Prevention of cardiovascular disease: Much more is needed

Atherosclerotic cardiovascular disease (CVD) is worldwide the number one cause of premature mortality, of disability adjusted life years and of increasing health care costs. It affects all countries but the dynamics of the epidemic have been very different between continents and regions. In industrialized countries a peak was reached in the late 1960s and the age-standardized CVD mortality rates have declined thereafter in most of these communities mainly through lifestyle changes and risk factor control.1–3 In Europe results from surveys among coronary patients and in high-risk subjects have repeatedly shown that the implementation of the European Society of Cardiology (ESC) guidelines on CVD prevention in clinical practice is poorly achieved in real life.4–9 The potential for a further reduction of CVD rates is still incompletely utilized in most communities in Europe and North America. In the meantime CVD has become a major burden in other regions of the world due to demographic changes but also to changes in lifestyle such as increased tobacco smoking, decreased physical activity, less balanced diets, increasing obesity; all this has been associated with more arterial hypertension, dyslipidaemia and dysglycaemia.