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Population-level changes to promote cardiovascular health


Authors: T. Jørgensen 1,2,3;  S. Capewell 4;  E. Prescott 5;  S. Allender 6;  S. Sans 7;  T. Zdrojewski 8;  D. De Bacquer 9;  J. De Sutter 9;  O. H. Franco 10,11;  S. Løgstrup 12;  M. Volpe 13,14;  S. Malyutina 15;  W. M. M. Verschuren 19;  D. Vanuzzo (jménem Oddělení Pep Eacpr) 20
Authors‘ workplace: Výzkumné středisko pro otázky prevence a zdraví Glostrup, Dánsko 1;  Univerzita v Kodani, Dánsko 2;  Univerzita v Aalborgu, Dánsko 3;  Univerzita Liverpoolu, Velká Británie 4;  Bispebjergská univerzitní nemocnice Kodaň, Dánsko 5;  Univerzita v Oxfordu, Velká Británie 6;  Ústav pro problematiku zdravotnictví Barcelona, Španělsko 7;  Lékařská univerzita v Gdaňsku, Polsko 8;  Univerzita v Ghentu, Belgie 9;  Univerzita v Cambridgi, Velká Británie 10;  Erasmova Univerzita Rotterdam, Nizozemsko 11;  European Heart Network Brusel, Belgie 12;  Univerzita Sapienza, Nemocnice Sant’Andrea, Řím 13;  IRCCS Neuromed, Pozzilli, Itálie 14;  Sibiřská pobočka Ruské akademie lékařských věd Novosibirsk, Rusko 15;  Univerzitní nemocnice v Lausanne, Švýcarsko 16;  Univerzita v Záhřebu, Chorvatsko 17;  Univerzita v Bergenu, Norsko 18;  Státní ústav veřejného zdraví a životního prostředí Bilthoven, Nizozemsko 19;  Medio Friuli Udine, Itálie 20
Published in: Vnitř Lék 2012; 58(12): 943-954
Category: Review

Overview

Background:
Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD.

Design and methods:
Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol).

Results:
Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life.

Conclusion:
Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structuralstrategies at international, national, and regional levels that in combination can substantially reduce CVD.

Key words:
cardiovascular, health promotion, population, prevention, public health, structural strategies


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Diabetology Endocrinology Internal medicine
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