This issue of European Cardiology reflects the wide spectrum of contemporary cardiology, from prevention to the final stage of cardiovascular disease, heart failure. I find this highly appropriate, since I believe it is important for cardiologists, irrespective of sub-speciality or particular field of interest, to take an active role in cardiovascular prevention. Today, public healthcare budgets are almost entirely spent on treating cardiovascular disease, and only minor public resources are left for prevention. In my experience, most people in general as well as most cardiovascular professionals do not really think about cardiovascular prevention, but rather about treating cardiovascular disease. This is quite unlike the situation in dental care – for 50 years or so we have been used to visiting the dentist to prevent disease in our teeth and adjacent tissues. If you think about it, it is rather peculiar; very few people die from dental disease, whereas around half of people in Europe die from cardiovascular disease. One might therefore argue that it should be the other way around. Personally, I have gone from being a heart failure specialist to becoming a cardiovascular preventionist. At some point I started to think that, although modern cardiovascular medicine offers heart failure patients a much better and longer life than was the case 10 or 20 years previously, it must surely be superior to prevent the disease from developing at all. Cardiovascular prevention should enable a longer life without disease, not just a longer life with disease. After all, we often cannot cure cardiovascular disease, so many of our patients live the rest of their lives with the disease. I assure you that my life as a cardiovascular preventionist is indeed fascinating and rewarding. I can definitely recommend it. Indeed, who would be better suited to work with cardiovascular prevention than a cardiologist?
I believe it is important that cardiologists and other cardiovascular specialists take an active role in developing preventative cardiovascular medicine. We should all take an interest in and carefully read the European Heart Health Charter, a document about cardiovascular prevention that was recently initiated by the European Society of Cardiology. All healthcare professionals in the cardiovascular field should stand behind this important document, which is in the process of being officially ratified by the EU and its Member States. It clearly outlines the importance of cardiovascular health and defines what this is. At first glance it might not seem as radical as I believe it is. After all, it states that cardiovascular health should be a human right to any European citizen born in this millennium, at least up to 65 years of age.
I do not believe that the costs of cardiovascular prevention will be covered to any significant extent by the public healthcare system in the near future. The costs of treating cardiovascular disease will most likely be too high to allow more than limited public resources to be transferred to the field of prevention. I think that in the short term cardiovascular prevention will be mainly financed by private citizens and by companies as a form of extended company health service. Perhaps insurance companies will also take an interest in this field. However, in the long run I believe that financing cardiovascular prevention is the responsibility of public healthcare systems. It is our responsibility as cardiovascular healthcare professionals to inform politicians and other decision-makers and make them realise this.
Soon after I got used to the idea of cardiovascular prevention, I found myself thinking that it is an obvious idea that goes without saying. How could I not always have been thinking like that? Still, just a few years ago I was deep into disease treatment, with little interest in cardiovascular prevention. Hopefully, most people will go through a similar transition in the near future.