Physicians' Academy for Cardiovascular Education

No consistent trends in cardiovascular disease burden across Europe

Literature - Nichols M et al., Eur Heart J 2013 Oct - Eur Heart J. 2013 Oct;34(39)

Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980-2009

Nichols M, Townsend N, Scarborough P, Rayner M
Eur Heart J. 2013 Oct;34(39):3017-27. doi: 10.1093/eurheartj/eht159

Cardiovascular disease in Europe: epidemiological update.

Nichols M, Townsend N, Scarborough P, Rayner M
Eur Heart J. 2013 Oct;34(39):3028-34. doi: 10.1093/eurheartj/eht356
Mortality from coronary heart disease (CHD) has decreased substantially across Europe, over the past decades. This has mostly been attributed to declines in risk factor exposure such as smoking. Nevertheless, cardiovascular diseases (CVD), and specifically CHD and stroke, remain the main cause of death in most European countries.
Mostly obesity, but also other risk factors for CHD, have been increasing over the same time period. It has been proposed that the observed reductions in CHD mortality have mostly occurred in older age groups, and that rates in younger groups are stabilising or even increasing because the gains from reduced smoking rates are increasingly cancelled out by increasing rates of obesity and diabetes.

Two studies published by the same team in the European Heart Journal describe different aspects of trends in CVD burden. One study reports trends in CHD mortality between 1980 and 2009 in the European Union, considering the different sexes and age-groups, while the other is a summary of the current burden and distribution of CVD and CHD in Europe, based on the European Cardiovascular Disease Statistics 2012 report.
The authors show that trends in mortality rates vary markedly between different countries in Europe, but less between age groups and sexes when countries are considered separately. Fifteen countries indeed show evidence of a recent plateauing of trends in at least one age group for men, and in twelve countries this was seen for women. The plateauing effect was not more apparent in younger age groups than in older adults. A minority of countries did, however, show recent stabilisation of mortality rates in younger age groups, and one country even showed a small increase in CHD mortality in young subpopulations.
Thus, there is limited evidence to support the hypothesis that there has been a consistent pattern of recent stabilisation of CHD mortality rates, or that this occurs primarily in younger age groups.
The report on CVD burden observes substantial inequalities between countries in rates of hospitalisation for CVD. Major improvements have been achieved on several measures of CVD, but these improvements are not universal across Europe.
There is a need for initiatives to standardise data collection, to better compare incidence data across Europe. This will allow better interpretation of trends and patterns in mortality data and to prioritise prevention and treatment actions.
Morbidity and mortality from CVD continue to have a big social and economic impact in Europe. Persistent and coordinated efforts should be directed at reducing CVD preventable risk factors for CHD and other chronic conditions, in order to promote wellbeing and equity across the region.
Find these articles fulltext online:
Eur Heart J 2013 Oct; 34(39): 3017-27
Eur Heart J 2013 Oct; 34(39): 3028-34

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