To the Editor,

We read with interest the article by Romero et al.1 about trends and socioeconomic barriers in the field of cardiovascular prevention. In fact, the progress made in recent decades has allowed for improved prediction of cardiovascular disease risk. This, furthermore, contributes to reducing associated mortality. However, despite improved identification of cardiovascular risk factors and therapeutic advances to halt their progression, the degree of control that has been achieved is well below target and the residual risk remains high. The authors point to the possible existence of unidentified factors, the possible adverse effect of certain aggressive therapeutic measures and unfavorable lifestyle linked to socioeconomic status. Nevertheless, it is worth mentioning a major obstacle to cardiovascular prevention: “professional barriers”. The implementation of guidelines in practice has been periodically evaluated since the nineties in three cross-sectional surveys: EUROASPIRE.2 Comparison of these surveys (1995-1996, 1999-2000, and 2006-2007) confirms a trend toward unfavorable lifestyles, with substantial increase in obesity and greater prevalence of smoking at younger ages. Despite a significant increase in the use of antihypertensive and lipid-lowering medication, management of blood pressure has not changed and nearly half of patients do not achieve recommended lipid goals. Asymptomatic individuals with high cardiovascular risk were first included in EUROASPIRE III,2 with alarming results. A large percentage did not reach recommended goals, without a clear linkage to socioeconomic barriers. The management of smoking was not as effective as expected, due to a lack of professional support to stop smoking. Another negative result was the persistence of obesity. However, a third of overweight or obese subjects had never been warned about their condition, and the vast majority had not received advice on diet or physical activity. These data and the above mentioned factors explain this lack of professional adherence (lack of time, lack of incentives, lack of training3,4); therefore, we should compare them with the proven benefits of different intervention programmes. EUROACTION5 was a multicenter, outpatient, nurse-run project for patients with heart disease and high risk individuals, as well as their partners or relatives. After one year, there was a significant improvement in lifestyle and control of cardiovascular risk factors between intervention and control groups, irrespective of the amount of medication used. These results should serve as a point of reflection: eliminating barriers is feasible from an individual perspective. Every physician should: a) ensure communication with both the patient and their closest family members, b) integrate nursing staff in order to implement lifestyle changes, and c) maintain long-term programs in the most appropriate settings. This will help to move past the current standstill and excessive medicalization, and toward effective cardiovascular prevention.