Suggests multidisciplinary approaches in vascular health
Canada urgently needs to focus on prevention of vascular diseases to avoid the burden from the expected tsunami of cases, says noted stroke expert Dr. Robert Côté, delivering the Heart and Stroke Foundation of Canada (HSFC) Lecture at the Canadian Cardiovascular Congress 2010.
"Vascular diseases could be considered Canada's biggest health problem," say Dr. Côté. "All of us will feel the impact in our lifetime." Vascular diseases include many types of dementia under the term vascular cognitive impairment (VCI) as well as Alzheimer's disease, diabetes, atherosclerosis, heart attack, and stroke.
The most common vascular disease, atherosclerosis or hardening of the arteries, accounts for more than a third of deaths in Canada each year.
Things are likely to get worse. Canadians are becoming less fit and more overweight and obese. We'll see more diabetes, more high blood pressure, more abnormal cholesterol levels in the blood - all resulting in more heart attacks and strokes.
"Vascular disease isn't just targeting our major blood vessels," says Dr. Côté. "In the brain, disease in the small blood vessels leads to tiny areas of damage that are associated with dementia, including Alzheimer's disease. The prevalence of these small, undetected strokes increases with age, as does the damage that they cause to the brain over time."
Each of these diseases is a significant health burden, affecting millions of Canadians, but it is the increasing prevalence of dementia, especially as our population ages, which is most alarming. "A specific challenge is the link between dementia and vascular disease of the brain, which is related to stroke," says Dr. Côté "The brain is a vascular organ, as much as the heart, if not more."
Recent reports estimate that the number of Canadians with dementia will increase from the current half million to over 1.1 million by 2038, resulting in costs to the Canadian economy of $153 billion per year.
"We need improved screening to better manage vascular risk factors," warns Dr. Côté, a professor of neurology at McGill University and a senior physician at the Montreal General Hospital. He says the best thing Canadians can do to reduce the burden of cognitive decline is to manage their vascular risk factors, especially high blood pressure, and diabetes.
"The risk factors are the same for all vascular diseases, including Alzheimer's," he says. "Simple measures such as smoking cessation, following a healthy diet, and physical activity will have the biggest impact in protecting the hearts and minds of our aging population."
Need for a comprehensive approach
We do not know enough about the causes of small blood vessel disease, so we know little about how to prevent it, detect it early or effectively treat it. Research in this area is limited and currently organized, like the healthcare system, around the different organs of the body - the heart, the brain, the kidneys.
"We urgently need to link researchers of these different diseases," says Dr. Côté. "By connecting the dots and developing a comprehensive approach that will help us understand more about the causal links between the various vascular diseases, this knowledge could inform health policies and practice."
The Canadian Heart Health Action Plan − supported by the Heart and Stroke Foundation − recommends investment in the creation of a multi-site network in vascular health that would link expertise in centres across the country and improve our knowledge of the broad spectrum of vascular diseases.
The cost to forge this critical link between researchers and clinicians is approximately $8 million per year over five years.
"This investment would be an opportunity for Canada to lead in international research while protecting the health of Canadians," says Linda Piazza, HSFC director of research and health policy. "The problem is urgent and growing. Canada has the talent and a plan. We can't afford to wait any longer."
Dr. Côté also calls on all cardiovascular professionals - including cardiac surgeons, neurologists, cardiologists, and nurses - to recognize the connection between areas of vascular health. "We want to build bridges and plant the seeds of vascular health to forge a path together towards the future."
Co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Congress is Canada's largest scientific conference, attracting close to 4,000 heart-health professionals from across the country.
Attendees representing 18 different organizations, including surgeons, pediatric specialists, cardiologists, nurses, rehab professionals, and others learn about the latest science and cutting-edge research. The congress runs from October 23 to 27 in Montreal.
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