of cardiovascular diseases. Since curative measures are not only very expensive but also not appropriate for the developing countries to control morbidity and mortality from cardiovascular diseases, preventive measures are the only viable option. Hence, the meeting came out with suggestions which are feasible, practical and can be implemented in a phased programme. The first such an important step which will be taken will be establishments of preventive cardiology departments in all the major medical institutions of Pakistan.

Group photograph of participants to the Preventive Cardiology Council meeting held at Islamabad recently

Initiative for this meeting was taken by Prof. M. Hafeezullah Vice Chancellor of Khyber Medical University who is also President of Preventive Cardiology Council of PCS and it was largely attended by a select group of eminent cardiologists and physicians from all over Pakistan. Those who were present in the meeting which was sponsored by Martin Dow Pharmaceuticals included Prof. Khan Shah Zaman Khan, Prof. Mansoor Ahmad, Dr.Bashir Hanif and Prof. M. Ishaq from Karachi, Major Gen. Azhar Kayani President of Pakistan Cardiac Society, Dr. Shahbaz Kureshi, Dr. Shahid Nawaz, Prof. Habibur Rehman from Islamabad, Prof. Javed Akram, Prof.Saulat Siddique, Brig. Afsar Raza from Lahore, Prof. Hafeez Chaudhry from Faisalabad, besides Dr. Nadeem Akbar Registrar of PM&DC.
Prof. Hafeezullah welcomed the participants and also highlighted the objectives of the meeting. This was followed by Dr.Khawar Kazmi’s presentation who discussed salient features of World Bank Report regarding Non-Communicable Diseases (NCDs). This report points out that NCDs can threaten healthy aging hence effective measures should be taken through regional responses that will reduce both population-level risk factors and the burden of NCDs. Population aging in South Asia is associated with a rapid increase in health problems such as heart diseases, cancers, diabetes and obesity which means unhealthy aging putting new pressure on health systems. Other factors like lifestyle changes are often associated with urbanization and globalization can also increase the risk factors and diseases onset at younger ages. It is estimated that over half the disease burden in South Asia is attributable to NCDs. Ischaemic Heart Disease is the leading cause of both death and forgone disability adjusted life years in working age in adults between the age of 15-69 years. On the contrary communicable diseases like tuberculosis, respiratory infections and water born diseases still remain prominent thus most of the developing countries face the double disease burden since they have not yet controlled communicable diseases but are also now faced with the burden of NCDs.
Low birth weight is still common in South Asia which is an important risk factor for NCDs. The fetal origins hypothesis of adult diseases postulates that fetal under nutrition, reflected by LBW is associated with susceptibility to development of IHD and other chronic NCDs in later life. The economic impact of NCDs is significant. These findings have serious implications for South Asia. Aging will not only increase NCDs but rapidly occurring without associated economic gains and social support systems; it can lead to unhealthy aging characterized by disability and premature death. Chronic NCDs require treatment over a much longer period than acute communicable diseases. Thus NCDs can hold back development and poverty reduction efforts in most of the low income countries. Fetal and childhood under nutrition is now recognized a major long term risk factor in the development of adult chronic diseases including heart diseases, diabetes and hypertension. Fortunately in view of these challenges, numerous opportunities for their prevention and control are available. Major decline in CVD mortality seen in numerous developed countries during the 60s and 70s was that nearly half the reduction can be attributed to population level changes in risk factors like tobacco use and the rest to treatment of diseases and their complications. Most of the treatment effect was due to early diagnoses and initiation of pharmacological interventions rather than medical or surgical interventions. Though both prevention and treatment strategies are needed but it is important to take up this challenge with an appropriate mix of preventive and curative measures. This report recommends that each country should develop a National Action Plan for the prevention and control of Non-Communicable Diseases. Such measures have been in place in many countries for the last many years but implementation of recommendations needs to be entrusted to a dedicated unit with capacity resources which are adequate to get the desired results.
The participants were then split into two groups which met separately and had in depth discussions. Later Prof. Khan Shah Zaman and Prof. Saulat Siddique presented proposals and action plans on behalf of their groups. Responsibilities of tertiary care Centers were highlighted by Prof. Khan Shah Zaman Khan while Prof.Saulat Siddique gave details of community based programmes. They also identified the different stake holders. Some of the decisions which were taken included setting of a joint task force to take up this important subject of preventive cardiology. In order to create public awareness, in collaboration with NGOs as well as Print and Electronic media, strategies will be worked out to disseminate information regarding heart diseases. It was felt that increased awareness among the primary physicians about the importance of cardiac problems will encourage them to look for modifiable causes and control the risk factors. Some of the clinics which are providing such services should be declared as Healthy Heart Clinics. They should be provided facilities to assess risk factors like blood pressure, weight and waist measurement, checking of cholesterol and blood sugar. Dedicated workshops should be organized for GPs Family Physicians to update their knowledge, establish free drug banks for treatment of hypertension and high cholesterol in general hospitals and special clinics. Special centers for obesity should be established and GPS should be encouraged to organize seminars for public awareness. Special software’s should be developed to help GPs to maintain record for follow up.
Prof. Khan Shah Zaman Khan told Pulse International that preventive cardiology departments are functioning at NICVD at Karachi as well as at AFIC at Rawalpindi. It was agreed to have a detailed look at their working and then come up with a comprehensive plan so that these model preventive cardiology departments are established all over the country in major medical institutions on similar pattern. The participants felt that all hospitals offering invasive services should have a well trained and staffed human resource with proper infrastructure and necessary resources. Close liaison should be encouraged between medical units, diabetic units, cardiac surgical units and these departments.
Perhaps the most important measures which were suggested included inclusion of preventive cardiology in FCPS training and examination. At present major emphasis is on learning and practicing interventional procedures. It is essential that all cardiologists should be trained in preventive aspects as well. The meeting suggested at least two months posting to learn and practice preventive cardiology. Dissertations in the field of preventive cardiology should be encouraged, questions on preventive cardiology should be mandatory in theory. Preventive cardiology should have at least two stations in OSCE and there should be emphasis on trails in preventive cardiology. President of CPSP should be asked to chair this section with participation from CPSP faculty of cardiology, some supervisors and examiners as well as senior cardiologists.
It was also decided that special cadre of human resources dedicated to preventive cardiology should be developed. They should have special training with emphasis to learn and practice preventive cardiology. All efforts should be made to promote the discipline of preventive cardiology. Medical universities should play their role by training M.Phil and MS in preventive cardiology. Their training components should include training in biostatistics, epidemiology, community health, practical training in conducting community based research, training in clinical cardiology so that they are able to recognize clinical patterns and presentations. They should be capable of identifying risk factors and their management. In addition they should have exposure to non-invasive clinical investigations to understand the indications, limitations and cost effectiveness. They must also have training in effective project management and communication skills. Prevention of cardiovascular diseases should be included in national priorities. Special funds should be created to conduct studies at district and tehsil hospitals. Just like TB control programme, national programme to control cardiovascular diseases should be initiated. Rheumatic Heart Disease prophylaxis and availability of penicillin at clinics should be an integral part of this national heart diseases control programme.
Responding to a question Prof. Khan Shah Zaman General Secretary of Pakistan Cardiac Society told Pulse International that this was an initiative by Prof. M. Hafeezullah who is President of Preventive Cardiology Council of Pakistan Cardiac Society. We have also decided to meet every three months to monitor the progress and see what more needs to be done to achieve our objective of preventing cardiovascular diseases, reducing their morbidity and mortality. To achieve all this effective, efficient and cost effective primary and secondary prevention programmes will be chalked out. The recommendations of the meeting were presented in the concluding session which was chaired by Maj.Gen. Azhar Mehmood Kayani President of Pakistan Cardiac Society who later on also briefed the media about the conference deliberations and recommendations.
It is an extremely ambitious programme wherein the preventive cardiology council also intends to involve the federal and provincial health ministers, President of CPSP, Vice Chancellor of medical universities besides representatives of NGOs and Media. How far it is feasible and practical and how much they are able to implement only time will tell. However, Pakistan Cardiac Society and its Preventive Cardiology Council all deserve to be commended to have taken this initiative. Martin Dow Pharmaceutical also deserves appreciation to have sponsored and facilitated this meeting which might turn out to be an important milestone in the prevention of cardiovascular diseases in Pakistan



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