A draft National Cardiovascular Health Plan sets a target of cutting early deaths from heart and blood vessel disease in Bulgaria by 25% by 2032. The Bulgarian Society of Cardiology presented it on 11 November.
The plan aims to monitor high blood pressure outside hospitals too, and to have people tested for cholesterol and blood sugar once a year. At least 75% of people aged 25 to 64 and at least 90% of those over 65 should have their blood pressure measured by a medical professional every year. For cholesterol and sugar tests, followed by a consultation on the results, the target is at least 65% of people aged 25 to 64 and at least 80% of those over 65.
Cardiovascular disease kills 166 people a day in Bulgaria. In 2022 the death rate was 847 per 100,000 women and 1,285 per 100,000 men. The draft describes an unprecedented demographic and health crisis and says Bulgaria has the highest rate of early deaths from these diseases in the EU. Adding up economic and social costs, the diseases cost €1.98bn a year.
The society has worked on the plan for almost seven years. Its chair, Prof Ivan Gruev, called it a national cause. He said interventional cardiologists treat heart attacks successfully, but there are about 25,000 a year and the number is not falling, which points to a lack of prevention.
"In Bulgaria we do very well with treatment, but on prevention we are in debt to our fellow citizens," Prof Gruev said. He described the current model as reactive, focused on hospital treatment of acute and complicated conditions. He said it does not suit modern healthcare and is economically unsustainable and socially destructive.
For primary prevention, meaning protection before disease starts, Prof Gruev proposes a ban on all smoking products indoors and outdoors, a ban on advertising them, and higher excise duties. Some 29% of people, or one in three, smoke every day. People drink 11.1 litres of pure alcohol each a year, 6% more than a decade earlier. More than 60% do not eat fruit and vegetables every day, and salt intake is over 8 grams a day, double the WHO maximum. Some 37% lead a sedentary lifestyle, a rise of 29%.
The draft names dirty air and climate change for the first time as a direct threat to the heart and blood vessels. People in Bulgaria are exposed to fine particles (PM2.5) averaging 17 µg/m³, against 11 µg/m³ in the EU. In 2023, 66% of the population faced extreme heat above 35°C. Because of it, new cases of high blood pressure among adults rose by 9.7%.
A new feature is due to launch in "E-Health", approved by the Ministry of Health. Anyone will be able to calculate and track their own cardiovascular risk, and family doctors will see which patients are at high risk. It uses the SCORE-2 and SCORE-2-OP calculators, validated by the European Society of Cardiology. The Bulgarian society gave them to the National Health Information System so they can be adapted precisely.
The European Commission encourages every member state to have its own heart plan based on the needs of its people, share good practice and track results. Bulgaria is not alone in tackling this problem, said Prof Cecilia Linde, president of the European Society of Cardiology.
As an example, Boryana Pervan, chief executive of the World Heart Federation, pointed to a woman in her early 50s with untreated high blood pressure who will have a cardiovascular event in a few years. "If hypertension is found in time and treated, and the patient stops smoking and cuts down on salt and sugary drinks, a heart attack will not be a threat," she said. Pervan said the most important thing is for national heart plans to have political support.