Table 8.
Current gaps in knowledge relating to resource effective strategies to prevent and treat cardiovascular disease and suggested next steps.
| Gaps in Knowledge | Next Steps |
|---|---|
| A. Evidence-Practice Gaps | |
| Evidence-practice gaps relating to the prevention and management of CVD in LMIC. | Continued follow-up and further analyses of data from the PURE study and other longitudinal cohort studies in LMICs, expansion and deepening of country/community based registries, such as those in the INDEPTH Network 107, strengthening of vital registration systems, and design and implementation of intervention studies in LMIC. |
| B. Barriers to Care | |
| Barriers to evidence-based and efficient CVD prevention and management in LMIC. | Systematic assessments of barriers to care at the patient, health care provider, and health system level in different countries to identify the important contextual factors and to inform resource effective strategies to prevent and manage CVD. |
| C. Interventions | |
| Evidence supporting the impact of dietary policies on CVD health in LMIC. | Large-scale studies conducted in LMIC, including descriptive, etiological, and interventional, where diet patterns substantially differ from HIC, complemented with research on the food environment and food policy, including the effects of trade liberalization. |
| Strategies to support the implementation of tobacco prevention and control policies (i.e., FCTC). | Promulgation and enforcement of laws that control tobacco cultivation, manufacturing, trade, distribution, marketing, taxation, and treatment. |
| Impact of contextually appropriate, simple, and cost-effective risk stratification and management tools on community-based populations. | Large scale studies across low-, middle-, and high-income countries to evaluate the implementation of WHO-recommended diagnostic and management strategies. |
| Clinical benefit of fixed-dose combination therapy for the prevention and management of CVD. | Randomized clinical trials evaluating the impact of a “polypill” on clinical events. |
| Appropriate clinical responsibilities of NPHWs in the prevention and management of CVD. | Large randomized controlled trials evaluating the effectiveness and efficiency of NPHWs and LHWs in the prevention and management of CVD, with additional studies evaluating the safety of NPHWs prescribing first-line CVD evidenced-based medications. |
*
CVD=cardiovascular disease, LMIC-low and middle income countries, PURE=Prospective Urban Rural Epidemiology Study, FCTC= Framework Convention on Tobacco Control, LHWs=lay health workers, NPHWs= non-physician health workers, WHO=World Health Organization.