Dr. Carlos Macaya, one of the world’s most renowned cardiologists and president of the Spanish Heart Foundation (FEC), outlines the landscape for cardiovascular disease in Spain.
Could you please start by introducing yourself? We understand that you are renowned for having operated on Mother Teresa.
“I have participated in over 200 international studies and even received the Jaime I Prize in Medical Research for my contribution to the advancement of this area of medicine”
I am a Professor of Cardiology at the Faculty of Medicine of the Complutense University of Madrid and have been director of the Cardiology Service at the San Carlos Clinical Hospital since 1999. Much of my career has been devoted to the research and development of pioneering percutaneous therapeutic techniques and methodologies of catheterizations including coronary angioplasty, mitral valvuloplasty, aortic, and more recently, new structural interventional techniques such as implantation of trans-catheter heart valves. As such, I have participated in over 200 international studies and even received the Jaime I Prize in Medical Research for my contribution to the advancement of this area of medicine. Furthermore, I was president of the Spanish Society of Cardiology (SEC) from 2009 to 2011 and was subsequently nominated president of the FEC in 2015.
The story with Mother Teresa is really rather simple. Back in 1993, when I had earned some recognition within Spain as an expert in the implementation of stents, I received an urgent call from Calcutta requesting that I fly out to India to operate on Mother Teresa. Essentially, she had suffered from cardiovascular problems since the early eighties and had already experienced a heart attack in 1991. It seemed that my name had come to the attention of one of her Mexican physicians. I was a young Spanish doctor aged only 41 and was tremendously honoured to receive such an assignment. Needless to say, the procedure was carried out without any complications.
What is your assessment of the cardiology landscape in Spain?
According to the latest report from the National Institute of Statistics, cardiovascular disease remains the leading cause of death in our country (29.17 percent), ahead of cancer (27.50 percent) and diseases of the respiratory system (11.4 percent). Around 120,000 people die every year in Spain from cardiovascular complications.
Within cardiovascular disease, cerebrovascular diseases were the deadliest in 2016 while by sexes, 64,417 women died from a heart-related disease. The deadliest disease was the stroke (15,556), followed by other heart diseases (12,886) and heart failure (11,279).
55,307 men die every year from a heart-related illness – 9,000 fewer than women – with strokes remaining the leading cause of death (11,556), followed by heart disease (10,372) and ischemic diseases. (10,062).
In terms of geographic data, the Autonomous Communities with the highest cardiovascular mortality are: Asturias (32.44 percent), Andalucía (32.12 percent) and Galicia (31.40 percent). In the Community of Madrid (25.39 percent), the Autonomous Community of Navarra (26.38 percent) and Catalonia (26.71) fewer people die due to cardiovascular complications.
Interestingly Spain is second only to Japan in terms of having the highest prevalence of hypertension. There is much debate over why this is the case, but my suspicion is it may well have something to do with salt intake. Both nations, after all, consume large quantities of fish. Though we are nominally host to the healthy Mediterranean diet, the reality is more complex: younger generations of Spaniards are increasing opting for unhealthy fast food.
What are the awareness levels of heart disease in Spain and where do you see opportunities for improvement?
Society is generally more aware of the importance of prevention for maintaining cardiovascular health than it used to be, but often ignores the fact that living a healthy lifestyle – with a varied and balanced diet and regular physical exercise – people would be able to reduce the amount of premature deaths from cardiovascular diseases by up to 80 percent. It could also be said that there is a considerable distance between the reality of what this disease entails and the perception of the disease. Few people would place the cardiovascular disease as the leading cause of death in Spain and even fewer would be able to identify the strong correlation between a healthy lifestyle and cardiovascular complications.
Good and efficient communication is necessary to eliminate misconceptions, such as the general belief that men die more from cardiovascular disease, when the reality is different: Spanish women die five percent more than men from cardiovascular diseases.
Regarding heart attacks, although there are more deaths of men in absolute numbers, it is nevertheless more lethal in women because they take longer to request healthcare due to the difficulties they have in identifying it. According to a study presented at the last SEC Congress of the Spanish Society of Cardiology, only 39 percent of women compared to 57 percent of men recognize the symptoms of acute myocardial infarction.
The message that the population must internalize is clear: have good eating habits, regularly partake in physical exercise and maintain the control of the main vascular risk factors, such as hypertension, cholesterol, diabetes, obesity and smoking. These are the keys to keeping a healthy heart.
However, in this aspect there is a long journey even in the recognition of risk factors, as well as in the need to point out some definite and concrete lines to guide how to make those good habits come true in real life.
What steps are being taken to better educate the Spanish population about cardiovascular health?
One of the most obvious examples in this case, might be guidelines to follow healthy eating, an area in which we cannot limit ourselves to launching generalist messages given its proven impact on our cardiovascular health.
In terms of data, 50.5 percent of the Spanish adult population (23 million people) has hypercholesterolemia (total cholesterol ≥ 200mg / dl), according to data from the Nutrition and Cardiovascular Risk Study of Spain (ENRICA); 29 percent of the deaths attributable to tobacco are due to cardiovascular causes; 42.6 percent of the Spanish population suffers from hypertension, although of people aged 18 years or older, 37.4 percent is undiagnosed, according to the Di@bet.es study published in the Spanish Journal of Cardiology (REC); The Nutritional Study of the Spanish Population (ENPE) states that the percentage of the population classified as overweight in our country stands at 39.3 percent, while obesity affects 21.6 percent of the population.
One field of fundamental action and surely the most effective for the future is early childhood education. It is necessary to intervene in the development of these healthy habits from an early age because the necessary prevention is based mainly on this, and we all know the difficulty of modifying habits once acquired. This is probably the greatest challenge of all and also the greatest opportunity to reverse the risky trend that the statistics point out.
Can you introduce the Spanish Heart Foundation (FEC) to our international audience?
The FEC is a non-profit institution, of national character, promoted by the Spanish Society of Cardiology. Its mission is to promote health with the help of the health education for the population through outreach campaigns of healthy lifestyles.It also encourages and supports the devel
opment of cardiovascular research in Spain through the granting of scholarships to basic and clinical research projects in cardiology, promoting the work carried out by the Spanish Society of Cardiology.
At present, the FEC has more than 7,000 members, including cardiologists, nurses, patient associations, private entities and private partners. Our governing body is the Board of Trustees, whose honorary presidency holds S.A.R. the Infanta Dña Margarita and it is formed in its great majority, of cardiologists with direct institutional responsibility in the Spanish Society of Cardiology, in addition to the person who exercises as President.
How does the foundation promote and support the development of cardiovascular research in Spain?
The FEC together with the Spanish Society of Cardiology (SEC) has a long tradition of supporting cardiovascular research, from the basic to the clinical research, through epidemiological aspects and of course for better knowledge of diagnostic and therapeutic techniques.
We can say that we have an inescapable and real commitment to the research and systematically, SEC and FEC award grants and scholarships for this purpose. For example, annually at the SEC Congress a special ceremony is held for the public and official recognition of these grants.
We must not forget that, despite cardiovascular disease continuing to represent the leading cause of death in our country, the percentage of people who have died due to this reason has been reduced in recent years. This has been made possible thanks to research and advances in the medical world.
At the same time, we support other studies and reports of perhaps more academic nature, but also of great interest, which will allow us to open new lines of research, such as the definition of the “Cholesterol Map” in Spain in cooperation with the WHF (World Heart Federation) or studies on Air Quality. We believe This latest project promoted at European level by the EPHA (European Health Alliance) will highlight the alarming relationship between pollution peaks and hospital admissions for cardio-respiratory causes.
We want to help raise awareness of the direct link between the air quality and cardiovascular disease, and we hope that Public Administrations – mainly the municipal ones – will take more action on this line.
How does the foundation foster better awareness and prevention of heart diseases through health education?
If cardiovascular disease is the leading cause of death and it can be prevented by more than 80 percent in terms of premature deaths, it is clear that it is tremendously necessary to act in the field of prevention, and this is our mission.
One of the main purpose of the FEC as stipulated in Statute is “to promote education, the prevention and research of cardiovascular health in civil society, the encouragement and dissemination of cardio-healthy life habits for the Spanish population.”
Therefore, the development of research, on the one hand, and the sensitization and education of the population on the other, center our basic lines of action that we concentrate and summarize in our main effort: to PROMOTE health in a permanent form among our population.
Focused on this main objective, the FEC develops various activities, campaigns, projects, and business programs, some of which have already become consolidated annual appointments such as the Heart Week or the Popular Heart Marathon, others of a more specific nature – campaigns that generate knowledge and sensitivity about the risk factors, the incidence of strokes in women, etc, and others implemented linearly over time, such as the Nutrition and Health Program (PASFEC), the Cardio-Healthy Companies Program (PECS), or the Cardiorespossible Areas Program (PACS). The last program mentioned is the most recent and puts the focus on cardioprotection and the importance of teaching and educating the population in an adequate and early care of sudden cardiac arrest, which, only in Spain is estimated at 30,000 cases every year.
Of course, we don`t forget our commitment with our patients, with whom we have a permanent relationship and join us in our activities, especially aimed for people who have suffered a cardiovascular complication, such as the Annual Patient Forum, or collaborate in programs such as Mimocardio- Expert Patient.
I want to add that we try to encourage in a special way “the use” of different communication tools depending on possibilities that we have.
I am pleased to say that we have a magazine published on paper (Salud & Corazón which can also be found and bought at a modest price in newspaper kiosks) and digital media such as an electronic newsletter with more than 35,000 subscribers. We are proud with all social networking activities where we are actively involved, with our website, which is in the final update process, and which has more than 11 million users per year.
How does the foundation bring together various entities from the healthcare sphere and encourage dialogue and synergies between the institutions?
We believe that cooperation between entities and institutions, especially those that have the main objective the health, is fundamental.
The problem is increasingly complicated due to the diversity of factors, and unfortunately has already become global, so the solution must be shared. Otherwise, it would be impossible to have acceptable results.
The WHO itself has set the goal of working together, at all levels, to fight against noncommunicable diseases, the main challenge of the developed world project 25/25.
The active participation of members from our Board, in different international organizations such as the World Heart Federation, worldwide, or the EHN (European Heart Network) in Europe, stimulates our contribution to the common lines of work with other countries, fostering a synergy between institutions that allows us to advance in our projects for the prevention of cardiovascular diseases.
At a national level, the FEC collaborates actively and in coordination with various entities, such as the National Committee for the Prevention of Smoking (CNPT), the Spanish Council of Cardiopulmonary Resuscitation (CERCP), the Spanish Association Against Cancer (AECC), the Spanish Diabetes Federation (FEDE) or the Spanish Society of Periodontics and Osseointegration (SEPA), among many others scientific entities, oriented to patients or also focused on prevention.
In conclusion I want to emphasize that this union of efforts is increasingly necessary to share a single and clear message, both to public administrations and to the population: the promotion of Health, without adjectives, which is the ultimate social goal in which we must all join our efforts.
How would you describe your relationship with the private sector?
We do collaborate with private enterprise on occasions where a clear synergy can be identified. For example we have been working in conjunction with the healthtech company Philips who design and manufacture defibrillators with a view to increasing public awareness about the correct usage of this sorts of equipment and have indeed been running joint training schemes to that effect.
What are the main priorities of the foundation to contribute to a better cardiology environment in Spain?
I will summarize the priorities in 3 fundamental lines. Firstly, we want to sensitize (providing viable information, disseminate) the society as a whole (citizens, companies, public and private institutions and governments) on the urgency of taking real measures to reduce the incidence of cardiovascular diseases.
Secondly, we want to raise awareness of the fact that, more than ever, in the case of cardiovascular diseases, the prevention not only saves lives and increases life expectancy, it also allows a very significant improvement in the quality of life.
Thirdly, we want to provide tools: identify and encourage healthy life habits in all aspects and areas of our life with a direct impact on cardiovascular risk: food and nutrition, physical activity and rest, state of mind (stress and anxiety), smoking, as well as the control of biological factors.
What is your final message to our international audience?
The best treatment to reduce cardiovascular mortality is to prevent it. For the FEC this is our main mission, but it is also the work and duty for all the other entities: the Administrations, which work for the citizens and which must also make the health system effective and sustainable, the companies, which collaborate for the health of their workers, in this way they will avoid one of the main causes of unproductivity, and of course, each one of us, who must learn to take responsibility for own health.
I will speak directly, mainly to you, to the media, those who may have in your hands one of the most important keys for raising awareness and transmitting messages. We thank you and ask for your continuing involvement in this great and vital goal: To promote the health of each and every one of us!