Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (SES). Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened. The management and prevention of IHD in individuals with a low SES in LLMICs are poor. Greater availability, access, and affordability for acute coronary syndrome management and secondary prevention are important. Primary prevention should focus on tackling the social determinants of health as well as policy and individual interventions for risk factor control, supported by task sharing and use of technology.

中文翻译：

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低收入国家的低社会经济地位人群在管理和预防缺血性心脏病方面面临的挑战

在大多数中低收入国家（LLMIC）中，心血管疾病（主要是缺血性心脏病（IHD））是最重要的死亡和致残原因。在这些国家中，社会经济地位低下（SES）的人的IHD死亡率明显更高。在LLMIC中低SES患者中，降低IHD死亡率的三个重要重点领域是：（1）急性冠状动脉护理；（2）心脏康复和二级预防；（三）初级预防。低SES急性冠状动脉综合征患者的死亡率较高是由于患者和基层医疗医生对症状缺乏了解，无法及时到达医疗机构，无法溶栓和冠脉血运重建以及昂贵药物（他汀类药物）无法负担，双重抗血小板剂，肾素-血管紧张素系统阻滞剂。需要在二级和三级护理医院提供快速诊断和可负担得起的长期护理设施，以进行IHD护理。需要特别关注健康的社会决定因素（低学历，贫困，工作和生活条件），更多的医疗保健资金以及有效的初级保健。需要通过消除烟草和反式脂肪，减少酒精，精制碳水化合物和盐的消费以及促进健康食品和体育锻炼的举措来提高初级预防的质量。需要以血压，脂质和糖尿病的管理为重点的高效初级保健。与社区卫生工作者的任务共享，电子决策支持系统，以及使用降压药物和他汀类药物的固定剂量组合可以大大降低危险因素，并有可能导致IHD大大降低。最后，应加强医师，护士和医护人员预防IHD的培训。LLMIC中SES低的个体对IHD的管理和预防很差。重要的是，急性冠脉综合征管理和二级预防的更大可用性，可及性和可负担性很重要。初级预防应着重于解决健康的社会决定因素，以及在任务共享和技术使用的支持下控制风险因素的政策和个人干预措施。应当加强预防IHD的医务工作者。LLMIC中SES低的个体对IHD的管理和预防很差。重要的是，急性冠脉综合征管理和二级预防的更大可用性，可及性和可负担性很重要。初级预防应着重于解决健康的社会决定因素，以及在任务共享和技术使用的支持下控制风险因素的政策和个人干预措施。应当加强预防IHD的医务工作者。LLMIC中SES低的个体对IHD的管理和预防很差。重要的是，急性冠脉综合征管理和二级预防的更大可用性，可及性和可负担性很重要。初级预防应着重于解决健康的社会决定因素，以及在任务共享和技术使用的支持下控制风险因素的政策和个人干预措施。