Valentí Fuster: “We need to create a culture of health and quality of life”

Dr Valentí Fuster (Barcelona, 1943) is one of the most renowned Spanish cardiologists and researchers in the world. His work has significantly improved the treatment of patients with heart diseases. In addition, his social commitment has led him to become involved in the area of prevention with the aim of improving the overall health of the population, especially that of young people. He currently combines his functions as director of the Carlos III National Center for Cardiovascular Research (CNIC), president of the Mount Sinai Fuster Heart Hospital and Physician-in-Chief of the Mount Sinai Hospital in New York.

In this interview, Dr Fuster reflects on some of the most important prevention projects he has developed together with the Fundación Pro CNIC and the SHE Foundation. In these two organisations, the ”la Caixa” Foundation is actively involved in supporting Fuster’s educational work to prevent disease and promote health. “They’re the key to reducing the prevalence of cardiovascular disease in the world”, according to the renowned cardiologist. 

I realised that I knew more about the heart and heart disease than about health itself. Also, in the past, intensive care units, defibrillators and surgery have helped a lot to reduce mortality. However, about 10 years ago we saw that heart disease mortality was beginning to rise again. So we decided to shift our research focus by using highly sophisticated technologies to understand what health is and how to prevent disease. We directed our research toward three different age groups: from birth to 20 years, from 20 to 60, and 60 to 100, because prevention is completely different in these three age ranges. 

Heart disease -that is, disease of the arteries that supply the heart- is the number one cause of death in the world, occurring roughly between the ages of 40 and 70. In the brain, the most important problems are senile degeneration and Alzheimer’s disease, which tend to appear somewhat later. It’s essential to understand that the same risk factors that lead to heart disease also affect the brain. Therefore, by preventing heart disease we also prevent cognitive decline. 

There are eight risk factors for heart disease. Two are physical: obesity and high blood pressure. Two are chemical: high cholesterol and diabetes. Then there’s smoking, lack of exercise, poor diet and finally, inadequate sleep. These risk factors also affect other organs because they’re all supplied with blood by arteries.

We’ve done a lot of research on individual prevention, mainly with children under the age of 10. But we’ve also done research on adults with collective studies, what we call group therapy. That is, groups of 10 individuals with different characteristics who help each other. And for children, we’ve used the family (parents, children, grandchildren) as the nucleus for prevention. In the end, what we’ve found is that prevention in the family, cultural and social spheres has much more impact and benefit than an individual strategy. We need to create a culture of health that starts with the family or in the workplace. 

We’ve used two different programmes, both with very visual materials inspired by the Sesame Street Muppets to engage the family unit. They work very well and children grasp the concepts. The first programme involves the whole family and they study it for a year. This has now been implemented in three or four corporations, including the ”la Caixa” Foundation. The second begins in the waiting room of a clinic, where participants are presented with visual materials they can access from home for a month. It’s already reached more than a million people in several Latin American countries. 

It’s never too late to start, but it makes a difference whether you start at an early age or in your 50s or 60s. This has been well-studied. For example, a hypertensive individual with high blood pressure who starts taking care of themself in their 30s or 40s will benefit much more than if they begin treatment for hypertension in their 70s or 80s. 

I believe that quality of life is urgent for everyone. To have quality of life, you have to prevent disease. Some people may think that if we prevent illness, people will die later and therefore economically there will be no difference. But if health is extended, mortality will be a very short pyramid of time, unlike now. If one thinks that quality of life is important and that health is fundamental to a country’s economy, then there’s no doubt that we’re facing an urgent situation.  

Right now, the consumer society is beating disease prevention. Obesity and diabetes are increasing and so, therefore, is mortality. So how can we beat the consumer society? We have to create a culture of health and quality of life. In other words, if we all believe that taking care of ourselves and having a good quality of life in our 70s, 80s or 90s is important, we can win the battle. And the economy will also benefit. I always give a very easy example with traffic lights: if there were no traffic lights, there would be enormous chaos. Traffic lights help us circulate so that everything works. It’s the same with health. Prevention is traffic lights. I’m hopeful about this because social thinking is changing. 

There’s no doubt that stress affects all aspects of life, especially cardiovascular health. However, stress is also a personal thing. We live in a 100% consumerist and competitive world, but everyone has to think about what they want in life. Often, competitiveness comes because you want to be in a much more advantageous financial position. But a much more primitive and less stressful life can also be rewarding. There are seven places in the world, the so-called Blue Zones, where people live in community, eat better and have less stress. So it’s essential to stop and think: “What do I want? And how can I survive?”.