Last year the American Heart Associations changed their definition of high blood pressure. Now, high blood pressure is any figure above 130/80 mmHg (13/8). A month ago, the European Society of Cardiology changed its guidelines for “bad” LDL cholesterol. Even in people without prior cardiovascular events, if they have a very high risk of having the in the future, the LDL must be below 55 mg/dL. This figure could even be reduced to 40 mg/dL in patients with repeat cardiovascular events.
Why am I providing this information? Not only so you check your blood pressure and your LDL, but I also want to delve into the need for these changes. Are we reaching a point of overdiagnosis? I don’t think so, because overdiagnosis is the diagnosis of a “disease” that will never cause symptoms or the death of the patient. In the area of cardiovascular prevention, the opposite is true. It is highly probably that untreated high blood pressure, high cholesterol, diabetes, tobacco use and a sedentary lifestyle will end up triggering symptomatic events and death. In fact, cardiovascular diseases are the leading cause of death worldwide, and this is particularly striking in western societies.
Unfortunately, the outlook is not good, and it appears that heart- and blood-vessel-related deaths will continue to increase in the future. There does not seem to be any true political will to change this. Some of the examples I provide below seem especially illustrative to me.
We have laws that require us to wear seat belts, but that allow us to smoke in the car, in the street and in other public places. I recently suffered together with my kids the company of a smoker sitting next to us at a sports stadium.
The Mediterranean diet is very effective in prevention, as has been proven recently in what is possibly the most often quoted Spanish study of all times (PREDIMED – Prevention with the Mediterranean Diet). However, in the shopping cart, another diet with processed foods is much more inexpensive than regularly consuming fruit, vegetables and fish. By the way, PREDIMED recommends extra virgin olive oil. Can you guess what the most expensive oil is? You guessed it.
Try the following test. When you travel around Madrid, look in Google Maps how long it takes in public transportation and walking. It is often similar or you arrive sooner walking. It’s the same at my hospital with the elevators (I would prohibit them except with just cause) and the stairs. However, public transportation is subsidized and walking is not. Elevators are free (although we all pay for them in public buildings). You even have to pay to go to the gym. It would be better to pay us an amount each time we exercised or used the stairs.
I could continue with many other examples. I don’t want to become tiresome, I just want to show that there is no real attempt to change the current situation. Meanwhile, each day, I still see more and more patients who come in with heart attacks that we spend millions of euros on to treat diseases that, in most cases, are preventable. In other words, in terms of costs, the above proposals (and I know they are expensive) are also cost-effective. It’s the old paradox: in medicine, we spend resources in tertiary prevention (treatment of diseases) when we should be doing it in primary prevention (avoiding them).
Is that utopian? No. There are successful cases in Spain and beyond. Santa Barbara, California; Nairobi, capital of Kenya, or Groningen, the Netherlands, are smoke-free cities in which you cannot smoke in any public space. In Tokyo they have begun offering incentives to workers who don’t smoke with extra days of vacation. In the Philippines smoking in public spaces carries fines of around €90 o up to four months in jail. There is even an entire country, Turkmenistan, where smoking has been banned. You can no longer smoke at the Camp Nou stadium; Talarn, in Lérida, has been a pioneering town in prohibiting smoking outdoors. The Galician beaches of Baiona, and the Las Canteras beach in Las Palmas are smoke-free.
The French government drew up a plan that paid €0.25 per kilometer travelled by bicycle to work. In just 6 months, the number of cyclists increased by 80%, and people participating in the program pedaled an average of five kilometers a day: some €25 a month per worker. Although this initiative was a pilot project, there are attempts at transferring it to a law that would establish a subsidy for all French citizens who chose to bike to work.
Levying taxes on soft drinks and foods high in saturated fats and, on the other hand, subsidizing fruits and vegetables would lead to beneficial changes of diet that would improve health, according to several studies and metanalyses conducted by experts from New Zealand. Helen Eyles and her team have proven it after studying models that associate the strategies of fixing food prices, food consumption and chronic diseases, primarily cardiovascular. A 10% decrease in the price of fruit and vegetables can increase consumption by between 2% and 8%. Until these measures are taken at a population level, what can we do? Take care of ourselves individually and as families, exercise, don’t smoke and follow a healthy diet. Not only will we live longer, we’ll also live better.