(Circulation. 1999;100:e100.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
New Risk Factors in Primary Prevention
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Introduction |
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At the great cardiology conferences, preventionists tend to gather in small rooms like early Christians in the Roman Empire, lamenting their failure to spread the word. Among the obstacles discussed in Barcelona at the XXIst Congress of the European Society of Cardiology were the continuing malign influences of the tobacco and food industries, the social class and educational inequalities of heart disease (the poor still die young), the dearth of relevant training at medical schools, and the power games in which specialists claim "ownership" of an activity that should be multidisciplinary. In Europe, a political obstacle is the fact that the European Union’s public health program from 1993 through 2000 barely mentioned coronary heart disease—although, as in the United States, this remains by far the most common cause of death—and the European Commission offers scant funding for prevention projects at the European level.
In the United States, low funding may have a different origin. From 1985 to 1995, allocations to the National Heart, Lung, and Blood Institute rose by only 4.5% (the total budget of the National Institutes of Health rose by 31.3%), and the proportion of funds allocated to heart disease by the Institute actually decreased. Charles Hennekens, Professor of Epidemiology and Public Health, University of Miami, Florida, speculated in Barcelona that cardiology may be the victim of its own success—that the remarkable reduction of cardiovascular mortality during the past few decades may have led to a perception that the disease is already beaten.
Prof Hennekens delivered the European