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Can we prevent four out of five heart attacks in Europe?

Joep Perk

In Europe, cardiovascular disease (CVD) cause more than 4 million deaths each year – the most common cause of death under the age of 75.  But we need not accept this fate. There are ways each and every one of us can fight CVD today.

The World Health Organization (WHO) states that “most cardiovascular disease can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol.”

 What does this message mean for the clinician, the patient and the population at large?

According to the 2016 European Prevention Guidelines, preventive care starts with an assessment of cardiovascular risk in four levels, from low to very high. Most Europeans are at moderate risk but most patients with CVD belong to the high risk group, with the greatest need of support. For each group there are target levels for risk management.

The six targets are: 

  1. No exposure to tobacco in any form
  2. A diet low in saturated fat with a focus on wholegrain products, vegetables, fruit and fish
  3. At least 150 minutes a week of moderate aerobic physical activity (30 minutes, 5 days/week) or 75 mins. a week of vigorous aerobic activity (15 minutes, 5 days/week) or a combination thereof
  4. A BMI of 20–25 kg/m2. Waist circumference <94 cm (men) and or <80 cm (women)
  5. Blood pressure of <140/90 mmHg
  6. An LDL-Cholesterol level <1.8 mmol/L (<70 mg/dL) for the very high risk group, <2.6 mmol/L (<100 mg/dL) for the high risk group and <3.0 mmol/L (115 mg/dL) for persons at low or moderate risk

How can an 80% reduction in cardiovascular disease actually be reached?

How can these six targets contribute?

Stop Smoking.  Smoking is the leading cause of CVD and heart attacks. It damages the walls of blood vessels (arteriosclerosis), raising blood pressure and the risk of blood clots. 

In most cases, when you stop smoking: 

Within two hours, your heart rate and blood pressure will return to almost normal levels. 

After 12 hours, your blood oxygen levels improve to those seen in healthy people. 

At about one year, your overall risk for cardiovascular disease decreases by half, and by five years,  your risk is reduced to the level of non-smokers.

Maintain a Healthy Weight and improving eating habits should be the next priority.  Diets high in saturated fat and refined carbohydrates -- and the extra weight they produce -- account for one third of cardiovascular disease.  They often raise blood pressure and trigger diabetes, which creates further problems for the cardiovascular system.  But eating a heart healthy diet -- including fruits, vegetables and whole grains -- and maintaining a healthy weight can produce dramatic benefits.  Overweight patients who lost at least 10 percent of body weight were able to reduce their need for blood pressure medications by 50 percent, on average. Cholesterol levels dropped markedly. And the rate of those showing early signs of diabetes was reduced from 30 percent of patients to just 4 percent.

Just Move. Combating physical inactivity is the third priority.  Moderate and regular physical activity produces meaningful health benefits – at whatever age you start. It can reduce the risk of CVD death by 50%. Even for those who have suffered a heart attack, participating in exercise-based cardiac rehabilitation (CR) programmes will decrease the risk of CVD death by 25%. Tragically, in many European countries, only a minority of patients in need of these programmes are actually enrolled.

A moderate use of alcoholic beverages, sound sleep habits and avoiding stress (as much as possible) will further diminish the risk of cardiovascular disease.

Basic improvements in lifestyle combined with up-to-date medical management of high blood pressure and/or high blood lipid levels can produce major gains in the battle against cardiovascular disease. It could save millions of lives each year, and improve the quality of life for millions more. 

For many physicians, conveying these essential facts to their patients remains a major challenge.

Joep Perk is one of the founders of the European Association of Preventive Cardiology (EAPC), acted as chair of the 2012 Joint European Societies Prevention Taskforce. He is senior professor of Health Sciences at the Linnaeus University in Kalmar, Sweden.