ESC opens Brussels Bureau: the European Heart Agency

Transcription

1 European Heart Journal (2013) 34, doi: /eurheartj/eht128 ESC opens Brussels Bureau: the European Heart Agency The ESC aims to influence policies for the prevention of cardiovascular diseases with a presence at the center of European politics Science is not enough to stop the cardiovascular disease (CVD) epidemic. Fifty per cent of CVD deaths could be prevented with proper policies. In light of the growing CVD burden, policies need to focus on primary prevention. On 27 February 2013, the ESC opened an office at the heart of European politics. ESC Brussels Bureau first meeting While the treatment of heart diseases in both primary and hospital care has been very successful with mortality rates declining markedly over the past 20 years, at community level, the primary prevention of CVD, despite the notable successes of anti-smoking legislations, has done less well. Cardiovascular disease is the biggest killer in Europe, with a huge impact on the economy, said ESC president Prof. Panos Vardas. It is our belief that public policies must be put in place to encourage its prevention. We have come to Brussels to be more active in the decision-making process. Studies have shown that CVD costs the European economy E196 billion a year, of which 54% is direct health expenditure which represents a cost of approximately E212/person/year. Cardiologists have been successful in the treatment and secondary prevention of heart disease. Although CVD-related mortality remains high, it has declined over the past 20 years thanks to the development of Clinical Practice Guidelines and new drugs and devices. Nevertheless, there is still a gap in primary prevention. Experience shows that science is not enough, said Prof. Vardas. All the evidence shows that we need to exercise more, eat less, reduce alcohol consumption, and stop smoking. Unfortunately, this knowledge has had little impact on the rates of CVD-related morbidity Panos Vardas and mortality. We have not been as (credit Sam C. Rogers) successful in primary prevention as we have been with treatments and secondary prevention. Individual approaches have not been enough, the way forwards is for policies to be put in place in order to encourage populations to choose the healthy options. According to the ESC, up to 50% of CVD deaths in Europe could be avoided with proper policies. Growing evidence shows that interventions at population level can contribute to a healthier lifestyle. New ESC projects will also be based in the European Heart Agency. The ESC aims to support other EU priorities from its Brussels bureau, announced Prof. Vardas. We have projects in the pipeline relating to personalized medicine, e-health, novel technologies, health economics, quality metrics and assessment and of course, regulation of clinical trials and medical devices. All these will be part of the future European Heart Health Institute. Another important objective is to regroup all ESC activities concerning education. We will establish the European Heart Academy, which will include our activities regarding accreditation, certification, continuous medical development, relationship with universities and also courses resulting in post-graduate certification. The ESC, through its European Affairs Committee, is already part of initiatives such as the Members of the European Parliament (MEP) Heart Group, the Alliance for Biomedical Research in Europe, and the European Chronic Disease Alliance. Some of its activities, such as the CardioScape project, will be based in the new Brussels office. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author For permissions please journals.permissions@oup.com

2 1528 CardioPulse Members of the European Parliament (MEP) Heart Group The MEP Heart Group is a discussion forum aimed at promoting measures to reduce the burden of cardiovascular disease in the European Union and raise cardiovascular disease as a priority on the EU political agenda. Structure of the MEP Heart Group The Members of the European Parliament (MEP) Heart Group provides an opportunity to generate dialogue, outreach and activities at EU and Member State level. It is made up European Union Flag of MEPs who have an interest in addressing cardiovascular disease (CVD) in the EU and in contributing to initiatives that aim to reduce the burden of this disease. Several of its supporters have a medical background and/or are members of the European Parliament Health Working Group. The MEP Heart Group is led by two co-chairs, Linda McAvan MEP and Cristian Silviu Buşoi MEP. European Heart Network s and ESC s close collaboration with MEPs on cardiovascular health (CVH) in the context of the Public Health Action Programme (PHAP) and CVH Resolution have increasingly highlighted the importance of an on-going dialogue about addressing Europe s number one killer. Several initiatives are currently underway to provide Member States with the appropriate tools to help reduce the burden of this disease. This includes the European Heart Health Charter, the EuroHeart Project, the European Parliament Resolution on action to tackle cardiovascular disease, and the revised European Guidelines on CVD prevention in clinical practice. Together, the European Heart Network, the ESC, and the co-chairs of the Heart Group agree that the scope and resonance of such initiatives would be further enhanced if co-ordinated under this representative umbrella group with crosspolitical and multiple Member State representation. Objective of the MEP Heart Group The main objective of the group is to promote measures that will help reduce the burden of CVD in the European Union and raise awareness of the disease among target audiences through a series of dedicated activities. Some of these activities may include: acting as a hub for exchange of experience and data on CVH and CVD prevention between relevant stakeholders; driving the development of political prevention guidelines on CVH promotion and prevention of CVD; liaising with relevant stakeholder groups to promote CVH and prevent CVD. Stakeholder groups may include patient, public health, professional and scientific organizations, industry, and others as appropriate; participating in roundtables or discussion groups in the EP and in Member States to address CVD risk factors and advocate new policy initiatives; providing input and guidance on inclusion of CVD in the revised PHAP, the EU Health Strategy, other health policy initiatives, and the EP Resolution on cardiovascular health. More information at: Enquiries to: secretariat@mepheartgroup.eu Air pollution and myocardial infarction mortality Exposure to air pollution is associated with increased mortality after myocardial infarction Air pollution contributes to an increased number of deaths among patients who have been admitted to hospital with myocardial infarction (MI), according to a study published in European Heart Journal recently. 1 The largest study yet to investigate the links between fine air-borne particulate matter (PM) and patient survival after hospital admission for acute coronary syndrome (ACS) found increased mortality with increased exposure to PM2.5: tiny

3 CardioPulse 1529 particles that measure 2.5 mm in diameter or less, 30 times smaller than a human hair. The main sources of PM2.5 in the UK are emissions from road traffic and industry, including power generation. Cathryn Tonne MPH., ScD, lecturer in environmental epidemiology at the London School of Hygiene and Tropical Medicine (London, UK) said: We found that for every 10 mg/m 3 increase in PM2.5 there was a 20% increase in the death rate. For example, over one year of follow-up after patients had been admitted to hospital with ACS, there would be 20% more deaths among patients exposed to PM2.5 levels of 20 mg/m 3, compared to patients exposed to PM2.5 levels of 10 mg/m 3. Dr Tonne and her colleague Paul Wilkinson, Professor of environmental epidemiology at the London School of Hygiene and Tropical Medicine, estimate that death rates would be reduced by 12% among ACS patients if they were exposed to naturally occurring PM2.5 rather than the higher levels they were actually exposed to. This translates into 4783 deaths occurring earlier than they should, due to exposure to PM2.5 from man-made sources. The researchers linked records of patients who survived hospital admission for ACS in England and Wales between 2004 and 2007 with modelled average air pollution concentrations for The patients were followed up until the end of the study in April 2010 or their death, whichever occurred earlier. During the average follow-up time of 3.7 years, there were deaths. The researchers adjusted their results to take account of the patients sex, age, medical history, treatments and drugs, whether or not they smoked, socio-economic factors such as income, education, and employment, and where they lived. The air pollution modelling of average exposures for different regions of the country showed the highest average exposures to PM2.5 and other air pollutants in London (an average of 14.1 mg/m 3 ), while the North East of England had the lowest exposure (an average of 8.4 mg/m 3 ). However, people s individual exposure to PM2.5 varied widely within each region. Evidence has been growing that exposure to air pollution is associated with the development of heart disease, but, so far, few studies have investigated its effect on survival after MI and the findings have been inconsistent. In addition, it is known that patients from poorer backgrounds often live in more deprived areas with higher levels of air pollution and that they tend to do less well after a diagnosis of heart disease than patients of a higher socioeconomic status. This raises the possibility that exposure to air pollution may explain, in part, the differences in prognosis among ACS patients from different backgrounds, said Dr Tonne. Our findings confirm an association between PM2.5 and increased rates of death in survivors of ACS. Our findings also show that PM2.5 exposure contributes only a small amount to differences in survival after ACS among people living in areas with different socio-economic conditions after accounting for factors such as smoking and diabetes. The implication is that while reducing levels of PM2.5 will lead to increased life-expectancy and is an important public health priority, it isn t likely to reduce socioeconomic inequalities in prognosis very much. There are likely to be many other factors that are more important than PM2.5 exposure in explaining socioeconomic inequalities in prognosis, and this requires further investigation. The study s strength was its size and the amount of available detailed data on the patients. A limitation was that the researchers lacked specific causes of death and so were unable to discover how many were heart related, although they suspect the majority were. Exposure to air pollution was based on where the patients lived and did not take account of amounts of time spent travelling or away from home. In an accompanying editorial, 2 Prof. Pier Mannucci, Scientific Director of the IRCCS Ca Granda Maggiore Policlinico Hospital Foundation in Milan (Italy), writes: The most important message is that reduction in the amount of pollutants in metropolitan areas does indeed decrease cardiovascular mortality within a time interval as short as a few years. He adds that the huge toll of deaths...worldwide owing to air pollution could be substantially reduced by approximately one million annually from the current estimate of 1.34 million if the World Health Organization recommendations pertaining to the limits of PM2.5 concentrations were implemented. The responsibility for controlling air pollution rests on national governments of the planet. In the meantime, individual clinicians should make patients aware of the existence of this risk, and encourage them to be cognizant of the media alerts on air quality in their living areas. Finally, he calls on the European Society of Cardiology to develop scientific statements on air pollution and cardiovascular disease in order to make governments, clinicians, and the public more aware of the problem. References 1. Cathryn Tonne, Paul Wilkinson. Long-term exposure to air pollution is associated with survival following acute coronary syndrome. Eur Heart J 2013;34: Mannucci PM. Airborne pollution and cardiovascular disease: burden and causes of an epidemic. Eur Heart J 2013;34:

4 1530 CardioPulse Cardiovascular disease data to be standardized across Europe ESC is to create an inventory of cardiovascular disease registries and a task force on data standardization Budgets are becoming tighter and health systems are under pressure to address the increasing burden of chronic diseases. Tackling chronic diseases requires up-to-date information on disease prevalence and risk factors but Europe currently lacks data on cardiovascular disease (CVD) that is standardized and can be compared. The European Society of Cardiology (ESC) announced on 4 March 2013 that it is creating a task force on CVD data standardization so that data from different registries can be compared. The ESC will also collaborate with the PAtient REgistries initiative (PARENT) Joint Action European Union Flag a to create an inventory of registries this will help the cardiology community find existing data and avoid duplication. The moves follow a meeting of cardiology organizations and experts initiated by the ESC in Brussels, Belgium, to discuss the need for co-ordination and standardization of CVD data in Europe. b The ESC task force on CVD data standardization will build on Cardiology Audit and Registration Data Standards (CARDS). ESC experts were instrumental in CARDS, which was an initiative of the Irish Ministry of Health and Children and co-funded by the European Union (EU) in CARDS aimed to standardize the definitions used in the collection of CVD data and resulted in three data sets for three subspecialties of cardiology: percutaneous coronary intervention, clinical electrophysiology, and acute coronary syndromes. Prof. Frans Van de Werf (Leuven, Belgium), who was the instigator of the Brussels workshop, said: CARDS is nearly 10 years old and should be updated. We need to get more countries and studies involved in implementing it so that everyone can benefit from standardized, comparable (credit Sam C. Rogers) data on cardiovascular disease. Prof. Van de Werf said: The inventory of registries will provide a single entry point for health professionals, researchers and policy makers looking for real life data on cardiovascular diseases. It will also avoid duplication of data collection in Europe. Countries will be able to use country-level data from European registries, rather than establishing their own registry. This will save valuable time and money. ESC press office a Joint Actions are projects carried out by the European Union (EU) and one or more Member States or by the EU and the competent authorities of other countries participating in the health programme. The PARENT Joint Action was established to support cross-border use of patient registry data for public health and research purposes, including health technology assessment, pricing, and vigilance and safety. It brings support to EU member states for the development and governance of patient registries. b The meeting was attended by: British Heart Foundation Health Promotion Research Group (BHFHPRG), University of Oxford (UK), European Commission, DG SANCO (Belgium), European Heart Network (Belgium), European Organisation for Research and Treatment of Cancer (Belgium), European Organisation for Research and Treatment of Cancer (EORTC) (Belgium), European Society of Cardiology (France), National Institute for Health and Welfare (Finland), National Institute of Public Health (Slovenia), Organisation for Economic Co-operation and Development (OECD), Universities of Ghent and Brussels (Belgium).

5 CardioPulse 1531 Vegetarian diet cuts risk of heart disease by one-third There is no increase in life expectancy for vegetarians and the jury is out on the protective effects of fish A vegetarian diet reduces the risk of being hospitalized or dying from ischaemic heart disease by one-third, according to the latest results of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study. 1 That s a finding that we think is due to the fact that the vegetarians have lower cholesterol and lower blood pressure, says lead author Dr Francesca Crowe (Oxford, UK). The vegetarians also had a lower body mass index (BMI, in kg/m 2 ) than the non-vegetarians, a factor that would contribute to their lower total cholesterol and lower blood pressure. But not all of the difference is explained by lower BMI, says Crowe. It could be lower saturated fat intake and higher polyunsaturated fat intake that s also lowering their cholesterol. While sodium intake is a determinant of blood pressure, dietary sodium is difficult to assess and the information was not available. The vegetarians had a slightly higher intake of fruits and vegetables, and the potassium content could help lower blood pressure. But Crowe says A lot of studies have found that fruits and vegetables lower the risk of heart disease but the exact mechanism through which they do that is not well established. Various aspects of the vegetarian diet are protective against heart disease. Crowe says that the main factor driving the association is likely to be their lower intake of saturated fat. Other contributing factors are higher intakes of polyunsaturated fat, the aforementioned fruits and vegetables, and dietary fibre. The principal harmful factor in the non-vegetarian diet appears to be increased saturated fat consumption, with meat being a prime source. The non-vegetarians also had a higher BMI. It is difficult to accurately measure calorie intake using conventional dietary assessment methods, but the higher BMI probably means that the non-vegetarians eat more. The researchers controlled for exercise, but it is another variable that is difficult to capture accurately. The vegetarians seemed to do slightly more vigorous activity than the nonvegetarians, says Crowe. Differences in energy balance, energy expenditure and intake could account for the differences in BMI. So what is the best advice for non-vegetarians on how to decrease their risk of ischaemic heart disease, apart from becoming a vegetarian? Lower saturated fat consumption, says Crowe. One of the sources of saturated fat is meat, especially red meat and fatter cuts of red meat; portions can be reduced or meat only eaten every other day. These are simple changes that nonvegetarians can make to lower their risk. Overweight people tend to gain a lot of weight when they hit an older age, which is also the time when they are at a higher risk of heart disease. Advice could be to limit weight gain, says Crowe, and then help on how to lose weight, although that s easier said than done. So, do vegetarians live longer, healthier lives or do they die at the same time of something else? Previous analyses at Oxford showed that mortality rates were similar between vegetarians and non-vegetarians. If the vegetarians are dying less from some causes then they re probably dying more from other causes, says Crowe. But it s not clear what. The study findings also beg the question; do the benefits of a vegetarian diet outweigh the protective effects of fish oils? The study cohort was divided into vegetarians and non-vegetarians who eat meat and fish. A next step in the research will be to study people in the cohort who do not eat meat but do eat fish. They may have a lower risk of heart disease than the people who eat meat and fish. Previous analyses from the EPIC-Oxford study showed that fish eaters have about the same BMI as that of vegetarians. Crowe says You would think that their risk should be lower than the people who eat meat and fish. The researchers also plan to investigate whether people with the highest intake of meat have the greatest risk of heart disease, compared with people who eat only small quantities of meat. Reference 1. Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and non-vegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr 2013;97: CardioPulse contact:, Managing Editor. docandros@bluewin.ch