Article Text

Download PDFPDF

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism
  1. Mayowa Owolabi1,2,
  2. Jaime J Miranda3,4,
  3. Joseph Yaria1,
  4. Bruce Ovbiagele5
  1. 1Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
  2. 2World Federation for Neurorehabilitation-Blossom Specialist Medical Center, Ibadan, Nigeria
  3. 3Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  4. 4CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  5. 5Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Mayowa Owolabi; mayowaowolabi{at}


Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Seye Abimbola

  • Twitter Follow Mayowa Owolabi at @mayowaoowolabi

  • Contributors MO drafted the manuscript. All authors gave substantial contributions to the conception of the paper and revised it critically for important intellectual content. All authors approved the final version of the paper for publication. MO is the guarantor.

  • Funding National Institutes of Health (U54 HG007479) and National Institute of Neurological Disorders and Stroke (U01 NS079179).

  • Competing interests The authors are members of the Global Alliance for Chronic Diseases—COntrol UNique to Cardiovascular diseases In LMICs—(GACD-COUNCIL) initiative. GACD is the first alliance of the world's biggest public research funding agencies, which currently is funding 15 hypertension and 16 diabetes implementation science projects in LMICs. MO is the pioneer chair of the H3Africa CVD research consortium, the largest in Africa with projected sample size of >55 000 participants. BO is a pre-eminent stroke physician with expertise in guideline development. JM has expertise in implementation science for CVDs in LMICs. The ideas presented here respond to the challenges of combatting CVDs in LMICs. MO and BO are supported by U01 NS079179 and U54 HG007479 from the National Institute of Health and the GACD.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.