No Room for Complacency in Face of Spanish CV Paradox

January 14, 2013

MADRID, Spain — The first study to report population-based data on cardiovascular health across an entire European country has found that the nation in question, Spain, is not performing particularly well and in fact is on a par with the US [1].

Surveying a cross-section of Spanish adults, Dr Auxiliadora Graciani (Universidad Autonoma de Madrid, Spain) and colleagues measured "ideal cardiovascular health"--as described by the AHA--and found that only 0.2% of the 11 408 subjects attained ideal values for all seven CVD health metrics: nonsmoker, body-mass index (BMI) <25 kg/m2, physical activity at goal, diet consistent with recommendations, untreated cholesterol <200 mg/dL, untreated BP <120/80 mm Hg, and untreated fasting glucose <100 mg/dL in the absence of clinical CVD and diabetes. Of those surveyed, 3.4% attained ideal values for at least six of the metrics and 15.4% for five, they note in their report published online January 8, 2013 in Circulation: Cardiovascular Quality and Outcomes.

"This is the first study to report information on cardiovascular health from Spain, a European country with low coronary heart disease mortality compared with many Western countries," observe the authors. However, the level of cardiovascular health in Spain "is as low as in the United States, primarily due to poor lifestyles, especially lack of ideal diet," they note.

High Rate of Angina: Why Do Plaques Seem to Be Stable in Spain?

Although the CHD mortality rate is low in Spain, recent research shows the prevalence of angina there is high, suggesting that atheromatous plaques are stable, the doctors say. Research is needed as to why these plaques do not rupture, translating into a high incidence of acute MI, as is seen in other countries, they state.

The apparent paradox of low CHD mortality with high CV risk factors in Spain should not lead to self-complacency.

This "paradox" of low CHD mortality and poor cardiovascular health in Spain could be explained by several things other than traditional CV risk factors, such as sedentary behavior, specific dietary components (eg, wine consumption and the Mediterranean diet), psychosocial factors (such as family support), and quality of medical care, among others, say Graciani et al.

And because lifestyles appear to contribute far more heavily than biological factors to poor cardiovascular health in Spain, there is a great need to strengthen the role of public-health efforts in the management of CVD there, they observe. Health services also need to improve, they add, noting that five out of every 10 people with elevated cholesterol are not being treated, and half of those with BP >140/90 mm Hg are unaware of this.

"In recent years, several prevention campaigns have been conducted in Spain to increase physical activity, improve diet, and reduce smoking. . . . But the results do not seem to reflect the effort," they observe. Young people should be a particular focus of primordial prevention in future, they note, since a third of this group smokes and has a poor diet, and half of them are overweight and physically inactive. Other groups particularly at risk are men and those with lower education.

"The apparent paradox of low CHD mortality with high CV risk factors in Spain should not lead to self-complacency, because CHD is one of the most important contributions to disease burden [there]. Our data suggest that CV health in Spain can be further improved by decisive intervention on the classical cardiovascular risk factors."

The authors report no conflicts of interest.