Prevention of cardiovascular disease
After an alarming rise in the mortality from atherothrombotic cardiovascular disease (CVD) in the 1950s in most industrialised countries, the CVD epidemic levelled off and an impressive decline started. That decline has occurred in most European countries, commencing earlier in some compared to others. The majority of the reduction in CVD mortality rates is attributable to preventive efforts more than to changes in care. However, the epidemic is still very dynamic in different parts of the world and changes may again occur in the wrong direction; it was recently reported that the rate of decline in CVD mortality has decelerated in the USA and was absent in young adults in Norway. It could also well be that prevention of CVD in the present generation of adults is to a certain extent only a postponement of events or a reduction of the case fatality rate rather than a complete prevention. Prevention of premature CVD mortality and of disability adjusted life years (DALYs) is great but could be associated with an increase in the prevalence of CVD in the elderly and in the very old, with an epidemic of end-stage CVD such as chronic heart failure, renal insufficiency and vascular dementia with all its consequences in terms of more need for care than for cure and of increasing healthcare costs.
Lifestyle, behaviour, socio-economic issues
Societal changes may affect the CVD epidemic in different ways. Globalisation, migration, socio-economic changes and unemployment may have influences. Differences in CVD health among countries, regions and neighbourhoods have increased over the years; these inequalities can be explained by components of human behaviour such as diet, exercise, smoking and job-related features but also by overcrowding, unemployment and other indicators of deprivation. Life expectancy increases continuously with income.
Regarding the dietary habits of the population, changes have occurred in different areas. For example, the intake of salt and saturated fats has been reduced in most societies. The food industry has reduced the presence of Tran’s fatty acids in different food items; this has been promoted by regulatory initiatives in some communities. However, the potential to prevent CVD through dietary adaptations is still poorly implemented. Adherence to a balanced diet is generally limited; the control of elevated blood pressure, dyslipidaemias and dysglycaemia can largely be improved through changes in lifestyle. Achieving better adherence with dietary recommendations requires the understanding of the determinants of poor compliance. At the population level, structural measures such as product information and consumer-friendly nutrition labelling may improve health-friendly choices. Energy-dense, nutrient-deficient foods are generally highly accessible and inexpensive; the marketing of such foods could be limited and taxed. On the other hand, fruits and vegetables tend to be more expensive; the subsidising of their costs may be useful.
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Current Trends in Cardiology