European Heart Network Research Articles

Results of European Heart Network Pilot Project “A Vending Machine for a Friend”

Children often grow up in obesogenic environments that promote unhealthy diets. Consequently, many European children are overweight. Vending machines (that usually distribute foods rich in fat, sugar, salt and calories) located in schools are one factor that contributes to this. The aim of the pilot project “A vending machine for a friend" of the Italian Society for Cardiovascular Prevention (SIPREC) in collaboration with the Lithuanian Heart Association (LHA) and under the aegis and sponsorship of the European Heart Network (EHN), has been to regulate and improve the nutritional quality of food and beverages served in vending machines, cafeterias and school canteens. In the pilot project were included 3 Italian and 2 Lithuanian high schools. Seventy-eight Italian students and seventy-eight Lithuanian students in the 2^nd and 3^rd year of high school, joined the intervention group, undertaking to consume only foods and beverages from “healthy” vending machines and healthy snacks in the cafeteria, versus seventy-seven Italian students and ninety-seven Lithuanian students in the 2^nd and 3^rd year of high school who were part of the control group. The intervention has also included an education and training program on healthy food dedicated to the students and to the teachers. The results of the Body Mass Index (BMI) in the intervention group (-2.1% in the Italian intervention group versus +0.0% in the control group and -2.2% in the Lithuanian intervention group versus +0.5% in the control group), and of the questionnaire administered after the seminars (+53.4% of improvement in the Italian intervention group versus just +2,5% in the control group, and +21.6% of improvement in the Lithuanian intervention group versus +3% in the control group), indicates the good results achieved by the students who have participated in the project. “Healthy” vending machines together with educational programs might be a good strategy for creation of a healthy nutritional environment in high schools to tackle overweight and obesity in adolescents. Bigger studies are needed to prove concept.

Contemporary cardiovascular risk prediction

Cardiovascular disease remains an important health problem, accounting for 3·9 million deaths every year in Europe alone. 1 Wilkins E WL Wickramasinghe K Bhatnagar P et al. European cardiovascular disease statistics 2017. European Heart Network, Brussels2017 Google Scholar To reduce the incidence of cardiovascular disease, risk prediction models are widely used for risk-tailored management, such as antihypertensive and lipid-lowering treatment. More than 350 risk prediction models have been developed for cardiovascular disease in the past decades. These models are mainly based on long-standing cohort data, but only a few models have been validated externally to test their generalisability in present settings. 2 Damen JA Hooft L Schuit E et al. Prediction models for cardiovascular disease risk in the general population: systematic review. BMJ. 2016; 353: i2416 Crossref PubMed Scopus (427) Google Scholar Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation studyWe constructed a large prospective cohort study representing typical patients in primary care in New Zealand who were recommended for cardiovascular disease risk assessment. Most patients are now at low risk of cardiovascular disease, which explains why the PCEs based mainly on old cohorts substantially overestimate risk. Although the PCEs and many other equations will need to be recalibrated to mitigate overtreatment of the healthy majority, they also need new predictors that include measures of socioeconomic deprivation and multiple ethnicities to identify vulnerable high-risk subpopulations that might otherwise be undertreated. Full-Text PDF

Cardiovascular disease in Europe: epidemiological update 2016.

This is the fourth in a series of papers describing the burden of cardiovascular disease (CVD) within Europe.1–3 CVD remains the most common cause of death worldwide, with the 2013 Global Burden of Disease (GBD) study estimating that CVD caused 17.3 million deaths globally. It accounted for 31.5% of all deaths and 45% of all non-communicable disease deaths, more than twice that caused by cancer, as well as more than all communicable, maternal, neonatal and nutritional disorders combined. The 2013 GBD also reported that CVD caused a greater number of deaths and was responsible for a greater percentage of all deaths than in 1990 when 12.3 million deaths were attributed to CVD, corresponding to 25.9% of total deaths.4 Previous publications in this series have reported that despite the decreases in CVD mortality in Europe more than 4 million people die from CVD across the continent every year, with more than 1.4 million dying prematurely, before the age of 75 years.1–3 In this article we present an updated overview of the burden of CVD in Europe, including new statistics for mortality, morbidity, and treatment. Where possible we provide statistics for all CVD and for coronary heart disease (CHD) and stroke in particular. All data included here are updated from previous publications and we present prevalence statistics for the first time. This series of publications describing the current burden and distribution of CVD and CHD in Europe has been based on the European Cardiovascular Disease Statistics 2012 report,5 the fourth in a series of Europe-wide compendia, which was published jointly by the European Heart Network and the European Society of Cardiology. Throughout this article, we present statistics from a number of data sources chosen with consideration of data quality, date of most recent update, and coverage of the …

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation.

In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors.

The Heart of 25 by 25: Achieving the Goal ofReducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and WorldHeart Federation.

In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors.

Air pollution: 6.6million premature deaths in 2050!

Air pollution: 6.6million premature deaths in 2050!

Public health nutrition actions across 14 EU countries: a qualitative study to elicit the views of policy makers and thought leaders

BackgroundCardiovascular disease (CVD) is the main cause of death in Europe. EuroHeart II is a research programme led by the European Heart Network and European Society of Cardiology to address the burden of CVD in Europe and to determine interventions for prevention of avoidable deaths and disability. One aspect identifies the most effective public health nutrition policies, to inform future evidence-based strategies to promote cardiovascular health. MethodsWe mapped national nutrition policies across 30 European countries, then contacted and recruited potential participants in 14 of those countries. Participants were identified through various sources; for example, the European Heart Network, via national Heart Foundations, via published work, the internet, and the snowballing technique. Before interview, participants were emailed information about the project, the interview questions (developed and piloted with senior stakeholders in the UK), and a summary of public health nutrition policies in their country. Policy makers, academics, and other public health nutrition experts at the national level shared their views on a range of possible approaches to public health nutrition strategies, covering the entire policy spectrum. The interviews were done in English, either by person, telephone, or Skype. The interviews typically lasted 45–60 min. The interview questions were open ended and used as a topic guide. This structure enabled the interviews to be led by the interviewees, not the interviewers. Also, the interviews were flexible with no maximum time limit. Interviews were transcribed and entered into NVivo software. The Framework approach was used to analyse transcripts. Cross checking of coding and interpretation of data was done by three researchers from the research team. FindingsWe did 70 interviews in 14 countries across Europe. The interviews enabled more up-to-date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation on the ground. European countries are at very different stages of addressing public health nutrition issues. Most are promoting dialogue, recommendations, and guidelines (often regarded as an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar, and total fat. Legislation, regulation, or fiscal interventions targeting salt, sugar, fat, or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed that they were more effective than voluntary measures and information-based interventions, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible than regulation and fiscal measures. InterpretationPublic health nutrition policies in Europe represent a complex, dynamic, and rapidly changing arena. Encouragingly, most countries are engaged in activities intended to increase consumption of health food and decrease the intake of junk food and sugary drinks. Exemplar countries showing notable progress might include Finland, Norway, Iceland, Hungary, the UK, and Portugal. However, most countries fall well short of optimum activities. Implementation of potentially powerful nutrition policies remains frustratingly patchy across Europe. This study provides only a snapshot of activities up until 2012; developments are ongoing, and data may not be complete and will require regular updating. We propose future work to identify and assess population-based policy actions across the WHO European Region to expand and refine the evidence base. This information could support development of a nutrition policy assessment method for each country to use to promote—and implement—healthier food strategies. FundingEuropean Union Health Programme.

Identifying the most effective public health nutrition policies: The views of policy-makers and thought-leaders across 14 EU countries

Background EuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology. One aspect of the project aimed to identify the most effective public health nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular health. Methods We mapped national nutrition policies across 30 European countries. We identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of public health …

OP15 Identifying the most effective public health nutrition policies: The views of policy-makers and thought-leaders across 14 EU countries

BackgroundEuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology (http://www.ehnheart.org/euroheart-ii.html). One aspect of the project aimed to identify the most effective...

New Basic Care Goals Seek to Rein In Global Rise in Cardiovascular Disease

LEADERS FROM THE CARDIOVASCUlar disease prevention community have joined forces to endorse a plan to reduce the global burden of noncommunicable diseases. The plan follows adoption of a global target to reduce premature noncommunicable disease mortality 25% by 2025 by ministers of health attending the World Health Assembly in Geneva, Switzerland last May. Noncommunicable diseases, such as cardiovascular disease, stroke, cancer, chronic respiratory disease, and diabetes mellitus, have replaced communicable diseases as the world’s major disease burden. Almost half of this burden comes from cardiovascular disease, which is the leading global cause of death, accounting for about 17.3 million deaths each year—a number expected to increase to more than 23.6 million by 2030. In addition, about 80% of these deaths occur in lowand middle-income countries, where human and financial resources are most limited. Members of the global public health community believe such dire forecasts can be minimized if nations implement simple and inexpensive therapies and lifestyle modifications within the next few years. To that end, leadership from the World Heart Federation, the American Heart Association, the American College of Cardiology Foundation, the European Heart Network, and the European Society of Cardiology issued an advisory September 17 that sets target levels for 8 cardiovascular disease risk factors. It also sets drug therapy target levels for individuals at high risk for myocardial infarction and stroke and calls for making available basic technologies and generic essential medicines required to treat major noncommunicable diseases.

Bringing prevention to the population: an important role for cardiologists in policy-making

The European cardiology community has long been involved in the prevention of the disease it was trained to cure and treat. This commitment is actually engraved in the mission statement of the European Society of Cardiology (ESC): ‘to reduce the burden of cardiovascular disease in Europe’. The ESC reflected this commitment to cardiovascular disease prevention with the creation of dedicated committees, such as the working group on Epidemiology and Prevention and the working group on Cardiac Rehabilitation and Exercise Pathology. In 2004, these merged to form the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), an affiliated association of the ESC. However, cardiology practice with individual patients is very different from mass strategies. Cardiologists therefore soon sought the support of policies to help implement prevention plans at the population level. In 2004, the then President of the ESC, Professor Michal Tendera stated that ‘Cardiologists alone cannot handle the problem of cardiovascular disease’; this declaration is even truer for preventing the disease. The European Society of Cardiology engaged in influencing European policies in 2002, with the creation of a dedicated Committee for EU Relations. They became familiar with EU policies and learned to adapt to EU jargon. ‘Prevention’ strategies had to evolve into ‘Heart health promotion strategies’. The horizontal approach adopted by the European Commission in the field of public health prompted the ESC to address risk factors and upstream health determinants. What it takes to be a good heart doctor is not necessarily what it takes to be a good spin doctor. However, cardiologists adapted swiftly in providing accurate expertise and alarming statistics on the huge burden and inequity of the disease across the EU and including also Europe in a wider perspective. The ESC has then successfully engaged, along with Brussels-based heart health promotion NGO, the European Heart Network …

Women and research on cardiovascular diseases in Europe: a report from the European Heart Health Strategy (EuroHeart) project

Cardiovascular diseases represent the major cause of mortality in women and in men.1,2 However, gender differences in the clinical presentation of cardiovascular diseases have been demonstrated3 and some therapeutic options may not be equally effective and safe in men and women.4 Furthermore, gender differences in pharmacokinetics and pharmacodynamics may contribute to a different response to cardiovascular drugs in women when compared with men.5,6 Accordingly, preventive and therapeutical interventions should be tested in populations that fairly represent the gender distribution. In contrast, under-representation of women in cardiovascular trials has been clearly demonstrated in the past. The European Heart Health Strategy (EuroHeart) project of the European Society of Cardiology (ESC) and the European Heart Network (EHN), co-funded by the European Commission, addressed the issue of women representation in cardiovascular clinical research in Europe. The enrolment of women in cardiovascular clinical trials funded by the NHLBI was 38% between 1965 and 19987 and 27% between 1997 and 2006.8 Furthermore, only 13 of 19 studies reported gender-based outcomes. In the European cardiovascular clinical trials of the same period, the proportion of women enrolled varied between 16 and 25%, although the female prevalence of clinical conditions under study in the general population was similar to that of men. In 2005, the European Medicines Agency and the ESC Policy Conference on Cardiovascular Diseases in Women recommended a significant representation of women in clinical trials.3 The current representation of women in European cardiovascular research has been assessed in the EuroHeart project. Observational studies; randomized clinical trials, including meta-analyses; European registries; Guidelines and Statements of European Scientific Societies, published between 2006 and June 2009, have been analysed, focusing on the number and percentage of women enrolled, age of participants, time of follow-up, availability of the analysis of …

Prevention of coronary heart disease in clinical practice: Summary of Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention ,

Since the first Joint European Societies—European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension—Task Force recommendations on coronary heart disease prevention in clinical practice were published in 1994 [ [1] Pyörälä K, De Backer G, Graham I, Poole-Wilson P, Wood D on behalf of the Task Force. Prevention of coronary heart disease in clinical practice; recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J 1994;15:1300–1331. Atherosclerosis 1994;110:121–61. Int Soc Hypertens News 1995;1:6–12. Google Scholar ] new scientific evidence has emerged in both secondary and primary coronary prevention, particularly in relation to lipid lowering. Therefore, a second Task Force was convened by the three major societies, including professional representatives from behavioural medicine, primary care and the European Heart Network, to revise the recommendations.

Prevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention ,

Since the first Joint European Societies—European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension—Task Force recommendations on coronary heart disease prevention in clinical practice were published in 1994 new scientific evidence has emerged in both secondary and primary coronary prevention, particularly in relation to lipid lowering. Therefore, a second Task Force was convened by the three major societies, including professional representatives from behavioural medicine, primary care and the European Heart Network, to revise the recommendations.