Auckland University researcher authors WHO report

University of Auckland medical researcher authors major WHO report

A University of Auckland medical researcher, Dr Anthony Rodgers, is a principal author of the World Health Organisation’s main annual publication. More than two years work by a team at the University’s Clinical Trials Research Unit including Dr Rodgers, Dr Carlene Lawes and Stephen Vander Hoorn, went into ‘World Health Report 2002 -- Preventing Risks, Promoting Healthy Life”, due to be released at the end of the month. Findings from the report on the causes and prevention of heart attacks and strokes were released internationally today. They show that more than 50 percent of deaths and disability from heart disease and strokes can be cut by a combination of simple, cost-effective national measures and individual actions.

“It is widely thought that high blood pressure, cholesterol, smoking and other established risks cause 25-50 percent of heart attacks and strokes, but the report clearly shows the figure is more than 75 percent,” said Dr Rodgers. “Cardiovascular disease is our leading killer so it is really important to get these numbers right.”

Dr Carlene Lawes and Stephen Vander Hoorn collated and summarized a “few trees worth” of research papers on blood pressure and cholesterol levels and their impact on cardiovascular disease around the world.

Dr Lawes said that “High blood pressure alone causes half of all deaths due to heart attack or strokes – amounting to about 7 million deaths globally each year. The impact is twice as much as previously thought.”

The WHO report goes on to show there are highly effective and affordable, but still underused, interventions to tackle these big risks.

“The most cost-effective cardiovascular interventions were those that can benefit the whole population. A good example in New Zealand would be gradually reducing the very high salt levels in our processed foods. At present many common foods such as soups and processed meats are saltier than seawater, and bread and breakfast cereals are about half as salty as seawater. Small repeated reductions by all manufacturers would lower everyone’s blood pressure, with large health benefits and no noticeable change in taste,” said Dr Rodgers.

Introducing and strengthening smokefree environments legislation was another key public health recommendation by WHO. Clearly, this was relevant to the Smokefree Environments Bill being considered at present in New Zealand, he said.
“A recently developed prevention strategy was also found to be hugely effective, and likely to more than halve stroke and heart attack rates in those at high risk,” said Dr Rodgers.

“The strategy involves giving combination therapy - a statin (to reduce cholesterol levels), low-dose blood pressure lowering medications and aspirin (to reduce blood stickiness) – to people at high risk of stroke or heart attack in the next few years. This is for people with ‘average’ levels of blood pressure and cholesterol, as well as those with higher levels.

“The approach was pioneered by another New Zealander, Professor Rod Jackson, also of The University of Auckland’s Faculty of Medical and Health Sciences, whose work on the prevention of cardiovascular disease has gained international prominence,” he said.

Cardiovascular disease is the leading killer in New Zealand. In 1999 heart attacks caused 23 percent of all deaths (affecting 6,558 people in total) and strokes caused a further 23 percent (affecting 2,820 people). The worldwide figure is 12 million deaths.

“A common misperception is that these conditions only affect the old and don’t cause disability. In fact, cardiovascular disease is by far our leading cause of lost healthy life years and about half the burden is borne by middle-aged people.

“If no action is taken to improve cardiovascular health and current international trends continue, WHO estimates that 25 percent more healthy life years will be lost to the disease globally by 2020. The brunt of the increase will be borne by developing countries,” said Dr Rodgers.

The WHO report cites examples of successful measures taken by countries around the world to reduce the risks associated with cardiovascular disease. This includes the introduction of the National Heart Foundation Pick the Tick logos for healthier foods in New Zealand, which has led many companies to reduce the salt and content of processed foods. New Zealand smokefree legislation has also been a great success, although there is still considerable scope for improvement.

As the main annual report from WHO, this publication has huge global reach. Almost all Ministers of Health around the world contributed at the World Health Assembly earlier this year in Geneva, and will receive a copy. Past reports have been front page news on more than 6,000 newspapers worldwide and there will be simultaneous publication in the prestigious medical journal The Lancet.

The report, one of the largest ever undertaken by WHO, involved more than 100 scientists from around the world. It was co-ordinated by Dr Rodgers together with Professor Alan Lopez, Dr Majid Ezzati and Professor Christopher Murray at WHO.

Dr Rodgers became involved in authoring the report through groundbreaking international work on the determinants of heart disease and strokes being carried out at The University of Auckland’s Clinical Trials Research Unit, part of the Faculty of Medical and Health Sciences. Since its inception in 1989 the Unit has co-ordinated clinical trials involving thousands of people in Australasia, Asia and Europe. A team from the University of Otago, led by Dr Tony Blakely, also contributed to the report by assessing the extent to which the risks of cardiovascular disease have affected those living in poverty around the world.

“This is the first ever global analysis of the major risks to health causes of cardiovascular disease,” said Dr Rodgers. “It is likely to challenge current priorities for health systems around the world.”

“The world once thought of cardiovascular disease as a Western problem, but we now know that this is not the case,” says Dr Rodgers. “Conditions like high blood pressure and high cholesterol are much more prominent in developing countries than previously thought.”

Dr Rodgers’ and The Clinical Trials Research Unit’s work for the WHO report has been funded by the Health Research Council of New Zealand and The National Heart Foundation.

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