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Home » Cardiac Health, EU Health, Health

Prevention of cardiovascular disease should be the priority

Submitted by on 12 Apr 2018 – 09:10

Today, we all know the causal factors leading to cardiovascular disease (CVD). The most important risk factors for CVD are smoking, high blood pressure, high cholesterol, diabetes and abdominal obesity. In addition, factors such as psychosocial deprivation, air pollution and unhealthy foods contribute to this epidemic. Prof Lale Tokgozoglu, President, European Atherosclerosis Society, writes about the importance of prevention of CVD.

It is possible to prevent or retard the progression of the disease by controlling these risk factors.

We also know that socio-economic deprivation increases the dependence on alcohol and tobacco use as well as leading to consumption of unhealthy foods. Often, we notice that cardiovascular risk goes hand in hand with low income.

Age-adjusted mortality has decreased significantly in Western Europe due to the reduction in cholesterol, blood pressure levels and smoking. There are success stories like the one in Kuopio, Finland, where by decreasing smoking, high blood pressure and cholesterol, the death rates from CVD decreased significantly. Unfortunately, the increase in other risk factors attributable to modern lifestyle like obesity, type 2 diabetes, sedentary lifestyle and psychosocial stress will have a negative effect on these gains.

Lifestyle interventions are an integral part of therapy and have the advantage of targeting multiple risk factors all at once. One cannot emphasise enough the importance of diet, physical activity and abstinence from smoking in the prevention of atherosclerotic vascular disease.

Stopping smoking is the most cost-effective strategy for prevention of atherosclerotic vascular disease. Blood pressure control with lifestyle intervention as well as medications is also recommended depending on the level of blood pressure and the risk of the patient. Management of hyperglycaemia in diabetics reduces the risk of complications and to a large extent CVD.

Decreasing cholesterol levels is also important for prevention. Randomised trials have consistently demonstrated that reducing LDL cholesterol reduces the risk of CV events, proportional to the absolute reduction in LDL cholesterol independent of other risk factors.

There is strong evidence showing that it is possible to decrease CVD by simply controlling the major risk factors. Although we know how to decrease CVD, in reality, it has not been possible to do so. Europe and especially low and middle income countries have undergone rapid industrialisation, urbanisation, economic development and market globalisation.

Although these developments led to many positive changes in health outcomes and increased life expectancies, they all also caused inappropriate dietary patterns, physical inactivity and obesity. Fat and energy consumption is increasing mostly in Eastern Europe and smoking remains a key public health issue despite decline in some countries.Physical inactivity and sedentary lifestyle is also on the rise.

There are strong geographical disparities between European countries. Eastern and Central European countries have higher rates of cardiovascular mortality than Northern, Western and Southern Europe. The past 30 years have seen a decline in age-adjusted cardiovascular mortality in most Northern and Western European countries. This change has been less consistent in Central and Eastern Europe. The cost to the European Union economies is high at €210 billion per year. Looking at the percentage of total healthcare expenditure on CVD, more than half of the resources go to inpatient care and about a quarter to medications.

Unfortunately, primary care gets a minor percentage despite the fact that prevention is much more important and cost-effective than treatment. CVD can be prevented or postponed by effective prevention policies. It is important for policymakers to make prevention the priority.

Prevention of CVD needs to be the priority by creating healthier environments, strengthening the patient-centred primary healthcare and increasing universal health coverage. High quality research should be strengthened with partnership across countries and different sectors such as healthcare providers, cardiac societies, healthcare authorities and the European Union.