Cardiovascular mortality has decreased by 25% in Romania in the last 10 years, but it is still high despite renewed efforts between the Romanian Cardiac Societies and the government to increase life expectancy and decrease death rates through coronary heart disease or stroke. Ranking fifth among the European countries in terms of high cardiovascular risk, according to an ESC statistic, Romania has been struggling with hypertension as the leading risk factor (39.1%) together with hypercholesterolemia (39.1%), followed by smoking (26.7%) and obesity (21.3%) 1. Another alarming fact is that the prevalence of insufficient physical activity in adults over 18 years of age is 25.3% (2010). Moreover, the prevalence of diabetes is estimated to be 11.6% in the population between 20 and 79 years of age (between 535 413 and 1 967 200 individuals). Newly reported cases represent 20.69% 2.
However, in 2010, Romania joined the ‘Stent for Life’ program, with a tremendous impact on cardiovascular mortality, which has decreased from 13.5 to 8.15% in 2013. Currently, there are 35 public and private centers in Romania for interventional cardiology, representing an average of 0.8 percutaneous coronary intervention centers/million inhabitants (the estimated number of percutaneous coronary intervention procedures/million inhabitants is 325) 3.
General practitioners are the key actors of both primary and secondary prevention, but their main role is to detect cardiovascular risk factors in the general population. School doctors are also important for the implementation of a healthy lifestyle during childhood. Secondary prevention is offered to the public through cardiologists, internal medicine specialists, and general practitioners. At the national level, primary prevention is provided by the Ministry of Health through the ‘National Program for The Prevention of Chronic Diseases’. National prevention programs are also jointly developed by the Romanian Society of Cardiology (RSC), namely, the Working Group for Prevention and Rehabilitation, and the Romanian Heart Foundation. There are two national coordinators for these programs. The RSC and the Romanian Heart Foundation are members of the World Heart Federation. The Romanian Heart Foundation is a member of the European Heart Network and the National Forum for cardiovascular disease (CVD) Prevention is a member of the European Network for Smoking and Tobacco Prevention 3.
Primary prevention is delivered at the national level through mass media (broadcast and digital media), but it is also enforced by law as the Parliament recently decided to ban smoking in all indoor public spaces. In primary care, including in schools, general advice for a healthy lifestyle is provided, but there is no dedicated national program. The main arena for both primary and secondary prevention is the country’s hospitals, through their departments of cardiology and internal medicine. During admission and before discharge, the patient receives recommendations for the prevention and treatment of the main cardiovascular risk factors, which include printed flyers 3.
Numerous associations, clubs, and foundations are also committed to promoting cardiovascular prevention, but they are not working in a synchronized and quantifiable manner. Such an initiative is ‘The Athletic Club of the Romanian Society of Cardiology’, a real success story in promoting daily physical activity.
There are no national guidelines on the prevention of CVDs because the RSC has fully embraced and translated the European Guidelines on Cardiovascular Prevention, Dyslipidemia, or Hypertension. The use of the SCORE risk charts in both primary prevention and cardiology practice is promoted. Unfortunately, we do not have an audit system to evaluate the results of nationwide cardiovascular prevention. There is an ongoing national survey called SEPHAR, organized by the Romanian Society of Hypertension, on the prevalence and control of arterial hypertension in Romania, which is now in its third edition. Romania has also participated in the EuroASPIRE trials III, IV, which is now currently undergoing the fifth edition.
There are a number of country-wide campaigns aimed at cardiovascular prevention such as ‘Alianta Romania Respira’, the largest national campaign designed to approve and implement the smoking ban in closed public places, or ‘PROFI iubeste sanatatea’, a smoking-cessation project delivered to the first private company member of National Forum for CVD Prevention. ‘Romanian Heart Week’ comprises of a series of events taking place during the whole week that include World Heart Day, raising awareness of the importance of physical activity. Also, ‘Promenada Inimilor’ (based on ‘Sli na Slainte’ project of Irish Heart Foundation) is a project aimed at identifying accessible walking routes and to encourage individuals of all ages to exercise as a daily part of cardiovascular prevention measures (project implemented in more than 30 cities across the country during World Heart Day). Athletic CardioClub organizes activities throughout the year and the Romanian Heart Foundation together with CardioPrevent Foundation have started a project called ‘CLIPA’ aimed at early detection and management of familial hypercholesterolemia. World Hypertension Day is a joint venture between Alianta Romana de Control al Hipertensiunii Arteriale (ARCHA) and the Romanian Heart Foundation, celebrating World Hypertension Day every year by checking blood pressure, determining cardiovascular risk and distributing educational materials to the population 3.
In addition to these campaigns, a series of projects have been launched to raise awareness of cardiovascular risk factors such as SOS Cardio and to encourage individuals to participate in yearly controls at their general practitioner for early detection of CVDs. ‘Bike for your heart’ promotes physical exercise exclusively through social media channels and the ‘Heart Ball’ hosted at the House of the Parliament brings together decision-makers in healthcare, mass media, and political authorities to bring attention to the importance of preventive interventions to reduce cardiovascular mortality. ‘Your Heart Agenda’ is an educational tool for encouraging healthy habits such as fruit and vegetable intake, daily exercise routine, weight management, smoking cessation, and leisure activities. ‘Young Health Programme’ offers a unique focus on young individuals and primary prevention of the most common noncommunicable diseases, such as type 2 diabetes, cancer, and heart and respiratory diseases 3.
Last but not the least, cardiovascular prevention is part of the training curricula in cardiology; however, few universities include it in their curriculum for students. Victor Babeş University of Medicine and Pharmacy from Timisoara also has an accredited Master in Prevention and Rehabilitation in Cardiovascular and Respiratory Diseases. The National Forum for Cardiovascular Disease Prevention also organizes a series of interdisciplinary educational conferences (cardiodiabetes-nephropneumology) called ‘Master Classes’ 3.
In contrast, the Romanian Diabetes Society has been conducting a campaign to ‘Control your Diabetes’, involving two editions, one in spring and one held in conjunction with the World Diabetes Day, in autumn. The main objectives of the Campaign are to involve authorities and the media in spreading the message of awareness about the increased incidence of diabetes in Romania; to inform and educate the public of the importance of diabetes prevention, and also the effective control of diabetes and improved lifestyle for patients affected by this disease 4.
The Romanian Society of Diabetes, Nutrition and Metabolic Diseases organizes a number of courses every year to increase and constantly improve the level of education of its members and specialists involved in the management of patients with diabetes 4.
Currently, the main obstacle in the implementation of all CVD prevention measures is the stressful economic situation, which hinders the achievement of these goals. The RSC works according to a pre-established program, which includes among its objectives a move toward a more pragmatic approach for the issues now facing Romanian Cardiology. Specific programs have been launched and are continuously developed for each of the four major risk factors: smoking, hypertension, lack of exercise, and high cholesterol 3.
The common ground on which cardiologists, diabetologists, nephrologists, and internal medicine specialists wage war on their common enemy, atherosclerosis, goes by various names according to their field of expertise. The battle is ferocious and yet the goals are not impossible to reach as these specialists not only have the necessary skills, knowledge, and determination to implement the guidelines but also the support of their national societies reunited under the Forum for CVD Prevention to achieve cardiometabolic prevention in Romania as more than just a mere midsummer’s night dream. Spirits have been running high and low when it comes to mitigating the ever-present effects of atherosclerosis in our daily practice; however, hopes are high that the taming of the shrew is not an impossible feat in terms of interdisciplinary work.
The authors thank Dr Iulia Kulcsar, Dr Gabriel Tatu Chitoiu, Professor Dumitru Zdrenghea, Professor Florin Mitu, Professor Dana Pop, Professor Mircea Ioachim Popescu, Professor Mircea Ioan Coman, Dr Dan Gherasim, Professor Dr C.C. Iliescu, Professor Dr Cristian Vladescu, and Dr Mircea Iurciuc for their invaluable efforts in providing us with information.
Conflicts of interest
There are no conflicts of interest.