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Country of the Month - Turkey

October 2013 (report updated in November 2014)


Report by Prof. Dilek Ural and Prof. Meral Kayikçioglu

National CVD Prevention Coordinators for Turkey:

Dilek Ural
MD, Professor

1. Head, Department of Cardiology, Kocaeli University, School of Medicine, Kocaeli, Turkey
2. Director, Clinical Research Centre, Kocaeli University, Kocaeli, Turkey
contact: email
mobile number: +90-532-2368975


Meral Kayıkçıoğlu
MD, Professor

Ege University, School of Medicine, Department of Cardiology, İzmir, Turkey
contact: email
mobile number: +90-532-4123489

Health care
  |  Risk factors  |  Main actors & prevention methods  | Cardiac Rehab. | Prevention activities  |  Future


Documents to download

Health Care

The state provides health services through 5 different governmental health insurance schemes that operate under a common General Health Insurance scheme. Governmental insurance covers the majority of Turkish citizens. The number of private insurance companies is increasing but most of their customers have also governmental coverage. The majority of the citizens are followed by a family practitioner, but they are also free to attend to hospitals or specialist. Prevention is the main target of the government and every regulatory effort is taken to promote healthy lifestyle habits. Implementation actions may also be taken by local municipalities. Cardiac rehabilitation is recently covered by general health insurance scheme with a small reimbursement, but needs considerable improvement in the following years.

Risk factors

Turkey is among the countries with highest CV mortality in Europe. Total mortality rate is 5‰ and mainly due to CV Disease (37.9%). The prevalence of major CV risk factors in recent surveys are as follows:

Dyslipidemia (total cholesterol >200 mg/dl)25%
 Low apoA1  45% (men) and 27% (women)
 High apoB  52% (men) and 52% (women)
 Hypertension  31.4%
 Smoking  21.7%
 Obesity  36% (central obesity 53.6%)
 Type 2-diabetes  13.7%
 Physical inactivity  


Standard risk factors, especially high cholesterol level, fail to identify a large proportion of individuals at high coronary heart disease risk, whereas inflammatory markers and type-2 diabetes are far more pertinent in this regard, particularly in Turkish women, than in Western populations. Risk factors related to unhealthy life style habits are on the rise in children and youth.

Main actors & prevention methods

Ministry of Health controls Social Security Institution and General Health Insurance scheme, coordinates the main preventive projects according to the National Heart Health Policy.
Social Security Institution provides all healthcare mainly through family practitioners, state and university hospitals. Nurse-based programmes and cardiac rehabilitation centres are lacking in Turkey.
Turkish Society of Cardiology (TSC) is heading the preventive activities by arranging campaigns and endorsing ESC guidelines.
Other national medical societies are also very effective in providing education and research in specific cardiovascular risk factors.

Cardiac Rehabilitation

The concept of cardiac rehabilitation (CR) is not acknowledged enough in both public and private health sector in Turkey. Cardiologists and cardiovascular surgeons are not sufficiently demanding and awareness of health professionals on this issue is quite low. Therefore, cardiac rehabilitation practices could not become common enough and do not allow for routine service.

Prevention activities

Turkish Ministry of Health and Turkish Society of Cardiology created a National Heart Health Policy that aims to decrease the burden of CV disease and its risk factors in Turkey in 2006.

  • Ministry of Health leads the main influential projects for CV health, like National Tobacco Control Programme and the recently started Obesity Prevention and Control Program. Other important programmes are Salt Reduction program, Healthy Cities program and (together with Ministry of Education) regulations and control of School Cantinas project. Prevention of diseases is among the main topics of education in primary and secondary schools.
  • Among the non-governmental organisations, Turkish Society of Cardiology  is heading the preventive activities. It provides brochures, radio programs, TV spots, special web pages, and informative TV programs produced by the members of the Society. Because of these activities the society has been awarded as the most successful NGO for several times.
  • Turkish Society of Cardiology is the main organisation responsible for the endorsement of ESC guidelines.
  • Prevention of CV disease and its individual risk factors are included in core curriculum programmes of medical students.
  • The interest of mass media in CV prevention is great. Most of the authors and consultants are senior specialists in either cardiology or internal medicine. Erroneous information may appear time to time, but their effect is limited.

Aims for the future

  • Calibrate a global risk assessment tool with the best accuracy to national mortality data
  • Simple, clear, credible prevention guidelines that suit Turkish culture and traditions
  • Public awareness and education programmes starting from school years
  • A more coordinated partnership among health authorities, municipalities, societies and health professionals
  • Provide rehabilitation for both primary and secondary prevention


The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology