CVD Burden Declining in Europe, Country Disparities Remain

Marlene Busko

August 21, 2014

OXFORD, UK — Mortality rates from CVD have dropped substantially over the past decade in most of 53 European countries, with notable exceptions, a new study reports[1]. For example, 50- to 54-year-old men in Russia, Ukraine, and Belarus now have a greater risk of dying from CAD than 75- to 79-year-old men in France.

The study, largely based on data from the World Health Organization, updates a similar one in 2013, and is published August 19, 2014 in the European Heart Journal.

"There is evidence of continuing reductions in the burden of CVD," Dr Melanie Nickols (University of Oxford, UK and Deakin University, Geelong, Australia) and colleagues write. However, "in contrast to ongoing decreases in mortality, hospitalizations for CVD have increased in the majority of countries," probably partly due to an aging population, but this "emphasizes the continued high burden of CVD in the European population," they note.

Country and Gender Differences

The analysis revealed that four million deaths per year in Europe—51% of deaths among women vs 42% of deaths among men—were caused by CVD. About 20% of deaths among men and women were caused by CAD. But compared with men, women had a higher rate of death from stroke (14% vs 10%) and from CVD other than CAD (16% vs 14%).

In the 18 countries with updated mortality data since the last report—Belgium, Croatia, the Czech Republic, Estonia, France, Germany, Greece, Hungary, Israel, Luxembourg, Norway, Republic of Moldova, Serbia, Spain, Ukraine, Latvia, Armenia, and Denmark—age-standardized rates of death from CVD continued to drop in men. However, these rates increased slightly among women in Hungary, Israel, Norway, and Serbia.

"It will be important to continue to monitor the gender-specific trends in CVD and CHD mortality amid this and other evidence that decreases in mortality rates may have begun to slow or even reverse in some specific subpopulations," the authors write.

The latest analysis also showed that cancer is sometimes edging out CVD as a leading cause of death. In 10 European countries—Belgium, Denmark, France, Israel, Luxembourg, the Netherlands, Portugal, Slovenia, Spain, and San Marino—cancer caused more deaths in men than heart disease. For the first time, cancer overtook CVD as the main cause of death among women in one European country: Denmark.

This "is due to the fact that fewer people develop cardiovascular disease and, in those who do, fewer die from it," coauthor Dr Nick Townsend (University of Oxford) said in a statement. "This is probably due to . . . decreases in the number of people smoking tobacco, along with better treatments, including preventive ones, such as the increasing use of statins. However, increases in some risk factors, such as rising levels of obesity, suggest that these decreasing trends may be in danger of reversing," he cautioned.

CVD caused three in every 10 deaths of Europeans younger than 65 and 37% of deaths in those younger than 75.

The study also revealed mostly substantial improvements in survival after MI or stroke. In most of the 25 countries with recent five-year data, there was about a 5%-per-year reduction in the number of patients who died after being admitted to the hospital for MI and a smaller reduction in patients who died after being admitted for stroke.

Two years ago, the World Health Assembly (WHA) adopted a global target of reducing mortality from noncommunicable diseases (NCDs) by 25% by the year 2025, the authors note. "Worldwide, there have been few moments in history during which NCDs have enjoyed such a prominent place in the world's attention, with CVD at the forefront of the activity," they write.

However, there has been little national or regional commitment to improving the monitoring and reporting of CVD risk factors and outcomes, they add.

While some richer countries are making huge progress, many Europeans in other countries are dying prematurely from CAD and stroke. "It is clear that in many countries of Europe, CVD mortality has continued to decrease substantially in recent years and will make a large contribution to achieving this [WHA] goal. In these (predominantly high-income) countries, a 'tipping point' is rapidly approaching, when cancer deaths will outnumber CVD deaths, particularly among men. In many other countries, however, the CVD burden dwarfs that of cancer, and a large proportion of the populations will lose their lives prematurely to heart disease and stroke," Nichols and colleagues conclude.

The authors have no conflicts of interest.

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