From the last EuroPrevent towards the first ESC Preventive Cardiology Congress

The 15th year of the European Association of Preventive Cardiology (EAPC) was celebrated in Lisbon during the annual EuroPrevent Congress with scientific, educational and networking events. More than 1200 health professionals attended the Congress, which this year covered several special topics. These included a focus on the new environmental and psychosocial risk factors, such as the importance of natural and built environment as determinants or potentiators of cardiovascular disease (CVD). Growing evidences suggest that noise and air pollution lead to atherosclerosis, endothelial dysfunction, hypertension, myocardial infarction, stroke and heart failure through mechanisms that include perturbation of the autonomic nervous system and activation of prothrombotic, pro-oxidative and pro-inflammatory pathways.1,2 Also, psychological and psychiatric diseases have been shown to play an essential role in the development of CVD. The influence of social relationships on mortality is indeed comparable to well-known risk factors, such as obesity and physical activity throughout all ages; childhood disadvantage and maltreatment increase the risk of inflammation and cardiovascular disease throughout adulthood;3 in young adults, the healthy cardiovascular and metabolic functioning is influenced by social integration during adolescence;4 adults who have few social contacts or feel unhappy about their social relationships are at increased risk of premature mortality;5 finally, elderly people with an active social life have a reduced risk of hypertension and cardiovascular disease.6 Poor social relationships are associated with a 29% increase in the risk of incident cardiovascular heart disease and a 32% increase in the risk of stroke.7 Therefore, efforts to reduce CVD incidence should also consider psychological factors: addressing them by community programmes, cognitive–behavioural interventions and online resources would benefit public health. As such, the World Health Organization now lists ‘social support networks’ as a health determinant. On the other hand, cardiovascular events per se may worsen psychological and psychiatric diseases as well as impair the heart–brain axis. Exposure to modifiable cardiovascular risk factors in young and middle age adults influences the structure and integrity of the heart–brain axis: targeted prevention strategies may improve brain vascular health and cognitive function.6,8 Special ‘how-to-sessions’ that focused on different prevention and rehabilitation strategies were carried out. These included: alternatives on how to improve lifestyle, new ideas on how to help patients quit smoking, improve diet habits and increase physical activity, also during working hours; advice from experts on important common clinical situations relevant to sport, such as how to choose the right pacemaker for an athlete, prescribe exercise to patients with cardiac dysfunction, manage athletes with atrial fibrillation and congenital heart disease and those after myocarditis or infarct; how to set up both an exercise programme for patients with CVD and a cardiac rehabilitation programme, showing how to evaluate patients with CVD risk at entry of a multidisciplinary rehabilitation programme, how to assess muscle strength and set the intensity of exercise, adapt the exercise prescription and provide progression in the rehabilitation programme when different combinations of CVDs and risk factors emerge, but also what impact muscle electro-stimulation may have in certain clinical populations. Of note, some of these sessions involved patients also: it was the first time that patients were actively involved in EuroPrevent Congress and their testimonial was really welcomed by participants. The programme also covered basic science sessions with symposia dedicated to vascular biology, arterial stiffness and the autonomic system. Novel findings on omega-3 fatty acids and lipid mediators of the resolution of inflammation were illustrated. The results from the recent CIRT study showing no effects of low-dose methotrexate8 and the last outcomes of the debated ODYSSEY study, showing a reduced risk of recurrent ischaemic cardiovascular events with alirocumab compared with placebo,9 were presented along with the on-going COLCOT clinical trial (Colchicine Cardiovascular Outcomes Trial; ClinicalTrials.gov identifier: NCT02551094), which, hopefully, will help to define the potential role of anti-inflammatory drugs in cardiovascular medicine. The influence of resistance training on cardiac autonomic control in healthy compared with individuals with diseases was debated. The discussion started with an overview on the assessment and monitoring of cardiovascular autonomic functions from healthy to cardiac patients, evaluating the prognostic value of autonomic assessment on cardiovascular diseases and the effects of exercise training and daily physical activity.10–12 Very practical symposia were the main format of the sports cardiology section. A symposium was dedicated to addressing several aspects related to mass endurance events. Dr Aengevaeren (@VAengevaeren) and Dr Borjesson extensively presented the assessment of veteran runners. The symposium then focused on the prevention strategies to reduce the risk that participants and medical teams might face during mass endurance races. Prof. Sharma (@SSharmacardio), medical director for the London Marathon, showed the complex and challenging organization of the medical services, whilst very touching was the presentation of Dr Baggish (@abaggish), medical director for the BAA Boston Marathon, reporting his experience during the bombing attack at the marathon of 2013. Another symposium focused on the new recommendations for participation in sports for athletes with cardiovascular disease, based on real cases. In particular, it was discussed how to apply the new exercise recommendation to athletes with coronary artery disease, hypertension or cardiomyopathies.13–15 Updates on the role of eHealth in cardiac prevention and rehabilitation were provided in a dedicated symposium. The cost-effectiveness of technology-enabled cardiac rehabilitation was discussed. The features of the OptimEx, a project exploring the physical activity telemonitoring in patients with heart failure with preserved ejection fraction, and those of The Box project, focused on the role of SMART technology in myocardial infarction patients, were presented. The last results of the vCare and the SWEATY HEARTS projects were also shared. The vCare is an EU Horizon2020 project (769807) that assesses the role of virtual coaching for cardiovascular risk factor in elderly patients. The project, lasting for 48 months, involves centres from Romania, Germany, Italy, Spain, The Netherlands, Austria and Scandinavia. The SWEATY HEARTS project (590538-EPP-1-2017-1-IT-SPO-SCP) is an EU Erasmus and Sport project, including cardiac phase III telerehabilitation for ischaemic heart disease patients: a collaborative partnership to develop, implement and evaluate a model of long-term physical activity and behavioural change in European coronary heart disease patients. It involves centres from Italy, Austria, Hungary, Greece and Belgium. According to the idea of the SWEATY HEARTS project, patients will be gradually accompanied by the assisted sessions to the independent phase of cardiac rehabilitation long term activities. The switch is a very delicate point of the programme: to maintain the motivation, the patients have been forewarned of the risk of relapses, and family members were directly involved in the programme. Joint sessions with the Brasilian Ergometry Association (DERC), the Japanese Society of Cardiac Rehabilitation, the Portuguese Society of Cardiology and the Saudi Group for Cardiovascular Prevention and Rehabilitation (SGCVPR) were also organized, highlighting the continuous efforts of the EAPC to create, maintain and strengthen the collaboration with International Societies. Temporal trends comparing results from EUROASPIRE V16 with the previous EUROASPIRE IV17 survey were presented during EuroPrevent and showed still high prevalence of uncontrolled risk factors in people at high cardiovascular risk: no change in smoking, obesity, central obesity and achievement of physical activity target, insufficient therapeutic control among patients on blood pressure and lipid lowering medication, and/or diabetes. Improved control was noted only for lipid level, but low-density lipoprotein cholesterol and glucose control are still not well managed. Risk factor control in people at high CVD risk remains poor and more efforts must be made to improve cardiovascular prevention in apparently healthy people at high CVD risk. Interactivity was also one of the key components of the Congress in case-based patient-oriented sessions led by experts and covering practical and technical aspects of sports cardiology and rehabilitation, but also with quiz sessions of exercise prescription, cardiovascular risk assessment, cardiopulmonary exercise testing and sports cardiology, taking place during the meeting in the exhibition. The youngest participants this year were not cardiologists or trainees but medical students: grants for a free registration to the Congress were given to the first 20 medical students registering to the Congress. The young participants had the opportunity to meet during the Young Community open meeting, where Prof. Massimo Piepoli (@m_piepoli), Editor-in-Chief of the European Journal of Preventive Cardiology (EJPC), answered their questions and provided his advice on how to get their research published. Moreover, they had also the opportunity to get advice on their career development during the ‘Career-Café’, a speed dating format session where the future generation of cardiologists have the opportunity to interact with the leaders of their speciality, seeking career development advice and recommendations in an individual interview of 20 minutes with Ana Abreu, Paul Dendale (@PaulDendale), Diederick Grobbee (@Grobbee), Joep Perk (@JoepPerk), David Wood, Monika Hollander, Nicolle Krankel, Martin Halle (@ProfessorHalle), Arno Hoes (@arnohoes) and Antonio Pelliccia (@antoniopellic10), renowned professionals with years of successful careers behind them. The opportunity to meet, create collaboration and exchange ideas was also given in the now traditional evening networking event, organized for the Young Community but open to the whole association in order to give the opportunity for interaction between generations in a less formal environment. Considering that almost 800 abstracts were submitted to this year’s Congress, it’s clear that the competition for the young investigators’ awards sessions was fierce. This year the winners are: Carolina Ochoa-Rosales (Population science and public health); Oeyunn Kleiven (Sports cardiology and exercise); Nicolai Mikkelsen (Secondary prevention and rehabilitation). Best moderated posters awarded this year were those of Tiago Marques Pimenta; Iwona Bil-Lula; Peter Kokkino; Joao Sousa; Elena Cavarretta. During the General Assembly, the initiatives and successes of the EAPC were presented: the EAPC President, Paul Dendale, showed the future programmes of the Association, including the patient optimal care post myocardial infarct, the familial hypercholesterolaemia screening and the climate smart healthcare projects, as well as initiatives focused on nutrition and on more involvement of patients in the Association; Constantinos Davos, EAPC Treasurer, elucidated the 2018 report; Silvia Castelletti (@SilCastelletti), Membership committee chairperson, showed the numerous new benefits of being an upgraded member of the Association; Diederick Grobbe, past-president of the Association, launched the new centre accreditation programme; Massimo Piepoli, EJPC Editor-in-Chief, presented the successful progresses of the journal, which can now boast an impact factor of 4.542. In line with one of the aims of the Association, the healthy lifestyle promotion, this year a number of healthy activities were planned: a dancing demo, two yoga sessions and a bike tour were attended with great enthusiasm from numerous participants of all ages. The video of the dancing demo has collected more than 8000 views on Instagram. The Congress indeed was also greatly attended on all the Social Media with great success: #EuroPrevent was tweeted 2.5 K times, reaching 3.5 K visualizations and 11.6 impressions during the Congress. We are sure that the great success of this year will be replicated and overtaken next year in Malaga, where the Congress will be held 2–4 April with a new name and a new hashtag: ESC Preventive Cardiology Congress, #escprev2020. Don’t miss the opportunity to be part of it! The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.