Cardiovascular Healthcare in 2020 – Alarming Realities in Romania

DOI: 10.2478/jim-2020-0014 The unprecedented progress recorded over the last decades in the field of prevention and management of cardiovascular disease (CVD) has led to a significant reduction of premature cardiovascular (CV) mortality across Europe.1 Despite this progress, a new reality is emerging and generates serious concerns for public health policies. The burden of CVD presents alarming inequalities among different European regions, remaining disproportionately larger in lowand middle-income countries (LMICs) compared to high-income countries (HICs). Moreover, economic constraints at local level involve substantial disparities in availability of CV care and services, with dramatic effects on the healthcare benefits of CV patients in LMICs.2 The recently published map of “ESC Cardiovascular Realities 2019”, a map of ESC member countries based on monitoring CV health expenditure, infrastructure, and workforce across European countries, raised alarming signs for healthcare systems regarding the social and economic burden of CVD in different regions of Europe.3 From this point of view, Romania presents a concerning reality in all points of interest highlighted by the ESC’s call to action: insufficient control of risk factors and harmful behaviors, increased burden of CVD, and disparities in availability of CV care. Extensively investigated, the important influence of potentially reversible well-established risk factors in the determination and progression of CVD provides a strong rationale for giving a higher priority to risk reduction strategies. In HICs, the ongoing modern-day epidemics of obesity and type 2 diabetes, particularly in younger adults, represent the most serious public health challenges which threaten to erode the health gains of recent years.4 In this European context, Romania seems to present inadequate strategies. Besides the negligible decrease in hypertension prevalence, poor strategies for the identification and effective treatment of people with established hypertension contribute to the continuing high rates of myocardial infarction and CV death. Moreover, the daily intake of large quantities of alcohol, insufficient selfreported physical activity, and altered nutritional intake proved to be important CORRESPONDENCE