This article is part of our special report Cardiovascular health.
SPECIAL REPORT / Europe’s leading cardiologists have advised policymakers to look into unexpected areas such as e-cigarettes and personalised medicine in their efforts to prevent cardiovascular diseases.
Prevention of cardiovascular disease is often limited to public health campaigns focusing on physical activity, healthy eating, reducing alcohol consumption or smoking.
At a time of rising obesity, unhealthy lifestyles and changing demographics, prevention is considered the most cost-effective way of reducing the economic burden of cardiovascular disease on healthcare systems.
But prevention is also about finding alternative solutions for smokers, minimising cardiovascular risks through personalised medicines and offering better training to healthcare providers, according to Europe’s leading cardiologists.
Medical experts at the European Society of Cardiology (ESC) congress in London last week highlighted three examples that policymakers should consider to think differently about prevention.
And when it comes to prevention, tobacco is a case in point.
Smoking is the second cause of cardiovascular disease (CVD) after high blood pressure, according to the World Heart Federation, causing nearly 10% of heart disease worldwide.
While smoking bans have greatly contributed to reduce mortality, policymakers should now look into e-cigarettes, said Peter Hajek, a professor of Clinical Psychology and director of the Health and Lifestyle Research Unit at the Wolfson Institute of Preventive Medicine.
Hajek has looked into the latest studies on e-cigarettes and challenged what he believes is a generally negative view of them among policymakers.
E-cigarettes are harmful, he said, but much less than traditional smoking. And contrary to popular wisdom, there is also strong evidence that smoking e-cigarettes or ‘vaping’ is not a stepping stone for young people to take up smoking, he claimed.
“There’s absolutely no doubt that smokers who turn to vaping reduce risks dramatically. They would be best off quitting smoking of course, but for many this is not really an option,” Hajek told the ESC congress in London.
E-cigarettes contain cartridges filled with liquids containing nicotine, at higher or lower concentrations. The device heats the liquid and delivers the nicotine to the user in a cloud of vapour: There is no burning of tobacco, and no toxic smoke.
Hajek even criticised the European Commission for cracking down on snus, a smokeless tobacco product which is banned for sale across the EU, except in Sweden, where it has been used traditionally. Although damaging to human health, snus is widely considered less harmful than smoking, he claimed.
“Sweden is at the bottom when it comes to [deaths from] smoking,” Hajek said in reference to the country’s tobacco statistics. “You cannot help thinking that if the EU did not ban snus, then all countries would be where Sweden is. A large number of unnecessary lung cancers could have been avoided. This was a very serious mistake in public health regulation,” Hajek said, adding he fears something similar will happen with e-cigarettes as well.
EU Policymakers have recently debated whether to ban e-cigarettes in order to prevent young people from starting taking up smoking.
After years of negotiations, EU regulators decided that e-cigarettes that contain more than a certain amount of nicotine must be sold, and subjected to the same regulations, as medical devices. The directive came into force since April 2014, and member states have until May 2016 to bring their legislation into line.
Another area of prevention showcased at the ESC congress is personalised medicine, tailored to the needs of individuals.
‘One-size-fits-all’ medicines can be less effective and sometimes ignore the wellness of individuals, said Mary Kerins, a cardiac rehabilitation manager at St. James’s Hospital in Dublin.
Kerins defined personalised medicine as “providing timely, precise, personalised intervention and treatment”, with drugs dosed to suit the individual needs of patients. She encouraged healthcare providers to look into this as an effective approach to prevention and care, saying it could be highly efficient at reducing the risk of a cardiovascular event.
Personalised medicine also involves patients much more in clinical research, for example in stem cells therapy. According to Kerins, researchers can learn a lot from working closer with patients, who can in turn influence interventions based on their individual priorities.
Turning to cardiovascular disease prevention, Kerins highlighted “mass screenings” as a necessary tool to be used in combination with personalised medicine. But she also mentioned key issues that are holding back research in personalised medicines, including inconsistent legislation across Europe as well as overly stringent data protection rules.
Nurses take affair
Last but not least, the ESC congress focused on training for medical staff as an often overlooked aspect of cardiovascular disease prevention.
Nurses are on the frontline when it comes to prevention and could play a decisive role in reducing cardiovascular diseases, said Barbara Fletcher from the Global Cardiovascular Nursing Leadership (GCNL), a trade organisation.
Fletcher said the GCNL has dealt with cardiovascular prevention internationally since 2011, keeping nurses up to date on cardiovascular prevention to raise life expectancy in both developed and developing countries.
“For four decades, nurses have treated patients at risk of cardiovascular disease due to for example smoking, obesity, diabetes and physical inactivity. We are not new to this. We have experience in this. We have shown that we are capable of reducing cardiovascular risk factors,” Fletcher said.
Different educational systems and the fact that technologies vary around the world means that the organisation will work closely with nurses so that they can keep their important role in prevention.
Ultimately, the goal is to reach the World Health organisation’s (WHO) goal to reduce global death and disability from cardiovascular disease by 25% by 2025, Fletcher said.