Sir George Allanmoore Alleyne print      Biography   Graduated from the University of the West Indies, entered academic medicine there , becoming Professor of Medicinein 1972. Joined PAHO in 1981, Director 1994-2002. Currently Director Emeritus PAHO, Chancellor University of the West Indies, UN Special Envoy for HIV/AIDS in the Caribbean, Visiting Professor Johns Hopkins Bloomberg School of Public Health; Editor DCP Degrees; MD,FRCP Distinctions; Knight Bachelor, Order of the Caribbean Community.       Abstract   Cardiovascular Diseases (CVD) All countries have passed or are passing through the epidemiologic transition with increase in the burden of noncommunicable diseases, particularly CVD which are now the number one cause of death globally. It is less well known that CVD are now the leading cause of death (over 25% of all deaths) in low and middle income countries (LMIC). DCP examines ischemic heart disease (IHD), stroke and congestive cardiac failure (CCF) which together account for 80% of CVD burden. 82% of DALYs resulting from IHD occur in LMIC. Most CVD are attributable to a few risk factors: blood pressure,tobacco use, overweight, physical inactivity and abnormal blood lipids. Overweight is a major risk factor for diabetes which also contributes to the burden of CVD. DCP gives data for the cost effectiveness of pharmacological interventions for acute and long term management of CVD at the individual level and the pharmacological and non-pharmacological interventions at individual and population levels. There is no cutoff point for amount smoked, blood pressure, cholesterol or body weight as risk factors for CVD, thus the "absolute risk factor"approach, aiming to reduce any or all of these risk factors in the population, with benefits mainly depending on the underlying risk. A wide range of drugs is effective for treatment of CVD, but aspirin for treatment and secondary prevention of stroke and aspirin plus beta blockers for treatment and secondary prevention of acute IHD are the most cost effective interventions. The best strategy for reducing CVD burden is near universal access to effective drugs (perhaps a multi-drug regimen in a polypill) for those with existing CVD or clear risk, plus population interventions to redce risk factors. The most effective population intervention is to raise tobacco taxes: others include regulation to change the composition of dietary fat or decrease sodium intake and facilitate increased physical activity.