“JUST LIKE ALCOHOL ANONYMOUS, WHY CAN’T WE GET TOGETHER TO SOLVE SMOKING, SEDENTARY LIFE, OBESITY AND BLOOD PRESSURE ISSUES? THAT’S WHAT BASICALLY THE PROJECT IS ALL ABOUT. TO CREATE GROUPS OF PEOPLE THAT EFFECTIVELY HELP EACH OTHER”
Dr. Valentín Fuster
The Grenada Programme: Grenada Heart Project Builds a Model of CVD Prevention Amid Westernization
The Grenada Heart Project resulted from conversations between the principal investigator, Valentín Fuster, MD, PhD, and a panel of representatives from the United Nations, who were concerned by the dramatic increase in cardiovascular risk factors sweeping low and middle income countries and sought a cost-effective model for CVD prevention.
Located in the Caribbean Sea, the island nation of Grenada has a population of 111,219, and the majority are of African descent. The island has recently undergone a process of “westernization,” and it now has rates of hypertension and type 2 diabetes mellitus that surpass those seen in the United States. In contrast, the paradoxically low prevalence of CVD supports the view that the country is undergoing an obesity-related “risk transition.” This phenomenon usually results when there is a disproportionate increase in obesity-related diseases due to an excessive intake of fat and alcohol, generally in the context of a rapid westernization that particularly affects middle-aged individuals. In the case of a country such as Grenada that has limited resources, the potential increase in CVD combined with a high rate of infectious diseases saddles the country with a “double burden” of disease, which could have catastrophic consequences for population health. Although the risk transition is almost complete, the transition corresponding to increased cardiovascular morbidity and mortality remains to be seen, which presents a rare opportunity for the role of prevention in achieving cardiovascular risk-factor control and eliminating the future burden of cardiovascular disease.
The Grenada Heart Project conducted an observational study of 2,827 adults randomly selected from the national electronic voter list of Grenadians aged 18 to 70. The aim was to assess the clinical, biological, and psychosocial determinants of cardiovascular health in Grenada, in order to develop and implement a nationwide cardiovascular health promotion program. The study assessed behavioral risk factors, anthropometric measures, blood pressure, point-of-care testing for glucose and lipids, EKGs, ankle-brachial index, and self-reported personal and family history of cardiovascular disease and related risk factors. Analysis of the data revealed prevalence rates of obesity, hypertension, and diabetes significantly exceeding those seen in the U.S.
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A follow-up study, called Grenada Heart Project-CHANGE (Community Health Action to EncouraGe Healthy BEhaviors), is a randomized controlled trial of 402 individuals from the original 2,827, selected because they had one or more cardiac risk factors. The project, presented at the conference of the American Heart Association in November, by Sameer Bansilal, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, studied the effectiveness of a peer-support strategy in modifying the behavior of healthy individuals at risk of CVD. The study’s community-based intervention aimed to promote positive behaviors and focus more on what creates health, rather than what prevents sickness. In this program we tested the impact of promotion of healthy lifestyle behaviors through peer motivation, tracking a score called Fuster-BEWAT, which accounts for blood pressure, exercise, weight/BMI, alimentation (fruit and vegetable intake), and tobacco use.
The monthly peer group-based cardiovascular health promotion intervention did not demonstrate a significant improvement in the Fuster-BEWAT score of participants at 1 year as compared to the control group [1]. However, this study, completed in June 2016, demonstrated that the active participation of health care professionals is not always required. In this case, participants were divided into peer groups with the aim that they would help each other achieve their goals, such as consuming a diet rich in fruits and vegetables and low in salt, or increasing exercise. This model has allowed implementation of a local monitoring system that has proved to be efficient, particularly in environments with limited resources.
The baseline prevalence of obesity, physical inactivity, and poor nutritional habits, suggest in the future there could be a sharp rise in the incidence of cardiovascular disease [1]. For a small middle-income country such as Grenada, battling chronic cardiovascular disease could be devastating for their resource-poor healthcare system. This intervention demonstrated that a low-cost, peer-group-based intervention to promote heart healthy behaviors is feasible in a low- and middle-income country. Further studies should assess the effects of low-cost lifestyle interventions in low- and middle-income countries.
REFERENCES:
- Latina J, Fuster V et al. Am Heart J, 2020, 220:20-8. Grenada Heart Project–Community Health ActioN to EncouraGe healthy BEhaviors (GHPCHANGE): A randomized control peer group–based lifestyle intervention.