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Atherosclerosis: the 21St Century Epidemic THE PONTIFICAL ACADEMY OF SCIENCES Working Group on Atherosclerosis: the 21st Century Epidemic 31 May – 1 June 2010 • Casina Pio IV Introduction p . 3 Programme p. 5 Abstracts p. 7 Biographies of Participants p. 12 List of Participants p. 18 Memorandum p. 19 14 EMIA A D C S A C I E A N I T C I I A F I R T V N M O P VAtIcAn cIty 2010 n carrying out its distinctive service, the Pontifical Academy of Sciences always relies on the data coming from science and the Magisterium of Ithe church. In particular, concerning the present study group [on The Signs of Death ], christian Revelation also invites the man of our times, who in many ways seeks the real profound meaning of his existence, to face the theme of death casting his eye beyond human reality in its purest form and opening his mind to the mystery of God. Indeed, it is in the light of God that the human creature better understands himself and his final destiny, the value and meaning of his life, a precious and irreplaceable gift of the almighty Creator. Benedict XVI, Letter dated 8 September 2006 to his venerated Brother H.E. Msgr. Marcelo Sánchez Sorondo, chancellor of the Pontifical Academy of Sciences, con - cerning the working group on The Signs of Death , 11-12 September 2006. 2 INTRODUCTION Atherosclerosis: H.E. Msgr. Marcelo Sánchez Sorondo, Chancellor the 21st Century Epidemic The Pontifical Academy of Sciences he Pontifical Academy of Sciences, whose purpose cerebrovascular disease in developing areas is lower tis to promote the progress of the sciences for the com - compared to the developed world. mon good of the human person, in its Study Week of Epidemiological studies from developing regions are 31 May – 1 June 2010 at its headquarters in the Vati - scarce and often of limited reliability. Good epidemi - can, would like to focus on the wellbeing of the vascular ology studies are costly, complex and demanding and system, taking into account the revolutionary contri - resources in developing countries are limited. the de - butions of the last century in relation to the human tails on the distribution and characteristics of Vascu - heart and brain. lar Disease in the developing world are needed to iden - Vascular Disease accounts for 15 million deaths per tify the areas in greater need to distribute resources ac - year worldwide. this represents 30% of all causes of mor - cordingly. Surveillance data helps countries to devel - tality. Most vascular deaths are secondary to brain and op, implement and monitor prevention programs. heart infarctions. Stroke (cerebrovascular disease) If Governments do not include health policy ranks as 1st, 2nd and 3rd cause of death depending on changes in their agendas, in the next five years non the country or world region. Public recognition of cere - communicable vascular diseases will overcome infec - brovascular disease lags significantly behind identifi - tious diseases (tB, HIV and malaria) as the number one cation of coronary artery disease. cause of death in countries such as India and china. In the latter, there are about 300 million smokers, 160 Risk factors for Vascular Disease: known and treat - million hypertensive people and 20% obese children able… between 7 and 17 years of age, something unknown Genetic predisposition, hypertension, diabetes, to this region in the past. cholesterol, smoking, lack of exercise and obesity are the main risk factors that predispose to the occurrence Cognitive decline: a major health burden caused by and progression of atherosclerosis. Vascular Disease Increased blood pressure causes heart, brain and kid - Dementia poses a large burden of disease worldwide. ney disease and accounts for 13% of all deaths world - cerebral vascular injury causes cognitive impairment wide. Hypertension is easily identified and treatable, and dementia with a frequency similar to degenerative yet only 2 out of 3 patients are diagnosed and up to 80% dementia. For a given load of neuropathology findings of those diagnosed are treated but do not reach target of Alzheimer’s disease, the presence of cerebrovascular blood pressure goals. Hypertension accounts for 54% disease correlates with earlier clinical manifestations. of stroke and 47% of coronary heart disease deaths. With Some authors have speculated and provided data to sup - 1 billion people affected, the prevalence of hyperten - port that hypertension results in decreased cerebral blood sion is increasing worldwide. Against deeply rooted med - flow in brain structures commonly affected by ical traditions, recent data has shown that patients old - Alzheimer’s disease predisposing a vulnerable state for er than 80 years also benefit significantly from strict the development of degenerative dementia. Increased blood pressure management. blood pressure and cholesterol in the 4th and 5th Actively screening and treating hypertension, cho - decades of life correlate with dementia onset in the 7th lesterol and diabetes are justified since more than 50% decade. of vascular deaths are due to few risk factors. Moreover, different studies have shown that coronary heart dis - There is a major ‘implementation’ problem by ease and stroke share the same risk factors. Importantly, which the known measures and medications to pre - the most important vascular risk factor is a previous - vent vascular disease are largely under-used ly suffered vascular event. this emphasizes the im - Prevention is the first step in the cure for Vascular portance of stringent medical treatment of conventional Disease. yet, there is a major gap between knowledge and other vascular risk factors once a cardiac, cerebral and the implementation of measures for primary as well or other vascular event has occurred. Data from the as secondary vascular disease prevention. Effective treat - Framingham study has shown that, counter intuitively, ments for the acute and chronic phases of coronary and most vascular events occur in people with a moderate cerebrovascular disease are largely underused. the sci - load of vascular risk factors. entific community and Governments through their Min - istries of Health are responsible for the effective im - How is Vascular Disease distributed throughout the plementation of policies that achieve lower smoking world? rates, increased physical activity, healthy eating habits, In low income countries, vascular disease accounts and high detection rates for hypertension, diabetes, ab - for 80% of all deaths (11 million per year). In these re - normal lipids and other vascular risk factors. Stroke gions, cardiovascular disease occurs 1 to 2 decades ear - Units, proven effective by scientific evidence, should be lier compared to developed countries. Sadly, because available in most clinics/hospitals with coronary of a high case fatality rate, prevalence of cardiac and Units. 3 Atherosclerosis: the 21st Century Epidemic Introduction there is no doubt that significantly more interest of new therapeutic molecules. the scientific commu - is devoted to acute and invasive techniques compared nity should increase the interaction with the industry to prevention. And it is paradoxical that patients have and influence the research lines likely to have a nov - artificial heart valves inserted with endovascular tech - el and higher therapeutic yield. niques and cerebral clots removed with cork-screw like devices, among other novel techniques, but various stud - Conclusions ies have shown that patients are frequently discharged If the vascular disease burden could be reduced 2% from hospitals following a vascular event without the per year, 36 million untimely deaths could be avoid - adequate dose of anti-thrombotic, anti-hypertensive or ed by the year 2015. the World Health Organization cholesterol lowering medications. However, a measure has provided data showing that 80% of cardiac events as simple as counseling during hospitalization has been and strokes could be reduced with diet, physical activity proven to increase adherence to treatment after dis - and smoking cessation. there is also data proving that charge from the Hospital. the general public and physi - 80% of stroke risk would be reduced with adherence to cians need to be educated on the importance of vas - practice guidelines. A wealth of studies has proven the cular disease prevention. this teaching takes time but effectiveness of cardiac and stroke units. yet, with the it is most effective when it starts as early as childhood. exception of a few developed countries heading in this Healthy young adults must understand that a vast ma - direction, results in most world regions drift far from jority have vascular risk factors that justify treatment these projections. in the asymptomatic stage. In summary, preventive measures that should be - gin during childhood are needed to educate individu - The challenge: Effective Prevention of Vascular Dis - als on how to avoid the most common risks of vascu - ease lar disease. In addition to the former, disease specific the knowledge on vascular disease that has accu - information should be provided to the population as mulated over the last decade is greater than that gained a whole. Behavioral changes at the community level in the entire previous century. commitment with could be expected following effective education and in - vascular disease prevention has resulted in a 70% death formation programs. Active Government participation reduction in the USA, canada, Australia and the UK. and commitment with the appropriate health policies Primary prevention provides an invaluable
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