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"If you do not repair your gutter, you will have your whole house to repair."

Old Spanish proverb

In 1931, Paul Dudley White noted that there was no specific treatment for coronary heart disease. He described the treatment of high blood pressure as "difficult and almost hopeless". Today, effective and relatively inexpensive medication is available to treat nearly all cardiovascular diseases, including high blood pressure.

Improvements in surgical techniques have led to safer operations. Effective devices have been developed, such as pacemakers, prosthetic valves, and patches for closing holes in the heart. Other developments have led to a wide array of interventions that often make surgery unnecessary.

Together, these advances in treatment improve quality of life and reduce premature death and disability. They also add to the rising costs of health care. Increasingly, high-technology procedures are chosen over less expensive, but nevertheless effective, strategies.

In addition, marked disparities in the quality of treatment can be seen in groups of different race, ethnicity, sex, and socioeconomic status. In essence, many patients who could benefit from treatment remain untreated, or inadequately treated. In future, increased emphasis needs to be placed on the appropriate use of proven treatments for everyone with coronary heart disease or stroke.

Cardiac rehabilitation

Percentage of people with established 17% coronary heart disease advised to participate in cardiac rehabilitation

18% 2001 selected European countries

Spain Italy Finland

Greece

Poland, United Kingdom

France Hungary Ireland Czech Republic Germany Netherlands Belgium Sweden Slovenia

Patients reaching blood pressure and blood cholesterol goals during treatment

Percentage of people aged 70 years or below with established CVD who achieve blood pressure goal of less than 140/90 mmHg, or blood cholesterol goal of less than 5.0 mmol/l

2001

selected European countries blood cholesterol goal achieved blood pressure goal achieved

18% 2001 selected European countries

Belgium 23%

Czech Republic 28%

Finland

France

Germany

Greece

Hungary

Ireland

Italy

Netherlands

Poland

Slovenia

Spain

Sweden

United Kingdom

Types of treatment

Selected medication, devices and operations Medication used in treatment of

1 High blood pressure

2 Coronary heart disease

3 Heart failure

4 Arrhythmia (heart rhythm disorders)

5 Blood clotting disorders Devices

1 Pacemakers

2 Implantable defibrillators

3 Coronary stents

4 Prosthetic valves

5 Artificial heart Operations

1 Coronary artery bypass

2 Balloon angioplasty

3 Valve repair and replacement

4 Heart transplantation

5 Artificial heart operations

Trends in cardiovascular operations and in the USA

Number of operations and procedures 1981-2001 thousands heart catheterization open heart surgery coronary artery bypass surgery carotid endarterectomy cardiac pacemakers

inhibitors aspirin beta-blockers lipid-

lowering medication

Simple secondary 25% prevention medication treatments

Percentage reduction in two-year risk of heart attack, stroke or death from CVD in patients with previous coronary heart disease or stroke t r,

2002

Pat for tents all four drugs

Diabetes treatment

Percentage of persons with diabetes being treated with medication or special diet

2002-2003

selected countries 72% 73%

2 Implantable defibrillators

3 Coronary stents

4 Prosthetic valves

1 Coronary artery bypass

2 Balloon angioplasty

3 Valve repair and replacement

4 Heart transplantation

5 Artificial heart operations

Diabetes treatment

Percentage of persons with diabetes being treated with medication or special diet

2002-2003

selected countries 72% 73%

1986

1991

1996

2001

1981

1986

1991

1996

2001

Part s

I IH The Future and the past

"Let my heart be wise, It is the gods' best gift."

Euripides Medea, 431 BCE

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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