September 29, 2018 marks the anniversary of a pioneer in cardiovascular surgery. It would have been the 115th birthday of Dr John Heysham Gibbon Jr who, in the late 1930s, became the first clinician to develop a working ‘heart-lung’ (cardiopulmonary bypass) machine. Initially, he employed it for extracorporeal circulation that allowed experimental thoracic surgery to be performed in a cat. A similar device was first used successfully in humans during the closure of an atrial septal defect on May 6, 1953. History was made and the cardiopulmonary bypass machine is now commonly used in open-heart surgery. Dr Gibbon died on February 5, 1973 but left quite a legacy.

As September is National Heart Month, it is timely to recall the origins of cardiology. We could cast our minds back as far as William Harvey (1578-1657), court physician to James I and Charles I and an avid student of human circulation. Having performed many autopsies and animal dissections, it was Harvey who propounded that the pulse was a function of the contracting heart and he went on to publish his findings in a paper entitled the Anatomical Exercise Concerning the Motion of the Heart and Blood in Animals (1628). His paper explained the purpose of valves in the heart and veins, while also proving that blood does not pass through the septum of the heart. He went on to describe the atria, the ventricles, and separate pulmonary and systemic circulatory systems. In due course, it was the English clergyman and scientist Stephen Hales (1677-1761) who first noted the existence of measurable blood pressure in the arteries, but it was not until 1896 that the Italian physician Riva Rocci (1863‑1937) invented the sphygmomanometer. 

Fast forward to the modern day and cardiovascular health has never been more relevant. According to the World Health Organization, cardiovascular disease causes more deaths globally than any other illness, accounting for 17.7 million deaths worldwide (or 31% of all global deaths) in 2015. Of these, the WHO reports that 7.4 million are due to coronary artery disease and 6.7 million are due to cerebrovascular accident (CVA). Three quarters of all cardiovascular-disease-related deaths occur in low- and middle-income countries. Indeed, of 17 million premature deaths (namely deaths before the age of 70) caused by non-communicable diseases, 82% are in low- and middle-income countries, while 37% are due to cardiovascular diseases.

Naturally, the WHO advocates for population-wide interventions to reduce cardiovascular diseases, including tobacco control policies, taxation of foods high in fat, sugar and salt, strategies to reduce the harmful use of alcohol, infrastructures that encourage physical activity and so forth. In their Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013-2020, 194 WHO member states ratified a proposal to reduce the number of deaths from NCDs by 25% before 2025 by way of nine global targets, two of which focus directly on the prevention and control of cardiovascular diseases. 

In line with this, the Tobacco Free Ireland Action Plan aims to see Ireland ‘tobacco free’ (meaning a smoking prevalence of less than 5%) by the year 2025. According to its annual report, key achievements to date include epidemiological research into smoking habits, legislation for standardised packaging of tobacco products, the QUIT campaign and a proposed further increase in the price of tobacco products. Similarly, the stated goal of the Irish Heart Foundation is the delivery of services that will contribute to a 25% reduction in premature deaths in Ireland from cardiovascular diseases by 2025. Hopefully these measures will succeed. 

Resources

1. www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) 
2. www.irishheart.ie