The United Nations (UN) Sustainable Development 2030 Agenda targets 17 goals critical for the sustainability of the planet. This initiative was adopted by all UN member states in 2015, aiming to end poverty, protect the planet, and improve the lives and prospects for all (1). With less than 10 years remaining, urgent action is needed if these goals are to be met.
In a recent statement (2), the European Atherosclerosis Society (EAS) reaffirmed its commitment to the 2030 Agenda goals, in particular Sustainable Development Goal 3, which targets at least 30% reduction in premature mortality due to noncommunicable disease (NCD) by 2030. NCDs are the major cause of premature morbidity, disability and mortality worldwide, disproportionately impacting low- and middle-income countries, as almost 75% of all NCD deaths – including over 80% of premature deaths from NCDs – occur here (3). This in turn jeopardises the affordability of healthcare, and achievement of universal health coverage, another tenet of Goal 3.
Cardiovascular diseases represent the major contributor to NCD deaths (4). Worryingly, cardiovascular disease incidence is increasing, almost doubling between 2009 and 2019 (4). Of these, atherosclerotic cardiovascular disease (ASCVD) – ischaemic heart disease and stroke- is most prevalent; in 2019, ASCVD was responsible for about one-third of all deaths, with more than one in 20 in individuals younger than 50 years (4). This escalation in ASCVD is largely driven by major modifiable risk factors, in particular high body mass index (BMI), high blood pressure, high cholesterol, and poor diet, all of which are becoming more common globally, especially in low- and middle-income countries, in concert with increasing urbanisation (4).
The European perspective illustrates why the increasing prevalence of metabolic risk is such an issue. Whereas Europe has demonstrated significant improvement in ASCVD mortality over the last few decades, by combatting smoking and treating high cholesterol and high blood pressure, escalating rates of obesity and diabetes, consequences of an increasingly sedentary lifestyle and poor diet, put this at risk. Indeed, while diabetes affects 3.9% of the global population, the prevalence is almost double (7.3%) in Europe (5). Admittedly, Europe is not homogeneous, as countries are at different stages of economic transition. Despite this, it is evident that poor lifestyle choices and increasing metabolic risk are undermining the gains in cardiovascular health. Latest data from the EUROASPIRE V survey clearly illustrate this, with nearly half of high-risk patients in primary care in 16 European countries identified as obese (i.e., BMI ≥30 kg/m2) and nearly two-thirds centrally obese. There was also inadequate control of blood pressure, lipids, and diabetes (6).
The EAS: a key player in the 2030 Agenda
Given this scenario, the EAS has a valuable role to play. Indeed, the EAS was founded with the mission to advance and exchange knowledge on the causes, risk factors, prevention, and treatment of ASCVD. Now in its 89th Congress year, the EAS is even more relevant in achieving the 2030 Agenda Sustainable Development Goal 3.
The activities of the EAS extend across the central pillars of research, education, and advocacy. Key initiatives include the EAS consensus panel and task force statements, which provide critical appraisals of the latest evidence for lipoprotein-related risk factors and their association with ASCVD (7-9). These have been foundational for guidelines for the management of dyslipidaemia (10), in partnership with the European Society of Cardiology. Consensus-led initiatives have also proved integral to the development of research registries such as the EAS Familial Hypercholesterolaemia (FH) Studies Collaboration (11), and more recently, the Lipid Clinics Network project, which aims to establish uniform European Union-wide standards of diagnosis, management, and treatment of patients with lipid disorders, as well as inform on rare dyslipidaemias (12). Furthermore, the remit of the EAS extends beyond Europe, particularly in its advocacy role. One example of this is the recent ‘Call to Action on FH’ aiming to improve FH care worldwide (13). Additionally, the EAS provides grants to researchers and clinicians in middle- and lower-income regions to ensure wider access to accredited EAS educational programmes.
SMART approaches are the key
In the 21st century, especially in the context of this COVID-19 pandemic, new thinking is needed for implementation strategies to ensure the 2030 Agenda Sustainable Development Goal 3 is met. SMART approaches are essential to optimising use of the EAS resources for improved global health. Digital health tools, which are readily available on smart phones, and improved information technology offer practical and sustainable approaches to improving access to educational programmes for ASCVD prevention. In Europe and beyond, SMART approaches are also instrumental in optimising treatment strategies, to ensure that more costly therapeutic options are targeted to individuals most at risk of ASCVD. Such approaches are particularly relevant for middle- and lower-income countries, where affordability is an over-riding concern for healthcare delivery.
The clock is ticking. This latest EAS statement reaffirms the global role of the EAS in fulfilling the 2030 Agenda Sustainable Development Goal 3. Collaboration and communication provide the keys to lever actions to improve the health of all.
1. The United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. (Accessed 3 March 2021).
2. Parini P, Frikke-Schmidt R, Tselepis AD, et al. Taking action: European Atherosclerosis Society targets the United Nations Sustainable Development Goals 2030 agenda to fight atherosclerotic cardiovascular disease in Europe. Atherosclerosis 2021;
3. World Health Organisation. Noncommunicable diseases. (Accessed 3 March 2021).
4. Roth GA, Mensah GA, Johnson CO et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020;76:2982-3021.
5. World Health Organization data and statistics, Non-communicable diseases: Prevalence of diabetes mellitus. (Accessed 3 March 2021).
6. Kotseva K, De Backer G, De Bacquer D et al. Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries. Eur J Prev Cardiol 2020; doi: 10.1177/2047487320908698.
7. Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2020;41:2313-30.
8. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017;38:2459-72.
9. Nordestgaard BG, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J 2010;31:2844-53.
10. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-88.
11. EAS Familial Hypercholesterolaemia Studies Collaboration, Vallejo-Vaz AJ, Akram A, Kondapally Seshasai SR, Cole D, Watts GF, Hovingh GK, et al. Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: Rationale and design of the global EAS Familial Hypercholesterolaemia Studies Collaboration. Atheroscler Suppl 2016;22:1-32.
12. Alieva AS, Tokgözoğlu L, Ray KK, Catapano AL. Lipid Clinics Network. Rationale and design of the EAS global project. Atherosclerosis Supplements 2020;42:e6-e8.
13. Wilemon KA, Patel J, Aguilar-Salinas C, et al. Reducing the clinical and public health burden of familial hypercholesterolemia: a global call to action. JAMA Cardiol 2020;5:217-29.