Speaking on Vikerraadio's "Huvitaja" program, Ruth Kalda, professor of family medicine at the University of Tartu, said heart disease is largely considered a lifestyle-related illness. "Roughly 90 percent of people who end up in the hospital due to heart disease have risk factors such as high blood pressure and cholesterol levels, being overweight and often also type 2 diabetes," Kalda explained. Smoking also plays a significant role.

According to Kalda, the decrease in mortality and incidence is thanks to modern medicine and pharmaceuticals. Smoking has also declined. However, a growing concern is the increasing number of obese and overweight individuals, and fewer and fewer people are engaging in regular physical activity.

She pointed out that, as a family doctor, she often sees people only becoming aware of their risks once their health has already started to deteriorate, when symptoms appear or after a heart attack. Sometimes it happens when a loved one falls ill. "Changing your lifestyle is difficult — it requires not only awareness but also motivation and persistence to make lasting changes," Kalda said.

Sander Pajusalu, associate professor of clinical genetics at the University of Tartu, explained that heart disease is also partially influenced by genetic factors. There are well-known hereditary heart diseases that affect multiple family members, often from a young age. These are usually caused by changes in specific genes.

"Everyone is genetically different — some gene variants increase the risk of heart disease, others reduce it. We can't change our genetics, but we can become aware of these risks and address the modifiable factors," said Pajusalu. He added that although the healthcare system does not yet offer genetic risk assessments to everyone, gene donors can check their risk levels via the biobank portal.

"The importance of genes should neither be overstated nor underestimated. It's wrong to think that if you have bad genes, there's nothing you can do — or, conversely, that if your genes are fine, you don't need to live healthily. Lifestyle matters for everyone and its impact goes beyond any single disease. If your lifestyle is off track, the risk of heart disease is high even for those with good genes," he emphasized.

About ten years ago, there was hope that knowing one's genetic risk would motivate people to change their habits, but in practice, this hasn't worked as well as expected. "Even with counseling, lifestyle change is difficult. For some people, the knowledge can help, but the effect is hard to measure. That said, every bit of improved health counts," Pajusalu noted.

Compared with people in Northern Europe, Estonian residents have higher cholesterol levels. According to Kalda, the average total cholesterol level among Estonians is 6.8 mmol/L and the so-called bad cholesterol — LDL — is between 4.7 and 4.8 mmol/L. A healthy total cholesterol level is considered below 5 mmol/L and LDL should be below 3 mmol/L. If a person already has heart disease, those levels should be even lower.

When lifestyle changes aren't enough, cholesterol-lowering medications are used — most commonly statins, which block cholesterol production in the liver. These are not short-term treatments but must be taken for the rest of one's life.

Kalda noted that statin use is gradually increasing in Estonia, though still two to three times less than in the Nordic countries. Reasons include the previously high cost of medication and lingering myths about possible side effects.

Cardiovascular health study

This spring, the Estonian Biobank launched a heart health study involving 6,000 gene donors. The goal is to assess whether lowering cholesterol levels with statin treatment in people identified as having a high genetic risk score helps reduce the incidence of heart disease. The main hypothesis is that statin therapy can help prevent heart disease among those with elevated genetic risk.

What makes the study unique is that participants are offered immediate intervention — in this case, treatment. "We hope that heart disease occurrence will decline among those receiving treatment. If the study proves successful, this approach could become standard practice in preventive care," said Pajusalu.

Participants will be divided into two groups. In the control group, factors such as weight and cholesterol levels will be measured, after which participants will continue with their normal lives. They will be called back in five years for another round of measurements. The second group will begin statin therapy under the guidance of their family doctor and be monitored for five years. The study will not interfere with participants' everyday routines.

April marks Heart Health Awareness Month, and Ruth Kalda reminded listeners that at the core of a heart-friendly lifestyle is the Mediterranean diet — favoring vegetables, fish, whole grains and olive oil, while limiting red meat and refined fats. Regular physical activity is also crucial: at least five times a week, for at least 30 minutes per session, combining aerobic exercise with strength training.

In addition to diet and physical activity, Kalda emphasized the importance of mental health, sleep and rest for maintaining heart health. She also advised against excessive alcohol consumption and noted that smoking does no good either.

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