2023-10-30 09:24:00
Cardiovascular diseases remain the main cause of mortality worldwide for 20 years, according to the WHO. Despite the efforts in prevention, the development of therapeutic innovations and the awareness of society, this mortality continues to grow, so it is necessary to activate strategies that eradicate this trend and in which all the actors involved participate: Ministry of Health, industry pharmaceutical industry, autonomous communities, scientific societies and patients.
Heart disease has been the leading cause of mortality worldwide for 20 years. According to the World Health Organization (WHO), They claim 17.9 million lives a year and are responsible for one in four deaths.
Despite the efforts in prevention, the development of therapeutic innovations and the awareness of society – all of this has made it possible to reduce sedentary lifestyle, unhealthy diets or smoking – this mortality continues to grow.
“The good news is that these deaths are related to risk factors that can be detected and treated, such as cholesterol. Statistical data show that only 1 in 10 people are aware of their cholesterol levels,” he says. Shirley Gil Parrado, General Director General Medicines Sanofi Iberia.
“Cardiovascular diseases are the main cause of death in Spain. The good news is that they are related to risk factors that can be detected and treated, such as cholesterol.” Shirley Gil Parrado
To mitigate the epidemic of cardiovascular diseases in Spain, the report ‘Towards better cardiovascular health in Spain‘ puts in black and white the situation of cardiovascular health in the National Health System (SNS). This is a document commissioned by the European Federation of the Pharmaceutical Industry (EFPIA) and Farmaindustria, and prepared by the consulting firm PwC – in which Health, scientific societies, patients and doctors have participated – which highlights the interdependence between cardiovascular policies in Spain and in the EU.
And in April of last year, the Interterritorial Council of the National Health System approved the ‘Cardiovascular Health Strategy of the National Health System (ESCAV)’ with the aim of achieving a change in the cardiovascular health of the population and promoting healthy habits. Not in vain, Spain was the first EU country to approve a national strategy on cardiovascular health and the implementation plan for this strategy is currently being debated.
“In general terms, we have excellent cardiovascular health and a lower cardiovascular risk than other southern European countries. This is due to a combination of factors, where the diet we follow is more varied, with more fruit, more vegetables, fish, legumes and less processed food. But despite being in a good situation compared to the countries around us, there is a certain concern because in recent years we have witnessed a rebound (also in Europe) in the incidence of cardiovascular diseases after decades of reduction in mortality. We believe that this may be related to the fact that we have more overweight and more obesity in the population, diseases linked to cadiometabolic syndromes,” explains Alessandro SionisHead of Section of the Acute Cardiological Care Unit of the Hospital de la Santa Creu i Sant Pau in Barcelona and professor at the Faculty of Medicine of the Autonomous University of Barcelona.
The expert also adds that in the last 10 years, health spending on cardiovascular diseases has increased by 20%, and that we must address this situation with health policies at the national level.
Against this backdrop, preventing cardiovascular diseases has become a challenge, and Sionis is committed to constant investment in improving health with good primary prevention policies.
“The pillars of primary prevention should be the family and the school, because it is a job that has to start in childhood, educating children and getting them used to adopting a healthy lifestyle,” Sionis.
PREVENTION OF CARDIOVASCULAR EVENTS
“A patient who has already had a heart attack has a 20% risk of having a new heart attack in the next 12 months. “However, this risk can be substantially reduced by doing very good secondary prevention, controlling blood pressure, changing lifestyle habits, quitting smoking, eating well or controlling LDL cholesterol levels (According to data collected between 2017 and 2020, 86% of patients with atherosclerotic cardiovascular disease do not reach ideal cholesterol levels within two years after diagnosis)“, assures Alessandro Sionis.
“According to data collected between 2017 and 2020, 86% of patients with atherosclerotic cardiovascular disease do not reach ideal cholesterol levels within two years after diagnosis”
The management of cardiovascular diseases (CVD) in Spain, like the rest of Europe, has been focused mainly on the treatment of acute episodes, such as myocardial infarctions or embolisms, instead of combining prevention and treatment. If a patient survives a cardiovascular event, it is very important to prevent its recurrence; to do so, the main risk factors must be controlled, such as LDL cholesterol.
According to data from 2015, the total healthcare cost related to CVD was 9,240 million euros in Spain, emergency cases and hospitalization reached 37% (3,400 million euros) and primary and outpatient care for these diseases accounted for only the 25% (2,350 million euros). In 2022, ischemic heart disease alone accounted for hospitalization costs of 694 million euros.
These data suggest that, given that there is no systematic program for early diagnosis of CVD and its risk factors, a significant percentage of the disease burden goes undetected. In Spain, only one in ten people is aware of their ideal cholesterol levels and it is estimated that around three million cases of hypertension (6% of the Spanish population) are undetected.
“Strategy 556 in Spain: After the heart attack, the patient should be visited between 4 and 6 weeks with a new analysis to see if the cholesterol reduction has been achieved with the treatment prescribed after hospital discharge” Alessandro Sionis
The head of the Section of the Acute Cardiological Care Unit of the Hospital de la Santa Creu i Sant Pau in Barcelona also remembers that the reduction in mortality from cardiovascular disease in Spain, especially from the 70s and 80s, is more evident when there begin to be drugs and surgeries to address said disease. “40% of the reduction in mortality in recent decades is attributable to pharmacological treatments to treat hypertension, diabetes, dyslipidemia, patients with heart attacks, heart failure… All of this, in the end, has an important impact on cardiovascular health. Thus, for example, now mortality from heart attacks is 6%, while in the 90s it was 15%.”
Although the trend is decreasing, cardiovascular diseases continue to be the main cause of death in our country. 1 in every three deaths in Spain is due to these pathologies, a figure much higher than all deaths caused by cancer. Preventing these deaths and improving the quality of life of people who survive a heart attack, as well as their caregivers and family members, has a positive impact on both our society and the efficiency of the health system.
THE ‘556 STRATEGY’
The first year after an acute coronary syndrome (ACS) is a very vulnerable period for patients. In this regard, the recommendations of the guidelines of the European Society of Cardiology and Atherosclerosis reflect a 2-step strategy, where in an ideal scenario, the patient would reach his optimal pharmacological treatment in less than 12 weekswhich is the most vulnerable period of the post-infarction patient’s life.
“The European guidelines recommend, after a heart attack or stroke, reaching LDL cholesterol levels below 55 milligrams per deciliter, and also recommend a reduction in cholesterol of at least 50%. After the heart attack, the patient should be visited between 4 and 6 weeks with a new analysis to see if cholesterol reduction has been achieved. with the treatment prescribed after hospital discharge. Hence the name of the ‘556 Strategy’ in Spain,” says Alessandro Sionis, one of the authors of the strategy.
“A patient who has already had a heart attack has a 20% risk of having a new heart attack in the next 12 months. However, this risk can be substantially reduced by doing very good secondary prevention.” Alessandro Sionis
Sanofi works with healthcare professionals to promote the ‘556 Strategy’, which aims to ensure that all patients who have suffered an acute coronary syndrome reach the LDL-C goal below 55 mg/dL in a maximum of 6 weeks.
“Avoiding deaths (13,463 people died from a myocardial infarction in 2021) and improving the quality of life of people who survive a heart attack, as well as their caregivers and family members, has a positive impact on both our society and efficiency. of the health system,” says Shirley Gil Parrado.
He adds that Sanofi has been working for years to improve the health of people who suffer from cardiovascular diseases: poorly controlled cholesterol, diabetes and hypertension, which are the three most important risk factors for the development of cardiovascular diseases.
“We work from two perspectives. On the one hand, generating awareness among the population about the importance of taking care of cardiovascular health. And on the other hand, working daily to research and provide innovative treatments that improve people’s lives. It is a joint effort that we must carry out through an alliance of the health system, patients and the pharmaceutical industry. We will not rest until cardiovascular diseases stop being the main cause of death in our country,” the directive concludes.
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