The Year in Cardiology 2014: Prevention
In an update for 2014 on the burden of CVD across Europe, it was shown that the differing trends in CV mortality and case fatality have led to increasing inequalities between European countries. Cardiovascular disease caused by atherosclerosis remains an important challenge to prevention; this is even more important because in some European countries such as France the decline in CHD mortality was not observed in younger subjects; there is also an emerging needs to prevent a decline in quality of life particularly in the elderly with heart failure. In that respect, the publication in 2014 of a new validated Health-Related Quality-of-Life questionnaire for patients with CHD, developed with the support of the ESC and the EACPR is very welcome.
Smoking of tobacco remains a major cause of concern both in primary and secondary prevention of CVD. In the hospital arm of the EUROASPIRE IV survey, conducted in 24 European countries, it was found that only half of the coronary patients who smoked before hospitalization had stopped smoking 1.35 years later. Results from a large European study regarding determinants and prevalence of e-cigarette use in 27 countries illustrate the need to rapidly evaluate the health effects of e-cigarettes and the need for EU-based regulations. The AHA also released a policy statement supporting effective regulations that addresses marketing, labelling, quality control of manufacturing, and standards for contaminants of e-cigarettes.
Levels of physical activity have been found to be associated with CVD in the general population. In a large observational study of patients with type-2 diabetes, low physical activity was associated with 25–70% increased risk of CVD and mortality over a 5-year period. The importance of physical exercise has further been documented and explained in recent European and US guidelines on lifestyle and CVD prevention.
Compliance with multiple drug therapies in secondary prevention of CVD is a major source of concern. Intervention studies are ongoing to test the efficacy of strategies using a polypill formula that may improve long-term adherence.
We need more studies in the field of preventive cardiology. Results from a survey of the European cardiovascular research landscape and recommendations for future research strategy (CardioScape, EU 7th Framework programme), delivered in September 2014 (www.cardioscape.eu), indicate that in 2010–2012 research spend on CVD was highest for the area of human/clinical research and lowest for research in prevention/population/public health; EU funding for prevention/population/public health was negligible.
Finally, it should be mentioned that hard work has been performed in 2014 to have the new EACPR Textbook on Preventive Cardiology in Clinical Practice ready and we can look forward to its publication in 2015.