Atherosclerosis: the XXIst century epidemic: a meeting at the Vatican.

Major advances were made in the past decade in the understanding of endothelial injury and the key role of inflammation and atherosclerosis in cardiovascular disease (CVD). A large number of trials for drugs and devices have been successfully completed and it became clear that prevention should be at the core of efforts against CVD. However, every single publication on CVD highlights the “atherosclerosis epidemic” and the continuously increasing burden of vascular events faced by people from all regions in the world. The question is, can anything be done to stop and reverse this devastating trend? To explore possible answers to that question, a meeting was convened at the Pontifical Academy of Sciences in the Vatican. Of the approximately 60 million people who die per year worldwide, 18 million (30%) do so as a consequence of CVD. In other words, 160 000 deaths occur daily of which almost 50 000 are secondary to CVD (equivalent to 100 Boeing 777 aircraft full of people crashing everyday). All of the known risk factors for CVD similarly affect all races and ethnicities.1 More than two thirds of vascular events occur in people with few risk factors and close to 80% affect low-income regions with a higher case-fatality rate compared with the more affluent countries.2 In China and India, CVD will soon overcome communicable diseases (HIV, malaria, tuberculosis) as the Number 1 cause of death. High blood pressure, the most important modifiable risk factor, causes 7 million deaths per year, and its population-attributable risk for stroke and coronary heart events is 54% and 47%, respectively.3 However, only 2 of 3 people with hypertension are diagnosed and blood pressure is uncontrolled in the vast majority of treated patients. Excessive weight has reached epidemic proportions, duplicating the affected world population from 5% to 10% between 1980 and 2008. In the United States, at the current rate, by Year 2030, obesity prevalence in men and women 40 to 50 years of age will approach 60%.4 Moreover, recent data link vascular risk factors to degenerative brain disease of the Alzheimer type.5 The health, economic, and social burden of CVD is tremendous, yet it is a largely preventable and treatable disease in which we are missing the target. Estimates by the World Health Organization and other organizations suggest that if known and available measures and guidelines were appropriately used, CVD consequences would decrease by up to 80%.6,7 Management of the different conditions leading to atherosclerosis spans various medical specialties such as epidemiology, genetics, cardiology, stroke, lipids, diabetes, hypertension, and others. However, expertise is developed in separate arenas because each specialty has individual scientific meetings and its own specialized medical journals. Atherosclerosis is a complex and multifaceted problem too big to be tackled by 1 silver bullet. As geographical borders become less rigid in a globalized and technologically changed world, medicine should aim to integrate the knowledge from different disciplines by instituting a collaborative effort. Responding to the great concern of this growing epidemic, the Pontifical Academy of Sciences under the guidance of its Bishop-Chancellor Monsignor Marcelo Sánchez Sorondo decided to organize a Vascular Meeting that in some way would provide an alternative view to the CVD problem. A title suggestive of the purpose of the meeting was selected, “Atherosclerosis: The XXIst Century Epidemic.” Paraphrasing someone who said that TEAM is the acronym for “Together Everyone Achieves More,” to be a truly integrated meeting, speakers had to be representative of all the areas related to atherosclerosis. Following this comprehensive rationale, the state-of-the-art in cardiology was presented by Eugene Braunwald, Valentin Fuster (United States), and Attilio Maseri (Italy); stroke by Louis Caplan, Allan Ropper (United States), Geoffrey Donnan (Australia), Werner Hacke (Germany), and Pierre Amarenco (France); lipids by Terje Pedersen (Norway); obesity and diabetes by Arne Astrup (Denmark); vascular epidemiology by Shanthi Mendis (World Health Organization, Geneva), vascular research by Walter Koroshetz (National Institutes of Health–National Institute of Neurological Disorders and Stroke, US); vascular cognitive decline by John O’Brien (United Kingdom); vascular surgery by Felix Unger (Austria); and hypertension by Conrado Estol (Argentina). After the meeting, and introduced by Monsignor Sánchez Sorondo, Dr Braunwald and I had the Received October 7, 2011; accepted October 11, 2011. The opinions in this editorial are not necessarily those of the editors or of the American Heart Association. From the Neurological Center and Vascular Prevention Unit, Buenos Aires, Argentina; the Neurology Service, Guemes Hospital, Buenos Aires, Argentina; and the Argentine Neuroscience Association. Correspondence to Conrado Estol, MD, PhD, FAAN, Director, Neurological Center and Vascular Prevention Unit, Av Callao 875, C1023AAB Buenos Aires, Argentina. E-mail [email protected] (Stroke. 2011;42:3338-3339.) © 2011 American Heart Association, Inc.