The Authors
Report by Prof. Meral Kayıkçıoğlu and Assoc. Prof. Emre Aslanger, National CVD Prevention Coordinators for Turkey:
Meral Kayıkçıoğlu
MD, Professor
Ege University, School of Medicine, Department of Cardiology, İzmir, Turkey
Emre Aslanger
MD, Assoc. Prof
Yeditepe University, Department of Cardiology, Turkey
(This is an update of the 2013 report by Prof. Dilek Ural and Prof Meral Kayıkçıoğlu)
Documents to download
Health care
Turkey made several reforms in health system in line with the Health Transformation Program (HTP) in the last decade. Five different governmental health insurance schemes with different coverage types were consolidated to create a unified general health insurance scheme with harmonised and expanded benefits. HTP expanded access to health-care services for all citizens, especially the poorest population groups. Today the majority of Turkish citizens are covered with governmental insurance. The number of private insurance companies is increasing but most of their customers have also governmental coverage.
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Risk factors
Major CV risk factors in Turkish adult population are investigated in several national surveys. Among them Turkish Adults Risk Factors Study (TARF) − the earliest and longest epidemiological study sponsored by TSC − is the most comprehensive study that evaluated CV disease and its risk factors in Turkey. Accumulating evidence generated in the TARF study demonstrated that standard risk factors fail to identify a large proportion of individuals at high coronary heart disease risk and that inflammatory markers and type-2 diabetes are far more pertinent in this regard, particularly in Turkish women, than in Western populations. In an effort to establish a unique risk estimation system from TARF database, the authors reported that age, presence of diabetes mellitus, CRP, systolic blood pressure, LDL-cholesterol, smoking status, and HDL-cholesterol were relevant in the estimation of CV risk in men, while the latter two factors were not predictive among women.
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Main actors
The main actors in CV prevention are general practitioners. The majority of Turkish citizens have a family physician and can reach them easily. Primary care physicians are regularly educated in the management of main risk factors and logical drug use – to choose the most cost-effective evidence-based drug – is encouraged. Patients can also directly access internists and cardiologists.
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Cardiac rehabilitation
The concept of cardiac rehabilitation is not acknowledged enough in both the public and private health sector in Turkey. Cardiologists and cardiovascular surgeons are not sufficiently demanding, and awareness of health professionals on this issue is quite low. Therefore, cardiac rehabilitation practices may not be common enough, and do not allow for routine service.
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Prevention activities
National heart health policy established by Turkish MoH and TSC aims to decrease the burden of CV disease and its risk factors in Turkey. The Ministry of Health (MoH) leads the main public awareness campaigns, projects, and educational activities. Local authorities also conduct various projects for CV health. Turkey has succeeded in setting a national policy, action plan targets, collecting reliable mortality data and achieving risk-factor surveys. A Multisectoral Action-Plan was launched by the MoH in 2017 and its 4 strategic pillars:
- strengthening national capacities, leadership, governance and partnerships
- reducing modifiable and preventable risk factors
- strengthening the response of the health system
- monitoring trends and determinants of non-communicable diseases and evaluating progress in their prevention and control.
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Aims for the future
Despite the enormous effort spent on CVD prevention, all the epidemiologic data show an incremental rise in CV risk factors in terms of diabetes, hypertension, and abdominal obesity. For achieving more effective preventive measures we need:
- Continuation of public awareness campaigns, programs and education of population from school years.
- Increase health professionals’ awareness and willingness to participate in CV prevention and especially in rehabilitation.
- Establishment and promotion of patient organisations in order to increase public awareness, ease cooperation with health authorities, and provide education and self-support for the patients.
- Close control of the media in order to avoid the risk of false information
- To increase the health literacy throughout all social strata. Inclusion of relevant general health and prevention topics in the core curriculum of high schools.
- To increase the collaborative work of primary care physicians and cardiologists.
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The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
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