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National Heart Alliance and internists: Healthy Heart Act is a good start

The German Society of Cardiology and eight other medical societies, including the DZHK, strongly support the goals pursued in the ‘Healthy Heart Act’. However, the societies see further potential for action, especially in primary and proportional prevention. The aim must be a long-term national cardiovascular health strategy.

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Compared to the rest of Western Europe, Germany is at the bottom of the league when it comes to average life expectancy - even though we spend the most per capita on health. One of the main reasons for this is presumably the inadequate prevention of cardiovascular diseases.

The most important, but modifiable (or influenceable) risk factors for these diseases are smoking, high blood pressure, diabetes mellitus, obesity and elevated cholesterol levels. And while the number of young smokers is unfortunately increasing, other cardiovascular risk factors are recognised too late: High blood pressure is inadequately controlled and over 80% of people at high or very high risk of cardiovascular disease do not meet LDL cholesterol targets. Timely detection and prevention could prevent more than half of cardiovascular diseases, which could prevent premature death and illness in the medium term.

 

Eight specialist societies stand united behind the DGK statement

 

The draft law to strengthen heart health (Healthy Heart Act - GHG) contains many proposals to improve the lack of early detection of risk factors and prevention in Germany. The German Society of Cardiology - Cardiovascular Research (DGK) therefore expressly welcomes the aims of the law in its current statement submitted to the Federal Ministry of Health. The cardiac medical societies of the National Heart Alliance, the German Society of Internal Medicine (DGIM) and the German Resuscitation Council (GRC) agree with this.

 

Evidence-based prevention and treatment measures

 

The DGK statement, which is supported by eight professional societies, assesses the planned measures on the basis of scientific evidence - almost 60 sources on scientific papers, guidelines and studies form the annex to the statement - and supplements or concretises the proposals in the draft legislation.

With the inclusion of lipid screening in the U9 examination for children - instead of the J1 examination planned in the draft law - a congenital blood lipid metabolism disorder (familial hypercholesterolaemia, FH) can be detected simply, cost-effectively and reliably and targeted therapy can be initiated in these rare cases. With a prevalence of 1:250, FH is one of the most common hereditary diseases. Those affected have high LDL cholesterol levels despite a healthy lifestyle and a significantly increased risk of heart attack from the age of 35. Due to the high participation rate of 98%, the DGK is in favour of the U9 examination as the most suitable time to identify as many children as possible. In suspected cases, a low-cost cholesterol test is followed by genetic diagnostics. If the suspected diagnosis is confirmed, these children benefit from drug therapy, which prevents premature heart attacks.

In principle, it should be noted that consistent treatment of high blood pressure and elevated blood lipid levels means a lower risk of atherosclerosis. With a variety of blood pressure-lowering drugs such as statins, there are in principle inexpensive, well-tolerated and proven effective groups of drugs available to treat these risk factors, which are widespread in the population. In this respect, the DGK welcomes the initiative to make statins more accessible to high-risk patients in future in line with guidelines. However, it also emphasises that the decision-making processes for care lie with the Federal Joint Committee (G-BA). This committee makes its judgement taking into account the principles of evidence-based medicine and the current state of research.

The DGK supports the planned ‘heart check-ups’ in adulthood to recognise and treat cardiovascular risk factors. However, with reference to the SCORE2 calculation and the current study situation, the DGK is in favour of carrying these out from the age of 40.

 

GHG is a first important milestone on the way to a higher goal

 

‘The Healthy Heart Act is one of the most important health policy projects of recent decades,’ the statement reads. DGK President Prof Dr Holger Thiele adds: ‘The GHG can make a decisive contribution to improving the prognosis of cardiovascular diseases in Germany. Nevertheless, in our view there are still a few additional points that we would like to see in the final legislative text.’

In particular, primary and proportional prevention are still given too little consideration in the GHG. From the DGK's point of view, the draft law is a good start, but it should only be the starting point for a comprehensive cardiovascular health strategy for Germany and should therefore be flanked by the following measures in particular:

 

  • The problem of tobacco consumption must be addressed more clearly and more measures must be taken to drastically reduce tobacco consumption.
  • Consistent lifestyle modification should begin at an early age, ideally integrated into school lessons. This includes educational work on the harmfulness of certain foods, healthy school meals and the promotion of an active lifestyle.
  • Realisation of measures to increase the rate of lay resuscitation. An additional 10,000 people a year could be saved simply by consistent and correct cardiac massage by laypersons to bridge the time until the emergency services arrive.

Source: press release Herzmedizin (in German only)