Over the past few years the scope of cardiology has widened considerably, which is well reflected in the variety of topics in this 2006 issue of European Cardiovascular Disease. On one hand, new diagnostic methods, technical progress and effective drugs have contributed to an increased survival and a better quality of life of the cardiac patient. Yet, there is a flipside to this medal: more patients than ever are in need of cardiological expertise and the costs of treatment are steeply rising, prompting a debate on medical care priorities. Lifelong medication is being prescribed, although the length of this treatment is not always based on solid scientific evidence. Polypharmacy is increasingly difficult to explain to the patient and to motivate as longterm treatment. The recent debate on the 'polypill' or the 'polymeal' illustrates well the dilemma of modern cardiology. On the other hand, epidemiology and basic science has changed our understanding of the causes of cardiovascular illness. Geographical and social inequalities appear to play an important role; other psychosocial factors contribute. Lifestyle has become of key importance. The majority of premature cardiovascular disease (CVD) deaths occur nowadays outside the traditional industrialised countries. Furthermore, the distinction between primary and secondary prevention has vanished since better methods of atherosclerosis detection provide the possibility of an early start of intervention before the clinical onset of the disease.
In parallel to the focus on acute and interventional cardiology we are witnessing a rapidly growing interest in preventative cardiology, e.g. through the recent creation of an association for preventative cardiology within the European Society of Cardiology (ESC): the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). This is one of the rapidly growing initiatives within the ESC. In Athens in May 2006, the EACPR organised the first of its annual congresses, 'EuroPRevent', which gathered leading experts in the field of preventative cardiology. Presentations at EuroPRevent clearly showed that there is a true continuum between epidemiology, basic science, prevention and rehabilitation.
Thus, besides providing conventional cardiac care, the lifestyle of the individual patient is of increasing concern for the clinical cardiologist. In the 2004 Joint European Societies Guidelines on CVD prevention in clinical practice the concept of total risk of premature CVD death was introduced, a concept that will be further extended in the upcoming 2007 guidelines. New tools have been created to identify individuals at increased risk based on the SCORE project where a database of over 200,000 people provides guidance in risk estimation. Its interactive electronic application, 'HeartScore', has been introduced for low- and high-risk regions but is now even available in specific national versions for a growing number of countries. New versions are been developed to include other riskfactors (diabetes mellitus) and to estimate morbidity risk.
Even at the political level cardiologists have become active. On an initiative of the Irish EU presidency and in co-operation with the ESC an important statement was made by the EU council of ministers. The 2005 Luxembourg Conference marked a milestone on the road to widespread preventative cardiology: 'The Heart Plan for Europe'. In this council document the Member States have been recommended to act to improve the physical activity of their citizens, to promote better food habits, to initiate smoking cessation campaigns, effective blood pressure and blood lipid control and to diminish high levels of mental stress. The development of National Heart Health Charters has now started in several countries. Expert cardiology engagement in EU public health policy has started to give results.
In conclusion, cardiology of today has a widening spectrum of tasks, from the early detection of CVD before the onset of the disease and the identification of persons at risk to high-tech treatment modalities for patients with end-stage congestive heart failure or the palliative care of therapy-resistant coronary atherosclerosis. The content of this publication does reflect the variety of challenges. Therefore I hope that European Cardiovascular Disease 2006 will provide some fresh paint for the palette of the clinical cardiologist.