While 491 thousand 684 people died in Türkiye in 2025, 34.7 percent of the deaths were caused by circulatory system diseases. Accordingly, approximately 170 thousand 600 people died due to cardiovascular diseases. Hypertension, high cholesterol, diabetes, obesity, inactivity, unhealthy diet and use of tobacco products are among the main reasons for this alarming situation in heart health. This worrying picture and questions about heart health were explained by Prof. from the Cardiology Clinic of Seyrantepe Hamidiye Etfal Training and Research Hospital, faculty member of the Department of Cardiology, Faculty of Medicine, University of Health Sciences. Dr. Nurcan Arat told Haberglobal.com. “Our veins do not look at our identity cards,” said Prof. Dr. Arat emphasized that calendar age and vein age are not always the same. Arat said, “The veins of a 45-year-old person may have aged as much as the veins of a 65-year-old individual. On the other hand, the vascular health of a 70-year-old person who adopts healthy lifestyles may be much better than expected. For this reason, in cardiology, we now talk not only about calendar age, but also about vascular age.”
Why are cardiovascular diseases so common in Türkiye and what does this picture tell us about public health?
“A heart attack often does not develop in one day; it is the final act of a vascular disease that progresses silently for 20 to 30 years. One in every three deaths in Türkiye is caused by circulatory system diseases. We lost approximately 170 thousand 600 citizens due to cardiovascular diseases. This figure shows that cardiovascular diseases are not a health problem that only concerns cardiologists; It shows that it has become one of our country’s top public health priorities.
Is it possible to explain this high death rate solely by the aging of the population?
It would not be correct to explain this picture only by the aging of the population. Of course, the risk increases with age; But the real problem today is that our veins are aging faster than our calendar age. In other words, the veins of a 45-year-old person may be as biologically affected as the veins of a 60-year-old individual. This is due to lifestyle risks that accumulate over the years, rather than genetics. Türkiye has experienced a significant epidemiological transition in the last three decades. Chronic diseases replaced infectious diseases; In turn, our eating habits, working style and daily life have also changed.
What are the main risk factors that increase cardiovascular diseases in Türkiye?
Ministry of Health’s Turkish Household Health Surveys and Health Statistics Yearbook; It shows that cardiovascular risk factors such as hypertension, overweight, obesity and diabetes remain common in the adult population. These data reveal that most heart attacks are not sudden events, but the result of risk factors that accumulate over years and often progress silently. Scientific studies show that high blood pressure, in particular, is the single most important risk factor for cardiovascular deaths worldwide. However, hypertension is called the “silent killer” because it often causes no symptoms. When cigarettes and other tobacco products, high LDL cholesterol, diabetes, obesity and inactivity are added to this, the risk of heart attack and stroke increases significantly.
Is it possible to change this situation and prevent heart attacks?
The preventive cardiology approach focuses on this very point: As important as treating a heart attack, or even more important, is ensuring that a heart attack never develops. The way to do this is not only through hospitals; It passes through a broad public health approach ranging from tobacco control to healthy nutrition, from the physical activity of school-age children to the walkability of cities. Cardiovascular diseases are not destiny. Although genetic predisposition is important, the majority of heart attacks and strokes are associated with modifiable risk factors. Many heart attacks and strokes can be prevented by quitting smoking, lowering blood pressure and LDL cholesterol to target values, good control of diabetes, regular physical activity, Mediterranean type nutrition and healthy weight control.
Diseases such as heart attack, stroke and vascular occlusion are generally perceived as “old age problems”. However, in recent years, we have come across news of heart attacks at younger ages. Is there really an increase in cardiovascular diseases in young people, or has their visibility increased?
In recent years, two different views have emerged in society on this issue. One group thinks that heart attacks are significantly increasing at younger ages; The other group argues that this is a perception created entirely by social media. Scientific data is in the middle of these two views: Not only has the visibility increased, but there is a real increase in the risk of cardiovascular diseases in young adults due to some risk factors. First of all, it should be emphasized that heart attacks are already more common in older ages. However, in recent years, we encounter atherosclerotic vascular disease at an early age more frequently, especially in individuals between the ages of 40 and 55, due to the emergence of risk factors such as obesity, diabetes, hypertension and high LDL cholesterol at earlier ages. Large epidemiological studies from Europe and America show that the decrease in the incidence of heart attacks in young adults has stopped, while a rising trend has begun again in some subgroups.
What are the lifestyle changes that cause young people’s blood vessels to age earlier?
The most important reason for this change is the transformation in lifestyle. Nowadays, decreasing physical activity since childhood and young adulthood, increasing the time spent in front of the screen, overweight, insulin resistance and diabetes occurring at earlier ages accelerate vascular aging. Heart attacks often occur at the age of 45; However, the foundations of vascular disease are often laid in the 20s.
What kind of risk does hookah and electronic cigarette use pose for young people?
Smoking is still one of the most important preventable risk factors. However, the increase in hookah and electronic cigarette use, especially among young people, is striking. The common belief in society that “hookah is more harmless” is not true. Hookah smoke contains high amounts of carbon monoxide, nicotine, fine particles and toxic chemicals. The amount of smoke exposed during a hookah session can reach the level of many cigarettes, depending on the smoking method. This exposure can contribute to damage to the inner surface of the vessels, deterioration of vascular functions and acceleration of the atherosclerosis process. It is not possible to say “harmless” for electronic cigarettes; Its long-term effects are still being investigated, and evidence is increasing, especially regarding its negative effects on vascular functions.
How important is genetic predisposition for heart attack at a young age?
Different risk factors should also not be ignored in young people. Inherited lipid disorders such as familial hypercholesterolemia are one of the most important causes of coronary artery disease at an early age. The risk is significantly higher in individuals whose first-degree relatives have a history of heart attack before the age of 55 in men and before the age of 65 in women.. Even if cholesterol levels appear normal in these people, detailed cardiovascular evaluation may be required. Therefore, even if a young person has no obvious risk factors, if there is a strong family history of early age heart disease, standard cholesterol values should not be satisfied.
Are there any other hereditary risks that are not seen in standard cholesterol tests?
Another important but little known risk factor in society is high lipoprotein(a) (Lp(a)). Elevation of this lipid particle, which is largely genetically determined, may increase the risk of coronary artery disease and heart attack, especially at an early age; also associated with calcific aortic valve disease. The European Society of Cardiology recommends that Lp(a) level measurement in adults be considered at least once throughout life.
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