Latest research shows rates of heart disease and stroke continue to decline in Europe, but more people are hospitalised

Deaths from heart disease and stroke are declining overall in Europe, but at differing rates, according to research, published online in the European Heart Journal [1].

The research, which provides an update for 2014 on the burden of cardiovascular disease (CVD) in Europe, shows that death rates from CVD (diseases of the heart and blood vessels) vary enormously. For some eastern European countries, including Russia and Ukraine, the death rate from coronary heart disease for 55-60 year olds is greater than the equivalent rate in France for people 20 years older.

The age adjusted CVD death rates for men and women of all ages were six-fold higher in Russia than in France. In 2010 in Russia 915 men and 517 women died per 100,000 of the population, whereas the equivalent rates in France were 150 and 87 per 100,000 respectively.

In the UK the CVD death rates for 2010 were 205 and 129 per 100,000 men and women respectively.

Overall, CVD remains the single, greatest cause of death among Europeans than any other disease, and, in many countries causes twice as many deaths as cancer. However, the researchers, led by Dr Melanie Nichols, a Research Associate from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention at the University of Oxford (UK) and senior research fellow at Deakin University, Australia, found there were some countries where cancer was now causing more deaths than heart disease in men (Belgium, Denmark, France, Israel, Luxembourg, The Netherlands, Portugal, Slovenia, Spain and San Marino). For the first time, cancer has also overtaken CVD as the main cause of death among women in a European country: Denmark.

Co-author, Dr Nick Townsend, senior researcher at the BHF Centre on Population Approaches for Non-Communicable Disease Prevention, said: “The reason why cancer has overtaken cardiovascular disease as the main cause of death in these countries is due to the fact that fewer people develop cardiovascular disease and, in those who do, fewer die from it. This is probably due to improvements in the behavioural risk factors associated with CVD, such as 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.”

Dr Nichols and her colleagues in the Oxford research group looked at trends in deaths from CVD over a period of ten years to the most recent year available, (2010 to 2012 for most countries), for 52 out of 53 European countries (there were no data for Andorra). They looked at the total number of deaths for all ages, and also at those that could be classified as “premature”: those before the age of 65 and those before the age of 75.

Data from the latest available year showed that there were just over four million deaths (1.9 million men and 2.2 million women) from CVD, close to half of all deaths in Europe. This was made up of 1.8 million deaths from coronary heart disease, one million from cerebrovascular disease (stroke) and 1.2 million from other cardiovascular diseases.

Just under a million men died before the age of 75 and half a million before the age of 65. Half a million women died before the age of 75 and just over 200,000 before the age of 65. Three in every ten deaths of Europeans aged under 65 were caused by CVD, as were 37% of all deaths occurring before the age of 75

Dr Townsend said: “The proportion of women who die from cardiovascular disease is much greater than men: 51% of women died compared to 42% of men. This difference is driven mainly by a higher rate of stroke and other cardiovascular diseases among women. There was very little difference in the rates of coronary heart disease between men and women: 20% versus 21% respectively.”

Overall, the researchers say that CVD death rates are declining in most, but not all European countries. Trends have also been downwards for what are known as “case fatality rates” – the percentage of people who are diagnosed with a condition and die from the illness within a given period. In the 25 countries for which there were data, there was an average annual reduction in people dying after being admitted to hospital with a heart attack of five per cent in the past five years. On the other hand, the rates of people hospitalised for CVD have increased, probably reflecting the impact of increasing numbers of elderly people in the population.

In their paper, the authors conclude: “Worldwide, there have been few moments in history during which NCDs [non-communicable diseases] have enjoyed such a prominent place in the world’s attention, with cardiovascular disease at the forefront of the activity. Despite this, there has been little commitment at the national or regional level to greater monitoring and reporting of risk factors and outcomes for cardiovascular disease. 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 goal. In these (predominantly high income) countries, a ‘tipping point’ is rapidly approaching, when cancer deaths will outnumber cardiovascular disease 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.”

This study is the authors’ second consecutive report on CVD in Europe, with the previous one being published last year. A total of 18 countries have provided updated mortality data since last year’s report: Belgium, Croatia, Czech Republic, Estonia, France, Germany, Greece, Hungary, Israel, Luxembourg, Norway, Republic of Moldova, Serbia, Spain, Ukraine, Latvia, Armenia, and Denmark.

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Notes:

[1] “Cardiovascular disease in Europe 2014 – epidemiological update”, by Melanie Nichols, Nick Townsend, Peter Scarborough and Mike Rayner. European Heart Journal. doi:10.1093/eurheartj/ehu299