Why the charter now?

Key figures

  • CVD causes more than half of deaths in Europe (52%) and in the EU (42%)
  • Coronary Heart Disease(CHD) remains the leading cause of mortality in men over 45 years, and in women over 65 years throughout Europe
  • 51% patients had premature CHD at the time of their first clinical manifestation of CHD
  • 20% of the coronary patients had previously diagnosed diabetes
  • Overall CVD is estimated to cost the European Union economy 169€ billion a year
  • CVD is the main cause of death in women in all countries of Europe and is the main cause of death in men in all countries except France and San Marino
  • Each year 450 000 people in Europe die from CVD due to smoking
  • Each year 185 000 people in the EU die from CVD due to smoking
  • Diets are generally improving in Northern and Western European countries, but deteriorating in Southern, Central and Eastern European countries.
  • It is universally recognised that a diet which is high in fat, salt and sugar and low in complex carbohydrates, fruit and vegetables increases the risk of CVD. For instance, if people across the EU actually consumed the minimum recommended level of fruit and vegetables, i.e. 400 g/day, this could prevent 7% of CHD (coronary heart disease) and 4% of stroke, or save over 50.000 lives per year. If they consumed 600 g/day we could reduce the risk of CHD by almost 18% and stroke by over 10%, or save over 135 000 lives per year1.
  • Obesity levels are rising dramatically in Europe. Around a third of CHD and a fifth of stroke in the developed world is due to high levels of BMI - and almost 60% of hypertensive disease is due to high BMI.
  • Over 23 million adults in the EU have diabetes, and the level is rising
  • Levels of physical inactivity are high in Europe. It is estimated that over 20% of CHD and 10% of stroke in the developed world is due to physical inactivity

Trends

  • A parental history of CHD is considered to reflect genetic, biochemical and behavioural components that may predispose an individual to be at higher risk of cardiovascular disease
  • Lifestyle interventions and risk factor modification reduce cardiovascular morbidity and mortality
  • There is considerable variation between European countries in patient lifestyles, especially for smoking (30% in Hungary, 15% in Italy), and in the use of prophylactic drug therapies
  • Coronary surgery patients who stop smoking are more likely to survive.

The rationale for prevention of cardiovascular disease:

  • The mass occurrence of CVD relates strongly to lifestyles and modifiable physiological factors
  • The underlying pathology is usually atherosclerosis, which develops insidiously over many years and is usually advanced by the time the symptoms occur
  • Death, myocardial infarction and stroke nevertheless frequently occur suddenly and before medical care is available, and many therapeutic interventions are therefore inapplicable or palliative
  • Risk factor modifications have been unequivocally shown to reduce mortality and morbidity, especially in people with either unrecognised or recognised CVD

The priorities for CVD prevention in clinical practice are:

  1. Patients with established coronary heart disease, peripheral artery disease and cerebrovascular atherosclerotic disease
  2. Asymptomatic individuals who are at high risk of developing atherosclerotic cardiovascular disease because of:
    1. Multiple risk factors resulting in a 10 year risk of ≥5% now (or if extrapolated to age 60) for developing a fatal CVD event
    2. Markedly raised levels of single risk factors: Cholesterol ≥8mmol/l (320mg/dl), LDL cholesterol ≥6mmol/l (240 mg/dl), blood pressure ≥180/110 mmHg
    3. Diabetes type 2 and diabetes type 1 with microalbuminuria
  3. Close relatives of
    1. Patients with early onset atherosclerotic cardiovascular disease
    2. Asymptomatic individuals at particular high risk
  4. Other individuals encountered in routine clinical practice

Strategies to make behavioural counselling more effective include:

  • develop a therapeutic alliance with the patient
  • gain commitment from the patient to achieve lifestyle change
  • ensure the patient understands the relationship between lifestyle and disease
  • help the patient overcome barriers to lifestyle change
  • involve the patient in identifying the risk factor(s) to change
  • design a lifestyle modification plan
  • use strategies to reinforce the patients' own capacity to change
  • monitor progress of lifestyle change through follow-up contacts
  • involve other health care staff wherever possible

Recommendations for CVD prevention

  • No use of tobacco
  • Adequate physical activity - at least 30 minutes 5 times a week
  • Healthy eating habits
  • No overweight (body-mass index (BMI) of less than 25 kg/m)
  • Keep a blood pressure of lower than 140/90 mm Hg
  • Blood cholesterol below 5.0 mmol/L /190mg/dl
  • A LDL cholesterol concentration of less than 3.0 mmol/L
  • Normal glucose metabolism
  • Avoidance of excessive stress
  • Use appropriate prophylactic drugs when necessary
  • Screen close relatives of patients with premature cardiovascular disease

References

The European Guidelines on CVD Prevention in Clinical Practice

Screening of family members of patients with premature coronary heart disease - Results from the EUROASPIRE II family survey - European Heart Journal (2003) 24, 249-257

Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries - Principal results from EUROASPIRE II - European Heart Journal (2001) 22, 554-572. EUROASPIRE Study Group. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001; 357:995-1001

European Cardiovascular Disease Statistics 2005 Edition - © British Heart Foundation, February 2005 - © European Heart Network, February 2005.

1 Fruit and vegetable policy in the European Union : its effect on the burden of cardiovascular disease, EHN, Brussels, 2005.

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