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EuroPrevent 2008: Healthy lifestyles become a political affair

Prevention


Heart disease is the number one killer in Europe, taking over 2 million lives every year1, yet it is a preventable condition. Some segments of the population such as women and young athletes are not even aware that they are at risk.
Experts from all over Europe will gather from today in Paris to exchange scientific knowledge, professional experiences, upgrade skills and propose strategies to reduce the burden of cardiovascular disease across the continent. EuroPrevent is the annual congress of the European Association for Cardiovascular Prevention and Rehabilitation2.

“EuroPrevent is the biggest medical event concerning Cardiovascular Disease Prevention” says Prof Alain Cohen-Solal, FESC, of the Hôpital Lariboisiere in Paris, spokesperson for the European Society of Cardiology (ESC)3 and national organiser of the event which will last until 3 May 2008 at the Palais de Congrès. “It is the only meeting to embrace all aspects of prevention, from clinical practice to prevention in populations. At a time when health costs are making national budgets explode, it is the duty of doctors, especially of cardiologists, to reflect upon ways to promote healthy lifestyles through preventive measures. As professionals we also need to keep up to date with the latest therapeutic alternatives available. This is why EuroPrevent4 is such an important rendezvous for the medical world” explains Prof Cohen-Solal.

Despite repeated campaigns calling for individuals to adopt healthy lifestyles including a balanced diet, moderate exercise, avoidance of tobacco and stress, controlling cholesterol, diabetes and hypertension, the public does not seem to grasp exactly what “prevention” entails. Cardiovascular disease is estimated to cost the European Union 192 billion Euros a year thus making efforts to check the ailment a political priority.

“EuroPrevent is unique because it takes a holistic view of cardiovascular disease prevention. Ours is the only European meeting which brings together policy makers, public health, the complete spectrum of specialists – doctors, nurses, dieticians, physiotherapists, physical activity specialists, pharmacists, occupational therapists – and scientists, all of whom are making their own special contribution to cardiovascular prevention,” explains Prof David Wood, FESC, from Imperial College London, chairman of the Congress Programme Committee and President Elect of the EACPR.

The ESC has recently launched the European Health Heart Charter5 with other partners in order to stimulate the adoption of cardiovascular health in all policies for European citizens. So far 28 countries have signed the Charter. Individuals alone find it difficult to alter their behaviour. Sometimes change needs to be facilitated by creating a healthy environment which is the responsibility of political authorities. Members of the European Parliament have also understood the urgency of this challenge and have formed the MEP Heart Group6, of which the ESC is a member. A resolution was recently passed advocating the EU Commission to promote the adoption of the European Guidelines on CVD Prevention7. Professor Lars Ryden, FESC, Chairman of the European Affairs Committee of the ESC says "Political action is essential at an EU level if we are to seriously address CVD prevention across Europe."

The opening session of EuroPrevent 08 addresses these political issues starting with Professor Salim Yusuf’s vision of the worldwide challenges for CVD prevention. Professor Hugo Saner, FESC, EACPR President will present the clinical perspective with challenges for prevention and rehabilitation in those who have already developed CVD. He will promote the concept of ‘Prevention Centres’ which should be available to all vascular patients and those at high risk of developing the disease. The 22 country European wide survey of preventive cardiology practice called EUROASPIRE8 will be presented by Professor Guy de Backer. EUROASPIRE demonstrates how risk factors are being managed in comparison to goals set out by Guidelines. Research shows that many patients return to their bad habits (smoking, little or no exercise, no dietary changes) even after a cardiovascular event, and they have difficulties in achieving goals such as lowering blood pressure and lipids.
“The need for innovative models of care in clinical practice is evident given that only a third of patients with coronary heart disease access prevention and rehabilitation programmes, and the vast majority of high risk people in the community have no access to professional lifestyle programmes,” explains Prof Wood. “The Euro Action9 demonstration project in preventive cardiology shows the potential to raise standards of preventive care in Europe through multidisciplinary programmes. Nurse coordinated patient education programmes significantly improved adherence to recommendations.” Research shows that people particularly at risk are those of low socio-economic status, people suffering from social isolation, stress, depression. Patients in these categories need increased attention and counselling.

The European Society of Cardiology has developed clinical standards defined in Guidelines7 with recommendations to achieve lifestyle changes in patients with a high risk of heart disease. These include strategies to help patients quit smoking, make healthy food choices (fruits, vegetables, whole grain cereals, low fat dairy products, fish and lean meat) , increase physical activity (half an hour daily), manage their blood pressure , lipids and blood glucose. The European Guidelines on CVD Prevention also recommend prophylactic drugs such as aspirin, anti-coagulants, beta-blockers, statins and ace-inhibitors in certain cases.

Prof Cohen-Solal thinks lack of patient adherence to recommended changes comes from people not perceiving the consequences of unhealthy lifestyles unless a cardiovascular event forcibly makes patients aware of the risks involved. “Another reason is that people believe that medicines exempt them from taking lifestyle measures, or believe that it will be time to be careful later”. Unfortunately, later may be too late.

References

Notes
1. European CVD statistics 2008. EHN.


2. EACPR European Association for Cardiovascular Prevention and Rehabilitation

3. The European Society of Cardiology (ESC) represents more than 50,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

4. EuroPrevent08

5. European Heart Health Charter: Encourages the implementation and sharing of initiatives on heart health promotion among stakeholders (health professionals, health promotion organisations, health authorities and education systems) across Europe.

6. MEP Heart Group
 
7. EUROASPIRE III is a 22 country survey of the practice of preventive cardiology.

8. EuroAction is a demonstration project in preventive cardiology conducted across Europe in busy general hospitals and family doctor practices, EuroAction evaluated the impact of nurse-coordinated multidisciplinary preventive cardiology programmes. EuroAction is helping high risk patients and their families to achieve recommended lifestyle and risk factor reduction targets for cardiovascular disease prevention. The project involves over 10,000 patients and their families across eight European countries. (The Lancet 2008: in press)

9. European Guidelines on CVD Prevention