Prevention Key to the Future of Cardiovascular Medicine

July 27, 2016

Despite major advances in technology and treatment over the past several decades, cardiovascular disease is still the leading cause of death in the world. In fact, cardiovascular illness has continued to increase at an epidemic rate globally despite a general reduction in age-related mortality over the last 25 to 30 years.

As a self-proclaimed eternal optimist and arguably the world’s leading cardiologist, Valentin Fuster, MD, PhD, is convinced that the way out of this paradox is clear—prevent disease earlier and manage it more effectively through health promotion and education.

Speaking in June during a much anticipated visit to the Ottawa Heart Institute for the Wilbert J. Keon Endowed Lectureship, the renowned physician-scientist explained how a lifetime devoted to medicine and research in numerous international positions has convinced him that the surest way to turn the tide on the spread of cardiovascular disease is through a change in our behaviour.

Facing the Economic Reality

“Billions of dollars are spent for the treatment of cardiovascular disease, but not enough investment is made in terms of education and the promotion of health,” he said. “Yet, both of these areas are key to preventing a disease that is the leading cause of death worldwide.”

The enormous and continually growing economic burden of treating cardiovascular disease is unsustainable, said Dr. Fuster, and moreover, it places standards of care out of reach in much of the world. He argues that the challenge of the decade for researchers and clinicians is to keep the disease subclinical – that is, prevent it from progressing to a point where it becomes symptomatic and requires interventionby getting communities to modify daily routines and acquire healthier habits.

“Treating disease is much more expensive than preventing it in the first place,” he said. “We need to focus more on health than disease by promoting health and identifying disease as early as possible.”

Among several other positions which he currently holds, Dr. Fuster is Medical Director and Director of the Cardiovascular Institute at the Mount Sinai Medical Center in New York. He also works in his native Spain as the General Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III and Chairman of the SHE Foundation (Science for Health and Education).

He created the SHE Foundation out of a firm belief that one of medicine’s biggest challenges for the 21st century is to move from treating heart disease to preventive health care. The organization is investigating ways to foster environments in which children, young people and adults have the ability to act positively towards their health. One initiative is Healthy Communities, a health promotion program based on scientific evidence aimed at promoting behavioural change in the Spanish town of Cardona.

“By involving everyone in the city in the development of the strategy, we want to create a ‘healthy city’ where both physical and social environments promote quality of life, healthy development and healthy lifestyles at all stages of life,” said Dr. Fuster.

Innovative Approaches to Managing Heart Disease

Another major concern that Dr. Fuster is tackling head-on is the general under-usage of cardiovascular drugs. “Patients simply don’t stay on their medications,” he explained. “Some studies have shown adherence rates as low as 20%. The situation is worse in poorer countries.”

When cost or the difficulty in managing multiple prescriptions keeps patients from taking their blood pressure or cholesterol medication, their disease progresses and often requires more resource-intensive care. Dr. Fuster sees this as “low-hanging fruit”an issue that can be addressed without great technical difficulty or expense and will have a major impact by improving public health and alleviating the demand for health services.

Dr. Fuster’s development of an inexpensive polypill (combining an ACE inhibitor for blood pressure, a statin for cholesterol and aspirin for stroke in one pill) has been driven by the need to simplify the issue of drug adherence. Because the basic drugs are inexpensive, potential health care savings from proper treatment is massive.

Dr. Fuster’s unique international perspective has been forged over four decades of research and clinical work on four continents and his contributions to cardiovascular medicine have had an enormous impact. In recognition for his work, he is the only cardiologist to have received the highest research accolades of all four main international cardiology organizationsthe American Heart Association, the American College of Cardiology, the European Society of Cardiology, and the Interamerican Society of Cardiology.