An interview with professor F.L.J. Visseren
Professor Visseren is a medical specialist in Internal and Vascular Medicine at the UMC Utrecht. With his research team he investigates the role of adipose tissue in the development of cardiovascular disease. Besides, he is interested in the consequences of large clinical trials at patient-level. “What is the advantage of a novel treatment for this specific patient? What can he/she expect? That individual aspect does not get enough attention at this moment.”
However, it is of the utmost importance to do so, says Visseren. “At this moment, we can quite accurately estimate the chance of developing cardiovascular diseases of healthy individuals. Nevertheless, we lack the tools to reliably estimate this chance of individuals with comorbidities like diabetes or familial hypercholesterolemia (FH).” Some novel strategies, like adding genetic information are under investigation right now, but the preliminary results are disappointing.
Visseren emphasizes the importance of the long-term consequences of cardiovascular risk estimates. “When you are young, your short-term cardiovascular risk is almost always low, while the short-term risk of old individuals is always high. Too easily you could draw the conclusion to leave young individuals alone, and treat the elderly. However, high-risk is not equal to high-benefit. In my opinion the best starting point for cardiovascular treatment is early prevention.” Visseren aims to postpone the first cardiovascular event as much as possible. “We want do delay the development of cardiovascular diseases, so individuals don’t spend the last ten years of their life with physical disabilities and polypharmacy because of cardiovascular disease.”
He compares it to investing in your retirement. “If you wonder one day before you retire how your financial status will be, you are too late. Likewise, don’t start thinking how to prevent vascular diseases when you turn 65, start younger.” Visseren pleads for pharmaceutical interventions, e.g. statins, at a much lower age in individuals with increased lifetime risk. “If a 70-year old individual starts with statin treatment, he will gain several months of lifespan. When you start at a younger age, you will gain much more. Similarly, if you put a little bit of money aside every month from a young age on, the chance of a better retirement will definitely increase.”
Although some would designate this as medicalization, Visseren denies that. “The purpose of statins is to prevent individuals becoming hospitalized patients. We can provide the tools for patients to take matters into their own hand, and delay the first cardiovascular event. Besides, statins are incredibly cheap and extensively tested. Nothing else in the history of medicine has been so broadly tested as cholesterol reduction.”