Lifestyle change
Lifestyle change has probably contributed more than medical treatments to reduction in cardiovascular disease, said Professor Mike Kirby (London, UK). In industrialized countries it is estimated that 50-60% of the reduction in death from cardiovascular disease has been from reduction in risk factors. But there are specific areas of
concern.
“The increase in obesity and diabetes and lower physical activity in the population threatens to destroy some of the good work we have been doing.”
Another major concern is smoking in young people. In the UK, in recent years there has been no fall in smoking in people aged under 16. Visceral fat is a hidden danger. It used to be thought a benign substance but is now known to be extremely toxic.
“Visceral fat is an active endocrine organ and stores up problems for future vascular disease.”
Other key messages:
- “The amount of advice given on quitting smoking is directly related to the success of quitting”
- “It’s never too late to start: starting regular exercise in middle age is as potent a protector as stopping smoking”
- “A single bout of exercise can improve insulin sensitivity for 16 hours. So you need two bouts of exercise a day to get the best insulin sensitivity over 24 hours”
CV prevention in primary care
Young adults across Europe do not acknowledge the role of the GP in preventing cardiovascular disease. Professor Martin Roland (Cambridge, UK) said that a survey of around 3000 patients aged 18-45 across 10 European countries found that patients do not think they get useful advice from general practice on smoking, weight or physical activity. And few believe that general practice has a role to play in giving lifestyle advice on cholesterol or blood pressure.
“So here we have a real conundrum: many countries consider it a responsibility of primary care to give lifestyle advice to the general population. But our results suggest that young people across Europe are not receptive to receiving such advice.”
The study came out of the international EPA Cardio project to develop a set of quality indicators on cardiovascular disease prevention in primary care for use across Europe. It had not been possible to agree on reliable indicators for primary prevention. Indicators have, however, been agreed for assessing care of patients at high risk of CV disease
and for those with established CHD. These have been tested by audit of medical records, with the results pointing to areas in most countries where care needs to be improved.
CV risk estimation
Body mass index and HDL cholesterol level have important but different effects on cardiovascular risk estimation, said Professor Ian Graham (Dublin, Ireland) who discussed some of the new initiatives with the SCORE risk estimation system. The effects of BMI and HDL have recently been re-examined.
Increasing BMI, from 20 to 30, has been found to be a strong driver of risk – “more than we thought” – and to predict both total and cardiovascular mortality, especially in younger people. The effect is not independent of other risk factors, probably because its effect is partially or completely mediated through effects on other cardiovascular risk
factors. In contrast, HDL is an independent risk factor for cardiovascular mortality at all ages. As an additional variable in risk estimation, it might be useful in reclassifying people who are close to the management threshold.
Professor Graham noted that the electronic version of the SCORE system (http://www.escardio.org/) makes it easy to add in these risk factors. He commented that the new biomarkers do not contribute much to risk estimation but could be useful.
“By and large they (biomarkers) will not be treatable, but if they are very markedly raised they may encourage us to try harder with conventional risk factors. That’s how we currently use fibrinogen and homocysteine, for example. It signals to us that we had better try harder with what we can do, such as smoking and hypertension.“