'80% of cardiovascular disease is preventable and we are failing to prevent it.'
PROMOTING HEALTH
Interview with Ricardo Villa Bellosta, principal investigator of the CiMUS of the USC
Ricardo Villa Bellosta, coordinator of the ‘Metabolic homeostasis and vascular calcification’ group and a specialist in the cardiovascular research area at the Centre, is this categorical. He believes that heart disease is currently underestimated until it is too late and that, despite efforts to raise awareness, more education and public policies are needed to facilitate prevention and promote a culture of self-care from an early age. Because it is not only about preventing disease but also about improving the quality of life of the population.
80% of cardiovascular diseases can be prevented by a healthy lifestyle. Do you think society has a low awareness of cardiovascular health?
Although society recognises the importance of healthy habits such as a balanced diet, regular exercise and stress management for cardiovascular health, this knowledge is often not applied in everyday life. Factors such as lack of time, stress and an environment that encourages unhealthy behaviours (advertising of ultra-processed foods and sedentary lifestyles) have a negative influence on lifestyle. In addition, many people underestimate the risks of heart disease until it is too late, and disadvantaged communities face greater barriers to adopting a healthy lifestyle. Despite efforts to raise awareness, there is a need for more education and public policies that facilitate prevention and promote a culture of self-care from an early age.
What role does prevention play in this?
Prevention plays a key role in the fight against cardiovascular diseases, as a large part of these health problems can be avoided through lifestyle changes. Prevention focuses on adopting healthy habits such as a balanced diet, regular physical activity, stress management and eliminating risk factors such as smoking and excessive alcohol consumption. These changes can significantly reduce the incidence of cardiovascular problems, even before symptoms occur.
In addition, early prevention is key to detecting risk factors such as hypertension, high cholesterol and obesity, allowing corrective action to be taken before they become serious problems. The role of prevention also extends to public awareness campaigns, health education and policies that facilitate access to preventive resources such as regular medical check-ups, nutrition programmes and spaces for physical activity.
Prevention therefore not only reduces the burden of cardiovascular disease at the individual level, but also alleviates the impact on health systems and improves the overall quality of life of the population.
Do you think that moving from talking about disease to talking about health will improve this situation?
Yes. Shifting the focus from talking about disease to talking about health can have a transformative impact and significantly improve the situation. This new perspective alters the way people think about wellness from simply correcting problems to actively promoting a healthy lifestyle.
Talking about health encourages a more proactive and preventive approach. Rather than focusing solely on treating illnesses once they have already manifested themselves, people are encouraged to take preventive measures to maintain their wellbeing before complications arise. This includes adopting habits such as good nutrition, regular physical activity and mental health care, not as responses to a problem, but as positive practices for continued wellbeing.
This discursive shift reinforces the idea of holistic wellbeing, helping people to understand that it is not just about avoiding illness, but about improving their overall quality of life. Associating health with feeling good and living better may motivate people more to adopt healthy habits, not just to avoid a future problem, but to enjoy the present with greater vitality.
In contrast, talking about illness is often associated with fear and seriousness, which can lead to denial or avoidance of health problems. By shifting the discourse towards health, the focus is on wellness and the positive actions people can take, which makes the process less overwhelming and more encouraging.
What are the main risk factors?
The main risk factors for cardiovascular disease are a combination of genetic factors, medical conditions and unhealthy lifestyle habits. While some of these factors are not modifiable, such as age, gender or genetic inheritance, many others depend directly on lifestyle and are therefore amenable to change. Modifiable risk factors include smoking, excessive alcohol consumption, lack of physical activity, unhealthy diet, overweight and obesity, high blood pressure, high cholesterol, diabetes, exposure to air pollution and chronic stress. Adopting a healthy lifestyle can significantly reduce the risk of developing cardiovascular disease.
Most are modifiable factors, especially through lifestyle, yet there is an increasing number of cardiac pathology. What can we do to change this?
It is true that most of the risk factors for cardiovascular disease are modifiable, especially through lifestyle changes, yet the number of people with heart disease continues to rise. To reduce the increase in cardiovascular disease, it is essential to adopt a comprehensive approach that seeks to foster a culture of prevention and wellness. Key actions could include:
1. Education and awareness-raising: Promoting healthy habits through campaigns and educational programmes.
2. Access to healthy food: Facilitating access to fresh food and regulating advertising of ultra-processed products.
3. Promotion of physical activity: Improve the infrastructure for exercise and organise community programmes.
4. Tobacco and food industry regulation: Limit advertising of harmful products and continue tobacco control policies.
5. Access to health care: Ensure preventive check-ups and accessible treatment.
6. Stress management and mental health: Promote mental wellbeing and stress management.
7. Workplace initiatives: Implement wellness programmes in companies.
8. Public policy: Prioritise investment in public health and legislate to create environments that promote a healthy lifestyle.
Don't you think it is contradictory that risk factors are so well known and the prevalence continues to increase?
It is indeed an apparent contradiction. Although the risk factors for cardiovascular diseases are well known, their prevalence continues to increase due to several reasons: people do not always translate knowledge into action, the environment promotes unhealthy habits, there is unequal access to preventive resources, and many people underestimate their personal risk. In addition, factors such as stress, cultural pressures and slow implementation of effective public policies also contribute to the persistence of these problems. To change this situation, a comprehensive approach is needed that addresses personal as well as social and structural barriers.
Why would you say it is not given the same visibility as cancer, for example?
Cardiovascular diseases have lower visibility than cancer due to several factors: the silent progression of heart disease, the perception of cancer as a more immediate and emotional threat, and the more frequent portrayal of cancer in media and popular culture. In addition, cancer campaigns are more massive and emotional, whereas cardiovascular disease prevention may seem less dramatic. It is also influenced by the fact that cancer affects all ages, which generates more social alarm, and that it receives more funding for research compared to cardiovascular diseases.
What is the incidence of cardiovascular disease in Galicia and in Spain?
In Galicia, cardiovascular diseases are the leading cause of death, accounting for 36.5% of all deaths in the community, which places it above the Spanish average. This makes Galicia one of the regions with the highest cardiovascular mortality rates in Spain. Every year, more than 5,000 people die in Galicia due to these pathologies, which include heart attacks, ischaemic diseases and strokes.
At the national level, in Spain, cardiovascular diseases also represent one of the leading causes of death, accounting for 26.1% of all deaths in 2022, which translates into more than 120,000 deaths per year. Although there has been a reduction in the mortality rate in some regions, it remains a major concern in terms of public health and health system costs.
The high prevalence of risk factors such as hypertension, poor diet and smoking remains a key challenge despite preventive efforts. The situation in Galicia reflects the urgency of improving prevention and awareness strategies at national level to reduce these figures in the future.
What are the main lines of research in the cardiovascular area of CiMUS?
The cardiovascular area of the Singular Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS) is organised into several research groups that address different key aspects of cardiovascular diseases. The main lines of research are:
1. chemotherapy-induced cardiotoxicity and epigenetic modulators (CardioCHUS Group; Cardiovascular Area | CiMUS (usc.gal)): Led by Dr José Ramón González Juanatey, this group investigates the adverse effects of chemotherapy on the heart, looking for biomarkers to detect and prevent cardiotoxicity. They also study the role of microRNAs and other epigenetic modulators that regulate genes associated with diseases such as heart failure, atrial fibrillation and Brugada syndrome. Their aim is to improve the diagnosis and treatment of these pathologies.
2. Vascular calcification and metabolic homeostasis (Metabolic Homeostasis and Vascular Calcification Group, led by Dr. Ricardo Villa-Bellosta, Metabolic Homeostasis and Vascular Calcification | CiMUS (usc.gal)): This group specialises in the mechanisms that regulate vascular calcification, a determining factor in cardiovascular mortality, especially in patients with chronic renal failure, diabetics and advanced age. Its research focuses on identifying new therapeutic targets and biomarkers to prevent and treat calcification in arteries and heart valves.
3. Cavernomas and vascular malformations (Brain Cavernomas Group; Laboratory for vascular biology | CiMUS (usc.gal)): Led by Dr Juan Bautista Zalvide Torrente, this group focuses on the study of cerebral cavernous malformations, a type of vascular anomaly that can lead to strokes. Their research aims to better understand the genetic and molecular mechanisms behind these malformations, with the goal of developing more effective treatments.
4. Platelets and cardiovascular diseases (Platelet Biology Group, Dr Ángel García Alonso, Platelet Proteomics | CiMUS (usc.gal) ): This group investigates the role of platelets in the development of cardiovascular diseases. Its focus includes the study of platelet activation and its contribution to thrombosis, with the aim of identifying new markers and treatments to reduce the risk of cardiovascular events such as heart attacks and strokes.
Finally, what do you see as the main challenge?
The main challenge in the field of cardiovascular diseases is to make prevention effective and accessible to the whole population. Despite extensive knowledge about risk factors and advances in treatments, cardiovascular disease continues to increase, mainly due to unhealthy lifestyles, unequal access to care and lack of awareness of the importance of prevention.
A key challenge is to translate scientific knowledge into real and sustainable lifestyle changes, focusing on promoting healthy eating, increasing physical activity and, crucially, managing stress, which is an increasingly recognised risk factor. Chronic stress, related to modern life and work overload, contributes significantly to the development of cardiovascular problems. Integrating strategies to improve mental health and teaching people how to manage stress is therefore essential.