Reduce premature and preventable deaths caused by CVD and diabetes

Prepared by: Kristyna Cillikova, Diagnoza FH, z.s., Czech Republic

How can we reduce premature and preventable deaths caused by cardiovascular diseases and diabetes? The case for an European Cardiovascular Health Plan

This year’s Czech Presidency of the Council of the European Union (EU) has chosen prevention and promotion of public health as a priority in the area of health. In this context, particular attention has been paid to cancer and rare diseases. However, at the end of the Czech Government’s six months in Brussels, it can be said that the area of cardiovascular (CV) diseases, which are the leading cause of death in Europe – five thousand Europeans die from them every day, has not been neglected. There are therefore growing voices in the Union calling for a common systemic solution to this health crisis. The Czech Presidency has supported both the necessary paediatric screening for familial hypercholesterolaemia (FH) and negotiations on the creation of a common European action plan against CVD.

• How can we reduce the number of preventable and premature deaths caused by CVD and diabetes?
• Why is early detection of these diseases important?

These questions were answered by a panel of experts who met on 12 December at the Permanent Representation of the Czech Republic to the European Union, with the support of the Czech Society of Cardiology (CKS), the European Society of Cardiology (ESC), the European Diabetes Forum (EUDF) and the European Federation of Pharmaceutical Industries and Associations (EFPIA). The event was held under the auspices of the Czech Presidency of the Council of the EU. The invitation to active participation and discussion was accepted on behalf of the Czech Republic by Prof. Aleš Linhart, President of the CKS, Prof. Miloš Táborský, Vice President of the CKS, Mr. Jakub Dvořáček, Political Deputy Minister of Health and Ondřej Knotek, Member of the European Parliament.

The European Society of Cardiology was represented by the Chairman of the ESC Advocacy Committee, Prof. Francesco Consentino, from Karolinska Insitutet in Sweden. Bart Torbeyns, Executive Director of the European Diabetes Forum, spoke on behalf of the diabetes community, and cardiovascular patients were represented by Birgit Beger, CEO of the European Heart Network (EHN). The European Commission’s perspective on the issue was provided by Marianne Takki, from DG SANTE, the Directorate-General for Health and Food Safety, the group for the prevention and treatment of non-communicable diseases. It was the European Commission that launched the NCD initiative “Healthier Together” at the end of 2021, which aims to support EU countries in identifying and implementing effective measures to combat CVD, diabetes, respiratory, mental and neurological diseases between 2022 and 2027.

The party is over

Prof. Linhart pointed out that the “party is over” – European society seems to be at a turning point, where after decades of steady decline in CV morbidity and mortality due to better care and positive lifestyle changes, CV morbidity and mortality is on the rise again, even in Western countries. The unfortunate trend is likely to be accelerated by the ongoing socioeconomic crisis and the legacy of the covid-19 pandemic in the form of neglected prevention. Prof. Consentino added that public attention to CV diseases has, moreover, been insufficient and experts have not yet acted as skilled lobbyists. All these are probably the reasons why five thousand Europeans die every day from CV diseases, which is twice as many as from cancer. Nearly 60 million Europeans are living with some form of CV disease, which is associated with premature deaths, hospital admissions, disability and high costs of care – CV diseases account for 20% of all premature deaths (i.e. under 65 years of age) and claim 16% of total EU healthcare spending annually, which is about €200 billion. If we look at the Czech Republic, the situation is just as dramatic – 48 000 people die from CVD each year and around 23% of the population is treated for CVD.

Diabetes is also an ever-growing threat, and its carriers, of whom there are about 35 million in Europe, are by far the most likely to die from CV complications, and diabetes shortens their lives by 10 to 14 years. Under-diagnosis is also a problem – one in three diabetics are unaware of their disease and it is estimated that 20-40% of myocardial infarctions occur in people who have not previously been diagnosed with CV disease. As Magdalena Daccord, Chief Executive of the FH Europe network, added from the audience, a classic example of underdiagnosis is FH, which, according to epidemiological data, affects one in 300 people. However, 90% of them are not aware of their inherited condition and a CVD risk factor. FH is often first manifested by an acute myocardial infarction. “Cardiovascular diseases are often mistakenly perceived only as diseases associated with a poor lifestyle and the responsibility is shifted to the citizens themselves. This then leads to many inequalities,” says Prof. Consentino. He added that the truth is that CV diseases affect people of all ages. Most CV diseases are preventable – so a strategy that includes early screening and comprehensive prevention practices at all stages of life may be the key to change. “We lack a European action plan,” stated Prof. Consentino.

If we have a cancer plan, we can have a cardiovascular plan

Mr. Dvořáček expressed his conviction that the next presidency country, Sweden, will build on the Czech efforts and carry the banner of CVD prevention further. “The progress achieved in rare diseases shows that the cooperation between member countries is good. But through the European Commission we want to continue to focus on cardiovascular and we want to support activities towards a common European strategy or plan defining what needs to be done to improve cardiovascular health in Europe,” he said. According to Mr. Dvořáček said that the existing Europe’s Beating Cancer Plan has already paved the way – so he sees no reason why a similar plan for CVD could not be created. Czech cardiologists also support the idea of a plan, even at the national level. Prof. Linhart recalled that the National Cardiovascular Programme was established in the Czech Republic in 2013, but admitted that since then new challenges have been added and many changes have occurred in diagnosis and therapy. The plan will need to be updated and strengthened in both primary and secondary prevention or in redefining cooperation with GPs – the upcoming ten-year anniversary of the first concept seems to be an ideal opportunity for this.

The logical question is what a common European strategy will bring to the Member States and what is its ‘enforceability’. An explanation was attempted by Mr. Dvořáček. In his words, the recommendations or opinions of the European Commission reflect “best practice” from which Member States can choose objectives that are achievable for them, which then become a good lobbying tool on domestic soil. In other words, European recommendations can put pressure on national political representation, including demands to secure funding. “In my view, it is not that difficult to move forward in an area as important as cardiovascular disease,” he said. Marianne Takki added that the European Commission’s role is to support member states’ efforts to find the most achievable model, while helping to find consensus among countries. “I welcome the idea of linking CV disease and diabetes on the path to an action plan,” she added.

For a plan to be actionable, it must grow from consensus. Those present agreed that experts from all the specialties concerned must be involved, but health insurers, governments and patients or patient organisations cannot be left out. “Patient organisations bring education that is often more acceptable to patients than that of doctors. I am therefore pleased that patient organisations are becoming increasingly active,” said Prof. Linhart. Mr. Dvořáček added that part of the whole progression must be to set up a model to support patient organisations in their irreplaceable work while maintaining their independence. This problem, he said, is being addressed by most member states. Patients’ organisations need to be provided with funding for their day-to-day operations, as grant contributions tend to be project-related and do not allow for funding the running of the organisations – they are then exposed to a high degree of uncertainty and their long-term planning and growth are greatly hampered.

We can’t do it without data

Collecting health data and at the same time interpreting it correctly is essential, among other things, for providing better healthcare. The secure storage, exchange and use of health data at European level is to be ensured by the forthcoming European Health Data Space (EHDS), which, according to Mr. Dvořáček said that the emerging action plans should also play an important role. The opening and sharing of data will be essential for both patients and healthcare providers. Prof. Táborský, who has long advocated for the development of digitalization of medicine in the Czech Republic, described, among other things, the new E-lab project, a national database collecting all laboratory tests of patients, which brings many benefits for everyday patient care, but also has potential in the field of preventive care. He also added that another solution to move the field of CV disease and diabetes prevention forward could be the so-called European digital platform for CV prevention and diabetes, which is operational in some countries and should be supported by politicians.

If you’re failing to plan, you’re planning to fail

The efforts to secure an European Cardiovascular Action Plan have been already long underway. Birgit Beger aptly stated that if you’re failing to plan, you’re planning to fail. A plan will also enable action to be taken in a systematic and timely manner. She reminded everyone that prevention is always better than curing a pre-existing disease (and of course it is also cheaper). Prevention started early enough has many benefits for both the individual and society, especially since more than 90% of CV diseases are preventable. In this context, prevention should be seen as an ethical decision and at the same time, as Czech MEP Ondřej Knotek stressed, as an investment in the future of society, not as an expense. He added that the threats of CVD in Europe are clear and the situation needs to be addressed. Creating a common plan and implementing it seems to be the right way to go. He also assured that the European Parliament is paying attention to CV diseases. He considers himself to be a great supporter of screening and prevention strategies, but the population needs to be motivated to take part in them, for example through clear campaigns. According to Ondřej Knotek, the issue of inequalities, which are evident both between the so-called poorer and richer regions of the Czech Republic and between individual Member States, should also be addressed.

Especially in the case of hereditary CV diseases, such as FH, universal paediatric screening is an effective prevention tool. As Birgit Beger recalled, the Czech Presidency of the EU Council in September this year sponsored an international meeting in the Senate of the Parliament of the Czech Republic, which resulted in the Prague Declaration calling for the implementation of universal paediatric screening for FH in EU countries as an effective and cost-efficient tool, which was adopted as an EU best practice by DG SANTE in 2021. Birgit Beger also stressed, like other speakers, the need for collaboration between the EU and Member States, between the public and private sectors and underlined the importance of the creation of EACH (European Alliance for Cardiovascular Health) as the first initiative of its kind, bringing together 16 leading CV health organisations to mobilise European politicians to commit to CV care and develop a policy roadmap for Europe.

The December meeting, under the auspices of the Czech Presidency, cannot be seen as anything other than a confirmation of the tendencies that are growing in the European area, despite other real threats such as the energy crisis and the impact of the war in Ukraine – to stop the disproportionately high and progressive CV mortality in EU countries, by working together and with the participation of all key parties, using best practices based on effective screening for risk factors, early prevention, accurate diagnosis and rapid and targeted intervention at the right place. All this using the increasingly sophisticated capabilities of the digital world.

What was also heard:

“Screening can be very simple. Any doctor can measure blood pressure, heart rate, cholesterol and body-mass index, and listen to the heart.” F. Consetino

“Only a strong cardiovascular plan with political support and funding will bring tangible change.” B. Beger

“Prevention is sexy.” M. Taborsky

“The power of patients today in pushing for change and advocating for cardiovascular health is enormous.” J. Dvoracek

“A preventive checkup is like an annual car service. If we consider it natural to have our car checked, we should be able to do the same for our health. The earlier and more regularly, the better.” B. Torbeyns