Cardiovascular disease (CVD) and stroke are major causes of morbidity and premature mortality in women and men in the United States and globally. Recent data from the World Health Organization indicate an estimated 17.9 million deaths from CVDs in 2016, representing 31% of all global deaths and 44% of deaths from all noncommunicable diseases (NCDs).1 Important to note is that low- and middle-income countries (LMICs) bear the major burden of CVD, with estimates indicating ~75% of CVD deaths in LMICs.1

The importance of reducing the risk and burden of CVDs and promoting cardiovascular health on a global level was highlighted at the recent (2019) collaborative European Society of Cardiology and World Congress of Cardiology scientific sessions. The sessions focused on potentially modifiable risk factors, behaviors, and social and environmental exposures known to contribute to incident CVD and accelerate atherosclerotic and hypertensive processes, with an emphasis on the United Nations Strategic Development Goal2 of reducing premature deaths from NCDs by 30% by 2030. Consistent with the World Health Organization's global action plan for the prevention and control of NCDs,3 an emphasis was placed on both individual and population-wide efforts designed to prevent and control high blood pressure and dyslipidemia, reduce dietary intake of sodium, prevent smoking initiation and accelerate smoking cessation, promote physical activity, and reduce the prevalence of overweight and obesity. Engaging nurses and global nursing organizations, such as the American Heart Association's Cardiovascular and Stroke Nursing Council, is a key component for effective implementation of both individual and population efforts designed to reduce the risk and burden of CVD worldwide.

Toward that goal and recognizing that nurses form the largest healthcare discipline preventing and managing CVD globally, the Preventive Cardiovascular Nurses Association initiated the Global Cardiovascular Nursing Leadership Forum. Officially launched in October 2014 in New York City, the mission of the Global Cardiovascular Nursing Leadership Forum is to engage, mobilize, and empower an international community of nurse leaders to improve prevention of CVD and stroke worldwide through research, education, policy, and advocacy.4 Since its inception, the GCNLF has been endorsed and supported by AHA-CVSN, the European Society of Cardiology's Association of Cardiovascular Nursing and Allied Health Professions, and the World Heart Federation. With leaders in cardiovascular nursing from the 6 WHO regions, goals for the GCNLF were established in 2014 and reaffirmed in subsequent meetings in Barcelona (2016) and in Lisbon (2018).5 The goals focus on championing a global nursing movement for CVD and stroke prevention across the life span of individuals and families, informing nurses on the science and practice of CVD and stroke prevention (based on evidence including that generated by nurse scientists and clinicians worldwide), and developing and empowering nurses as leaders globally. A particularly noteworthy theme, the need for additional knowledge (educational materials) and skill-building programs, focused on enhancing the effectiveness and impact of nurses and nursing in global CVD and stroke prevention was emphasized by nurse leaders at all 3 in-person meetings of the Global Cardiovascular Nursing Leadership Forum.5 At the 2018 meeting in Lisbon, nurse leaders discussed the potential for an international cardiovascular nursing certificate program designed to equip nurses with the knowledge and skills essential for prevention of CVD and stroke.5 Working collaboratively with the Global Cardiovascular Nursing Leadership Forum, the Preventive Cardiovascular Nurses Association has assumed a leadership role in these efforts that are in progress and expected to be launched in 2020.

Clearly, given the global risk and burden of CVD and stroke, nurses have opportunities to be engaged in individual/clinical and population-based efforts focused on prevention and management of CVD and stroke. Data from the World Health Organization1 remind us of the urgent need for public health interventions that include and encompass environmental and policy approaches that impact population health and have the potential to promote health equity.1 Adding to the importance of population-based efforts is a recent global impact analysis, illustrating the potential of 3 public interventions on global mortality.6 The interventions are (1) scaling up access to treatment of high blood pressure to 70%, (2) reducing sodium intake by 30%, and (3) eliminating the intake of artificial trans-fatty acids. Implementation of these well-established interventions is projected to save ~100 million lives globally within 25 years.6 These initiatives will require multilevel, multidisciplinary efforts for successful implementation. As the authors duly note, a reliable supply of quality-assured blood pressure medicines and monitors, drug- and dose-specific treatment protocols, and healthcare information systems that facilitate tracking and improving blood pressure control rates, as well as expansion of primary care coverage, will be essential and a major challenge for successful implementation, particularly in LMICs.6 Relatedly, to reduce sodium intake by 30%, policies targeted to primary sources of sodium in each country will be central to achieving this goal. Of note, the elimination of artificial trans and unsaturated fatty acids is likely the least difficult of the 3 goals to reach, as 23 countries had such regulations in 2018 and the World Health Organization's REPLACE package has strongly recommended reviewing the sources of trans-fatty acids; promoting replacement with healthier oils; assessing time trends in trans-fatty acids in the food supply; creating awareness among industry, policy makers and consumers; and enforcing regulations.7 Of note, all 3 interventions have been evaluated as cost-effective, with hypertension treatment and sodium reduction designated as "best buys" by the the World Health Organization.8

As the largest discipline preventing and managing CVD and stroke globally, nurses and nursing organizations have a major role to play in advocating for the implementation of science-based policies that have the promise and potential of promoting optimal cardiovascular health and health equity for all peoples of the world. If you would like to get involved in reducing the global burden of CVD and stroke, please join and participate in the American Heart Association's Cardiovascular and Stroke Nursing Council's committees, activities, and scientific agenda this year.

REFERENCES