POLICY BRIEF

Achieving Cardiovascular Health
WHO and Global Health Goals

Cardiovascular disease (CVD) remains the leading cause of death globally, responsible for approximately 17.9 million deaths annually (WHO, 2023). Many of these deaths are preventable through primary prevention, timely diagnosis, and evidence-based management, including lifestyle interventions and medical treatments. The World Health Organization (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) 2013-2030 calls for a 25% relative reduction in premature mortality from CVD and other NCDs by 2025, aligning with Sustainable Development Goal (SDG) 3.4, which aims for a one-third reduction in premature mortality from NCDs by 2030. Importantly, climate change has emerged as a direct and indirect driver of CVD risk, with extreme heat and air pollution contributing to worsening hypertension, arrhythmia, and stroke risk. Achieving global CVD targets requires a multilevel approach that integrates prevention, clinical management, health system strengthening, climate adaptation, and addressing the social, economic, and environmental determinants of cardiovascular health. This Fast-Track Health policy brief explores best practices through five case studies, discusses challenges and opportunities, and provides actionable recommendations for municipal, national, and regional health authorities.

Hypertension Control Program in Canada: Canada’s national hypertension control initiative, led by the Canadian Hypertension Education Program (CHEP), has developed evidence-based guidelines, promoted clinical decision support tools, and implemented a strong primary care focus. This has contributed to one of the highest rates of blood pressure awareness, treatment, and control globally, with control rates exceeding 65% in adults diagnosed with hypertension. The program’s success is attributed to integration into primary care, regular provider education, and national health campaigns to raise public awareness (Campbell et al., 2021).

Salt Reduction Strategy in the United Kingdom: The United Kingdom pioneered a population-wide salt reduction program through voluntary industry reformulation, public awareness campaigns, and transparent monitoring of sodium content in packaged foods. From 2003 to 2011, the average salt intake fell by 15%, contributing to a decline in average blood pressure and CVD mortality rates. The program’s success demonstrates the impact of multisectoral collaboration involving public health authorities, civil society, and the food industry. (He et al., 2014)

HEARTS in the Americas in Chile: Chile is an active participant in HEARTS in the Americas, a Pan-American Health Organization (PAHO)-led initiative to improve CVD prevention and control at the primary care level. Through standardized treatment protocols, improved access to essential medicines, and team-based care models, Chile has significantly increased hypertension control rates in participating clinics. The initiative emphasizes equity, targeting underserved rural and peri-urban populations. By embedding the HEARTS model into routine primary care and aligning it with universal health coverage objectives, the program is creating sustainable, scalable improvements in cardiovascular outcomes across diverse resource settings. (Ordunez et al., 2022).

Community-Based Cardiac Rehabilitation in India: In rural India, a low-cost, community-based cardiac rehabilitation program has been implemented using trained community health workers to deliver lifestyle counseling, monitor medication adherence, and support patients after acute coronary events. This model addresses access barriers in low-resource settings and has shown significant improvements in physical activity levels, blood pressure control, and medication adherence, reducing readmissions. The hybrid model is now being studied for its potential to reduce long-term inequities in cardiovascular care access, particularly among Indigenous and socioeconomically disadvantaged populations. (Chow et al., 2021)

Urban Heat Mitigation and Cardiovascular Health in Athens: Athens has implemented a comprehensive urban heat mitigation strategy to reduce cardiovascular health risks associated with extreme temperatures. Heat waves significantly raise the risk of heart failure, myocardial infarction, and stroke, particularly among older adults and those with pre-existing CVD. The city launched public health campaigns targeting high-risk populations with heat-health advisories, hydration guidance, and early warning alerts. Coordination with healthcare providers ensures preparedness for cardiovascular emergencies during extreme heat events. (Founda & Santamouris, 2021)

Efforts to improve cardiovascular health are hampered by persistent inequities in access to preventive, diagnostic, and treatment services. Many low- and middle-income countries lack infrastructure for blood pressure and cholesterol screening, while even high-income settings face disparities affecting marginalized communities. Lifestyle-related risk factors – including high sodium intake, low physical activity, tobacco use, and unhealthy diets – remain pervasive and are often driven by powerful commercial determinants of health. Climate change intensifies these risks because extreme heat events, worsening air quality, and climate-induced food insecurity directly and indirectly increase CVD incidence. Inadequate integration of cardiovascular health into Universal Health Coverage (UHC) schemes and fragmentation between primary, secondary, and tertiary care limit the continuity of care. There is also limited global funding for NCDs compared to communicable diseases, slowing the scale-up of proven interventions and climate-adaptive strategies.

There is significant potential to accelerate progress toward cardiovascular health goals by leveraging evidence-based interventions, technology, and climate-smart policies. Expanding access to affordable antihypertensives, statins, and essential diagnostics could drastically reduce premature mortality. Digital health innovations, such as telemedicine, remote monitoring devices, and AI-driven risk prediction tools, offer earlier detection and personalized care opportunities. Policies that regulate food composition, promote active transport, improve air quality, and integrate climate resilience into health planning can reduce risk factors at scale. Strengthening primary care systems ensures sustainability and cost-effectiveness, while embedding equity-focused approaches reduces disparities in cardiovascular outcomes. And, integrating CVD prevention into broader NCD, UHC, and climate adaptation strategies can optimize resource allocation and produce co-benefits across health and environmental targets.