Integrated programmes for cardiovascular disease risk reduction: the need for new models of care

Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity worldwide. Although mortality rates for CVD have fallen by up to three-quarters in the UK, it still accounts for 26% of all deaths there. It costs the UK economy over £15 billion each year.1 Declining CVD mortality rates increases the number of individuals surviving into old age with CVD, leaving them at increased risk for a subsequent event. For individuals who have not suffered an event, the presence of certain genetic, behavioural and biological factors increases their risk of CVD. At least 80% of CVDs are potentially preventable by the elimination of health risk behaviours through a combination of changes to lifestyle—diet, physical activity, smoking cessation and reduction in the harmful use of alcohol.2 These behaviours are modifiable when evidence-based behavioural models of change are employed.3 Across Europe and other western countries, there are vast improvements in the management of risk conditions like hypertension, diabetes, dyslipidaemia and acute CVD events through medical interventions, devices and pharmacological treatments, but addressing the underlying causes of the disease to prevent further morbidity and mortality is more important. The 2016 European Guidelines on CVD prevention in clinical practice define priorities for CVD prevention in clinical practice, risk assessment and treatment goals.4 Yet gaps still exist in the delivery of such knowledge into daily clinical practice as shown in the most recent European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE IV) survey where there was suboptimal control of risk …