SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 8 NUMBER 4 • NOVEMBER 2011
147
Correspondence to: Dr Landi Lombard
Netcare Kuilsrivier Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2011;
8
: 147–148
UN call for action: prevention and control of
non-communicable diseases
LANDI LOMBARD
Landi Lombard
W
orldwide, non-communicable diseases (NCDs) are
currently responsible for more deaths than all other
causes combined. Traditionally, high-income populations
have borne the burden of NCDs. However, current evidence
indicates that the spread of disease is associated with increasing
levels of economic development. Low- and middle-income
countries now bear a greater burden of NCDs than high-income
countries. In Africa, NCDs are projected by 2020 to cause almost
three-quarters as many deaths as communicable, maternal–
perinatal and nutritional diseases combined. Currently, over 80%
of cardiovascular- and diabetes-related deaths occur in low- and
middle-income countries.
NCDs worsen poverty, while poverty results in rising rates of
such diseases. Strong evidence links poverty, lack of education
and other social inequities to NCDs and their risk factors. Lower
levels of education and residence in urban areas are associated
with an increased risk of diabetes. Physical inactivity, daily smoking
and regular alcohol consumption are more prevalent in those with
the least education. Female blue-collar workers have the highest
incidence of the metabolic syndrome, as well as higher rates of
obesity. NCDs create serious socio-economic consequences by
increasing individual and household impoverishment.
Paying for care associated with diabetes can cost low-
income households up to a third of their incomes. Catastrophic
hospitalisation expenditures are higher with NCDs compared
with communicable diseases. In developing countries, the lack of
healthcare capacity and dearth of social protection systems means
that people with NCDs are more likely to become sick and die at a
younger age.
At present, the main focus of healthcare for NCDs in many
developing countries is hospital centred. In the case of cardiovascular
diseases and diabetes, a large proportion of people at high risk
remain undiagnosed. When a diagnosis is made, it is often at a
late stage of the disease, when the patient is symptomatic and
admitted to hospital with acute events or long-term complications
and disabilities. Treatment for advanced-stage disease is expensive
as high-technology interventions are required. The impact of NCDs
can be prevented through primary healthcare measures to treat
those who have contracted or are at high risk of contracting such
diseases.
This issue of the journal focuses on three areas where primary
care can make a difference – obesity, lipid management and food
choices.
Cholesterol management in South Africa
The CEPHEUS study on cholesterol management in diabetes high-
lights the contribution that primary care can make to reducing car-
diovascular events in patients with diabetes. The strength of this
study is that it is representative of the public and private sectors,
and the diverse communities of South Africa.
Primary-care practitioners, after evaluating the effect of the
initial lipid-lowering agents prescribed, should up-titrate statins
sensibily and use combination therapy in their diabetic patients.
The CEPHEUS study confirms what has already been shown in
other countries in the world, that healthcare professionals do not
treat lipid levels effectively enough and therefore patients are still
exposed to higher-than-necessary risk of cardiovascular disease.
Healthcare professionals should know the targets and try harder
to achieve these set targets in order to save lives.
New lipid guidelines
This issue reports on the new South African lipid guidelines
announced recently by the South African Heart Association and
the Lipid and Atherosclerosis Society of Southern Africa (LASSA).
The new guidelines are more complicated than the previous
ones and use a three-tier design based on the Framingham risk
score. The first tier of patients (target LDL < 1.8 mmol/l), who should
be treated the most intensively, includes a wide variety of patients.
This will put more pressure on medical aids for funding, especially
combination therapy, but could also potentially save lives. Patients
at this level of risk should probably be managed by specialists.
Legislation on trans fatty acids in food
The worldwide prevalence of obesity has nearly doubled between
1980 and 2008. Growing globalisation and industrialisation is lead-
