Background: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations’ expectation. Celebrating the 40th year’s anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. Aim: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former ‘Soviet bloc’ countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. Method: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. Results: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former ‘Soviet bloc’ countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. Conclusion: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as 90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0–60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0–66.0) and 64.0 (51–80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0–62.0), 63.0 (56.0–68.0), and 79.0 (64.0–80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0–62.0), 63.0 (56.0–68.0), and 80.0 (76.0–80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies.

Background: The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors’ target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40–65 years and the success of achieving risk factors’ target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies. Methods: We conducted a cross-sectional study involving 37,778 patients aged 40–65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics). Results: For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%. Conclusions: The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.

Although nutritional advice and counseling are an important part of diabetes care, current Hungarian health care regulations make it available only in the secondary (specialist) care. Authors planned and implemented a self-financed nutritional counseling in primary care setting. For 67 of 108 diagnosed diabetic patients of a primary care practice in Budapest, a free of charge educational service was offered. The 47 patients (45 type 2 and 2 type 1) who accepted the invitation were educated in two consecutive group sessions. Only 24 of them were ready to take part in three further individual consultations. Fasting blood glucose and glycated hemoglobin were measured before and after the sessions and 1 year later. Comparison was made between genders (31 men, 16 women) and patients who took part in the group and the individual nutritional counseling, respectively. Patients with a higher educational level, males and persons with shorter duration of diabetes were more likely to participate in the consultation. All glycemic parameters improved after counseling in both groups, but this was significant only in men and for the group consultation. After 1 year, a further improvement was seen in women and in patients of the individually counseled group. In turn, fasting blood glucose and glycated hemoglobin concentrations of men and group-consulted patients increased again, reaching almost the baseline level before consultations. Nutritional counseling in the primary care offers more comfort and help for diabetics but requires changes in insurance regulation, and reimbursement system together with increase in resources.

Obesity management is a big challenge for health care providers. Obesity-related metabolic diseases are the most common chronic conditions and risk for shorter lifespan. Primary care is the appropriate level, not only for the management but for the prevention and early recognition as well. Obesity develops gradually and needs attention in the early phase of weight gain. The main results of four Hungarian and international studies in primary care settings were summarized, seeking relationship between weight gain in younger life and development of metabolic diseases. Data of primary care patients were collected about the changes of their weight gain from 20y to the present. Source: medical files and self-reports. Early weight-gain between 20y and 30y means a serious risk for developing diabetes, between 30y and 40y for hypertension and even faster weight-gain could be a risk factor for both metabolic diseases. In females, significant weight gain around pregnancies and the menopause could increase the risk of these morbidities as well. Primary care service providers/family physicians/general practitioners ought to be not only an inactive observers, they have to give more focus on those of their patients who show conspicuous weigh gain in their younger decades, to explore the individual reasons and to initiate the appropriate intervention as early as possible.