Coronary heart disease (CHD) is one of the most important cardiovascular diseases and is, together with acute myocardial infarction and ischaemic stroke, the leading cause of death and disease burden in Europe. Over the past two decades death rates from these diseases have been falling in most northern and western European countries but rising rapidly in most eastern European countries. However, the decrease in mortality in northern and western Europe has not been accompanied by reduction in CHD morbidity. So CHD remains the number one public health problem in Europe. To reduce the burden of this disease and to reduce the mentioned inequalities between the different parts of Europe is a major challenge.
The CHD epidemic is facilitated by a number of economic and social causes which are all very well known. However, so far this knowledge has not been transformed into efficacious tools which could be used to change the described situation. A good example for this is one of the most important risk factors for CHD – obesity, which is rising, even among children.
Although it is well known that CHD is a product of multiple risk factors (most of them modifiable) such as hypertension, smoking, overweight and obesity, diabetes and metabolic syndrome, dyslipidaemias seem to be the most important. A large body of evidence proves a direct association between dyslipidaemias and the development of CHD. Dyslipidaemias are at the same time the most in-depth studied risk factor for CHD. It is beyond any doubt that risk factor modifications, including dyslipidaemias, reduce CHD morbidity and mortality, particularly in high-risk subjects. Therefore, it comes as a surprise that only very recently the first European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines for the Management of Dyslipidaemias were published in the European Heart Journal and Atherosclerosis. Prior to this, in Europe we had only the Joint European Guidelines on Cardiovascular Disease Prevention – the last version was published in 2007.
The main task now is to develop the best implementation strategies for these new guidelines. This is of utmost importance because exactly dyslipidaemias are a good example that just having guidelines is not enough. The management of dyslipidaemias has substantially improved during the last two decades driven by the widespread use of lipid-lowering drugs but a significant number of patients on such a therapy is still not achieving the treatment goals according to any existing guidelines, including these recently published. One of the possible explanations might be that the preventive cardiology today is obviously much better in prescribing drugs than in adverse lifestyles modifications. Medicalisation is the easiest choice (although not always the best and very rarely the only one) and it is strongly encouraged by the pharmaceutical industry, which has a profound influence on the medical profession. Although the prophylactic use of certain medicines in prevention of CHD is often necessary, the drug treatment should always be combined with effective lifestyle changes. This is also one of the important messages of the new guidelines.
The collection of articles within these pages span the breadth of the cardiovascular discipline. I hope that you find many to provide you with timely update on salient issues to assist in your daily practice.