6th ICPC: Conferency Commentaries (more...)

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Barbara Roberts
Enviada em: terça-feira, 14 de junho de 2005 09:19
Assunto: [ProCOR] Conference commentary: 6th ICPC

The 6th International Conference on Preventive Cardiology in Iguassu Falls,Brazil provided ProCOR's representatives (Brian Bilchik, Catherine Colemanand myself), an opportunity to learn, to reconnect with old friends and makenew ones, and to share information about ProCOR and the Lown model of care.

With as many as nine concurrent sessions on some days, it was impossible toattend all the talks we would have liked. While many presentations weredevoted to cardiovascular disease in women, there was still little mention
of the lack of evidence-based data on which to base treatment decisions inwomen. There was a session devoted to a "polypill" for prevention whichwould contain (among other drugs) a statin and aspirin - this despite the fact that statins have not been shown to lower women's event rates in thetwo primary prevention trials which included them and that aspirin hasrecently been shown not to protect healthy women underage 65 against heart attack.

Many papers addressed the cardiovascular disease burden in

developing countries and countries in economic transition, from rural populations in Iran to urban populations in Romania. Speaker after speaker discussed the social and economic factors which influence health behaviors and health systems. In this regard, the conference contributed to a change to my way of thinking about cardiovascular disease prevention. Just as the cholera, yellow fever and typhoid fever epidemics of prior centuries were not controlled until governments, from the community to the national level, instituted sewerage systems, safe water supplies and insect control programs, the current cardiovascular disease epidemic will also require governments at all levels to take a more active role. The cardiovascular disease epidemic will not be averted solely by appeals to people to lead healthier lifestyles. Government action will be required to rein in the tobacco and food industries and to provide safe environments so that people can incorporate exercise into their daily lives.

As Sylvie Stachenko pointed out in her excellent valedictory address, an aging population, technology, urbanization and globalization are powerful forces driving the chronic disease epidemic. To counter these, public health in the 21st century must move the prevention of chronic diseases from a global priority to a global reality. This will require changes in public policy that will no doubt be opposed by sectors in the food and tobacco
industries. She imparted a memorable quote from Bismarck: "Two things you should never watch being made: sausages and public policy." However, averting our gaze from public policy is not an option. Unless the medical
community can influence public policy in meaningful ways, the cardiovascular disease epidemic will overwhelm the scarce health care resources of the developing world and continue to rob their economies of people in their mostproductive years.

I welcome comments from our readers on how we, as medical professionals, can best interact with policy makers to ensure that choosing healthy diets and lifestyles becomes not only possible but easy for people whether they live in Boston or Isfahan.

Barbara H. Roberts, MD, FACC
Contributing Editor, Women's Heart Health, ProCOR
Director, The Women's Cardiac Center at The Miriam Hospital