Heart disease still Europe's biggest killer

Cardiovascular diseases are still the main cause of death in Europe – and smoking, a lack of physical exercise and bad eating habits provide much of the explanation, writes health sciences professor

A new report shows that even if the efforts to reduce mortality from cardiovascular diseases have been successful, CVD remains the main cause of death in Europe with very significant differences in mortality rates between countries. The differences are greatest between northern, southern and western European countries and central and eastern European countries. For example, the death rate for men aged under 65 living in Russia is more than 13 times higher than in France, and for women it is almost 16 times higher. These differences should be of considerable political interest.

Indeed, CVD is the main cause of death in the European Union, accounting for 1.9 million deaths each year. The cost it causes to EU economies is not decreasing. Some 40 per cent of all deaths in the EU, including 43 per cent of deaths in women and 36 per cent of deaths in men, are from CVD. In the EU it is the second largest cause of death before the age of 75 after cancer, accounting for almost half a million deaths.

The newly published fourth edition of European Cardiovascular Disease Statistics is produced by the European Heart Network, an alliance of heart foundations and nongovernmental organisations, and the European Society of Cardiology, which represents cardiology professionals.

Overall CVD is estimated to cost the EU economy almost €196bn a year: around 54 per cent is due to healthcare costs, 24 per cent due to productivity losses and 22 per cent due to the informal care of people with CVD. This represents a cost per capita of €212 per annum, around 9 per cent of total healthcare expenditure across the EU. The amount spent on healthcare for people with CVD varies widely across the EU: cost per capita varied ten-fold in 2009, from €37 in Romania to €374 in Germany.

Three modifiable behavioural factors explain most of the prevalence of CVD: smoking, a lack of physical activity and inappropriate food habits. Smoking remains a major public health threat. Although smoking has declined, the rate of decline itself has slowed down and is even increasing in some countries, particularly among women. Women are now smoking nearly as much as men in many European countries. Trend data in 15-year-olds show a divergence over the last 15 years with smoking among adolescents in northern and western Europe decreasing substantially between 1993/94 and 2009/10 but a number of countries, notably Italy and the Czech Republic, seeing large increases in smoking among boys and girls, or mainly among girls in Russia, Latvia, Hungary, Estonia and Slovakia.

Few adults in European countries participate in adequate levels of physical activity, with inactivity more common among women than men. Participation in exercise or sport was relatively low across the EU, with 39 per cent of adults overall reporting that they never participate in these activities. The highest rates of regular participation in exercise were in the Scandinavian countries and Ireland. Participation in less formal physical activity was also quite low across the EU.

Among children and adolescents in Europe physical activity appears to decrease between 11 and 15 years of age. Physical activity is generally higher among boys than girls, particularly among 13 and 15-year-olds: more than double the percentage of boys compared to girls participate in more than one hour of moderate to vigorous physical activity. The proportion of children watching two or more hours of television per day, an indicator of sedentary lifestyles, shows in many countries that more than two-thirds of all 11 to15-year-olds watch more than two hours of television per day on weekdays.

Levels of obesity are high across Europe in both adults and children: in 34 of 40 countries with available data, more than half of adult men were affected by overweight and obesity. Despite the significance of diet in CVD prevention, high quality and comparable data from European populations are sparse, but it appears that fruit and vegetable consumption has increased overall across Europe in recent decades, while overall fat consumption has remained stable. In contrast, in children food habits remain far from satisfactory: the Health Behaviour of School-aged Children survey of 35 European countries revealed that less than half consumed fruit or vegetables daily with a greater proportion of girls than boys consuming daily.

Finally, the report provides information on blood pressure, blood cholesterol and diabetes mellitus: since 1980 average blood pressure levels have decreased in most countries, mainly in western and northern European countries. Over the period 1980 to 2008, estimated mean population total cholesterol levels were reduced in all countries for which estimates were available for both men and women. In contrast to these beneficial trends the prevalence of diabetes in Europe is high and has increased rapidly over the last ten years, increasing by more than 50 per cent in many countries.

As merely three percent of the healthcare budget for CVD is reserved for prevention the European Cardiovascular Disease Statistics and its important strategic information is recommended reading for decision-makers and healthcare workers alike.

Joep Perk is a professor in the school of health and caring sciences at Linnaeus University in Sweden