Reducing Cardiovascular Disease Burden by Therapeutic Lifestyle Changes

Implementing such an approach to health care systems by education programs is not effective enough. Specific proposals are needed for health care systems, with motivation being a key element of success.

The procedures proposed in primary care include long-term regular monitoring of personal risk factors (globally expressed as the Heart Score value), basal obesity management, establishment of nurse-led preventive cardiology clinics, and introduction of positive economic incentives by health insurance companies to decrease the levels of risk factors in population. There is a great potential of wide-spread use of the Heart Score value to evaluate the cardiovascular risk both as an individual parameter and a global group parameter, for instance, to calculate the average value of people aged 40-65 years in GPs’ health care on biannual basis. An alternative method is to calculate and monitor the difference between calendar and biological age counted according to the Heart Score program. An excellent fact is that this program is available in European national languages. For motivation, it is necessary not only to reward those patients who have been able to reduce significantly their levels of the Heart Score value and to reduce their pharmacotherapy burden, but it means to reward those GPs who have been able to manage their patients to change their lifestyle habits, thereby decreasing the averaged group Heart Score value and extending healthy lifetime prognosis. For this purpose, it is necessary to submit individual and group heart score values to the health insurance companies regularly, which will pass the group results to the national health statistic institutes. There is a potential to use telemedicine tools for data transmission (BP, cholesterol). Such an approach enables to modify health policies at national levels, and, perhaps, at the EU level too. Basal obesity management at the GP level should include bioimpedance analysis (BIA) of body composition, analysis of one-week daily food intake record, specific diet and exercise advice including partial fasting system and recommended heart rate values during exercises etc. Both these activities at the GP level may be led by qualified and experienced nurses who would be able to provide detailed information on food choice, food labels reading, cooking procedure, exercising, sleeping hygiene etc.

The procedures proposed in the specialized sphere include implementation of ambulatory cardiovascular rehabilitation (ACVR) in cardiology care centers or in specialized cardiovascular prevention and rehabilitation centers. In this approach, ACVR is considered not as a regular, controlled physical training only, but as complex secondary prevention including patient’s education, behavioral changes, management of smoking, stress, obesity, sleeping disturbances, and optimal pharmacotherapy, too [1]. In some cases, a questionnaire on sexual function and possible depression should be used. The final stage of the ACVR cycle includes a final test focused on patient’s education and physical fitness levels. The results of the final test at the end of the cycle should be submitted to health insurance companies. Continuing long-term contacts with every patient during following home-based training are envisaged.

In the public health area continuing education is needed, but perhaps more effective than simple recommendations. For instance, to substitute the recommendation to consume less than 10% of the daily energy intake by gram expression in new guidelines [2]. Food labels use gram content per 100g of the food product. There is a need to explain people that less than 10% of the daily energy intake means less than 30g per day for average person with daily caloric intake of 2500kcal. The recommended daily fiber intake should be 30-45g, but even in a daily diet including a lot of fruit, legumes and vegetables daily fiber intake reaches approximately 20g. People should be aware that the increase of whole grain cereals intake is needed rather than rely on fruit and vegetable intake only. There is a huge offer of various food supplements on the market and people buy them in tremendous quantity. However, people lack official experts’ information on their actual efficiency enabling them to choose supplements that would really help them. Perhaps clinical excellence centers at national or EU level may publish regularly information on their efficiency using evidence-based medicine approach.

1. Marco A, Ana A, Ugo C (2020) Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. Eur J Prev Cardiol 30.
2. Piepoli MF, Hoes AW, Agewall S, Christian A, Carlos B, et al. (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 37(29): 2315-2381.