More action needed against cardiovascular disease in Europe, says expert –

With cardiovascular disease being the leading cause of death in Europe, we need to drastically step up efforts to tackle it early in life, urged pediatrician and professor at the University of Ljubljana, Urh Groselj.

At EU level, Europe is still far too tolerant of cardiovascular disease compared to recent political ambition to tackle other public health issues, such as the flagship plan to combat against cancer, said Groselj.

“The cancer community is taking very good steps to fight cancer and find cancers, and I think the same should be done. [with cardiovascular diseases]“, said the expert.

Every year there are more than six million new cases of cardiovascular disease in the EU and 1.8 million related deaths, according to the Commission, which has estimated that it costs the EU economy more of 210 billion euros per year.

Limiting cardiovascular disease risk factors would not only benefit individuals, but would greatly reduce the burden on health systems.

Similar calls were made at a September event at the Czech Senate in Prague on pediatric screening for familial hypercholesterolemia (FH), with several participants calling for a European policy plan to tackle cardiovascular health.

Although there may still be some waiting time for a major initiative such as the EU cancer plan, increased political attention has recently been given to cardiovascular disease.

In June, the EU executive proposed the Healthier Together initiative targeting non-communicable diseases (NCDs), including cardiovascular diseases.

The European Commission Health Service (DG SANTE) has also set up in 2021 a portal dedicated to good practice on non-communicable diseases, which will disseminate calls for good practice in cardiovascular health.

A place to start

Following his research on FH and European pediatric screening for the disease, Groselj called the work “a showcase for larger-scale cardiovascular disease prevention.”

“I think there is growing recognition that we need to do primary prevention [of cardiovascular diseases] in childhood, if you really want to be successful,” Groselj said.

HF is an inherited disease affecting approximately 1 in 250 people that results in higher cholesterol levels than in the general population. It is caused by a faulty gene in the DNA, which is passed down from generation to generation.

FH leads to an increased risk of early cardiovascular disease, especially coronary heart disease (CHD).

It is estimated that 90% of people with HF do not know they have the disease and that undiagnosed HF can shorten their lives by 16 years compared to those with a diagnosis.

Although there are many steps that could be taken to reduce cardiovascular disease, screening children for HF and treating them early is one step that could significantly reduce the risk for many people.

Politically, it also attracts attention. September’s event in the Czech Senate resulted in the signing of the Prague Declaration on Pediatric FH Screening, a call to action for policy makers to recognize the importance of early FH detection.

The Commission’s best practice portal also recognized pediatric FH screening programs in the Netherlands, Slovenia and Czechia in 2021, which Groselj called a milestone.

However, many countries in Europe still lack systematic screening programs for HF. That should be able to change, according to Groselj.

“Once you have the broad professional consensus and some political tools (…), I think it’s easier. You can also fairly easily justify cost-effectiveness and so on, which is something you typically have to do when approaching health decision makers,” Groselj said.

“I would say that everyone with enough motivation to change things, I believe, has enough tools to do so,” he added, admitting that it could be smoother in some countries if they had already have programs in place where FH screening could easily be added.

Eliminate the risks

In Europe, Slovenia and the Netherlands are among the leaders in systematic pediatric screening for FH.

The Netherlands was a pioneer in the development of cascade screening for HF, Groselj said. Cascade screening means systematic screening for FH among family members of people already diagnosed with FH.

In Slovenia, on the other hand, universal screening for HF is practiced. This means that all children have their cholesterol levels tested and those with high levels undergo genetic testing. If a child has FH, a family cascade screening can be set up.

“It’s an opt-out system, so if a family decides they don’t want this test, they don’t get tested. But over 90% of families decide to have their child tested,” Groselj said. , adding that he is fully covered by National Health Insurance.

According to Groselj, it is possible to “normalize [children’s] risk of long-term cardiovascular disease” if they are diagnosed around the age of 8-10 years, what he calls a “window of opportunity”.

Often, countries already have various screening programs or systematized check-ups for children, which facilitates the introduction of pediatric screening for HF.

“If you catch this disorder early, I would say it’s very safe, simple, and accessible to treat people,” Groselj said.

[Edited by Gerardo Fortuna/Nathalie Weatherald]