A Focus On: Preventive Cardiology
Image: Fig. 6.10 Cardiomyopathy screening: examples of a healthy control (A), a patient with hypertrophic cardiomyopathy (B), a patient with idiopathic non-ischaemic (C) and ischaemic dilative cardiomyopathy (D). Upper panel: cine imaging reveals the structure and function and gives information about regional wall motion abnormalities. Middle panel: late gadolinium enhancement provides information on regional fibrosis. Lower panel: T1 mapping as an increasingly promising tool to differentiate normal from abnormal myocardium and examples of native T1 imaging in the corresponding cases. From the ESC Textbook of Preventive Cardiology. Edited by Stephan Gielen, Guy de Backer, Massimo Piepoli and David Wood. © European Society of Cardiology.
Preventive cardiology encompasses all aspects of knowledge related to the prevention of cardiovascular disease – either its manifestation or its progression – with the aim to avert life-threatening cardiovascular events and to reduce cardiac mortality. But much beyond the mere facts, preventive cardiology also calls for a different approach to our patients: it aims to influence the underlying systemic disease process of atherosclerosis, of which the acute events are just short manifestations. It focuses on the improvement of long-term outcome rather than acute symptomatic relief and accepts the fact that risk factor modification may have a greater impact on patient longevity than sophisticated interventions.
Cardiovascular prevention faces the dilemma of multiple terminologies coming from diverse historic backgrounds and each nation has its own historical background which also manifests in different insurance structures to pay for cardiovascular rehabilitation and prevention interventions. The term preventive cardiology tries to bring the diverse backgrounds together in a single approach. It also accepts the fact that the line separating primary and secondary prevention is increasingly fading away. Novel imaging techniques identify sub-clinical atherosclerosis and most patients with cardiovascular disease are diagnosed before the first event. The 5th Joint Task Force Guideline of the European Society of Cardiology therefore abolished the differentiation between primary and secondary prevention entirely and looked at the continuum of cardiovascular risk instead. Because of the diversity of healthcare infrastructures preventive cardiology separates the components of interventions (i.e. lifestyle changes, hypertension treatment, management of dyslipidemia, promotion of physical activity, healthy diet, smoking cessation intervention) from the actual setting of preventive care (i.e. acute care hospital, rehabilitation institution, community prevention center etc.). Whilst the aim of prevention remains the same, the individual path in implementation will differ between countries.
In contrast to terms like ‘interventional cardiologist’ a preventive cardiologist does not depend on a single methodology to define his work. In fact everyone who takes a genuine interest in his patient’s wellbeing beyond acute care is a ‘preventionist’: cardiovascular specialists, general physicians, general practitioners/family physicians, nurses, and allied health personnel all have a role in prevention.
Massimo F Piepoli, MD, PhD, FESC, FACC is with the Heart Failure Unit, Cardiac Dept, Guglielmo da Saliceto Polichirurgico Hospital, AUSL Piacenza, I-29121 Piacenza. He can be contacted at email@example.com. Professor Stephan Gielen is with the Heart Centre, University of Leipzig, Germany; Professor Guy De Backer is in the Division of Cardiology, University of Ghent, Belgium; Professor David Wood is with the National Heart and Lung Institute, Imperial College, London, UK.
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