Cardiovascular Diseases Are Killing Every Year More Than 17.5 Million People Worldwide

Tuesday, 16 February 2010 00:00

They are the main cause of death and disability in Europe, accounting each year for more than 4.2 million deaths in the WHO European region, and more than 2 million deaths across the EU member states, and costing the EU economy an estimated €192 billion a year.

Cardiovascular diseases-CVD (e.g Myocardial Infarction – MI and Stroke) are killing more than 17.5 million people worldwide. They are the main cause of death and disability in Europe, accounting each year for more than 4.2 million deaths in the WHO European region, and more than 2 million deaths across the EU member states, and costing the EU economy an estimated €192 billion a year.
There are many risk factors associated with myocardial infarction and stroke. The major modifiable risk factors, tobacco use, alcohol use, high cholesterol, high blood pressure (hypertension), obesity, physical inactivity, unhealthy diets, have a high prevalence across the world. The INTERHEART Study focused attention on an increasing number of risk factors (stress and social un-satisfaction, air pollution, are now in the lists) represent more than 95 % of the risk factors of CVD (Lancet 2004; 364:937-52 and Lancet 2006; 368:647-58). Multiple risk factor management is a critical area in the prevention and treatment of CVD and has been shown to be effective in reducing mortality and disability mainly in cardiovascular disease. All these risk factors can be modified either by life style changes or by medical and/or pharmacological intervention. There are so called non modifiable risk factors such as age, family history, and gender. Male gender is a greater risk of heart disease than premenopausal women. After menopause, women deaths and disability for CVD are becoming prevalent.  Also ethnic origin plays a role: people with African or Asian ancestry are at higher risks of developing cardiovascular disease than other racial groups (The Atlas of Heart Disease and Stroke, 2004).
The main form of CVD is coronary heart disease (CHD) (European Cardiovascular Disease EHN 2008). On the basis of data from WHO MONICA (Monitoring trends and determinants in Cardiovascular diseases project), the incidence of coronary events increased from 354,000 to 368,000 (5%) over the period 1990 to 2000 (Circulation 1994; 90 (1): 583-612).
Death rates from CVD have been falling over the past 15 years in most European countries and the US. However, despite availability of effective medication, numerous studies show that at-risk patients are often failing to reach the treatment goals recommended in guidelines. Lack of public awareness and understanding of CVD and cholesterol management amongst the general public may contribute to this treatment gap. Although mortality rate due to acute MI is reduced, WHO data indicate that a conservative increase of acute MI events will be 25% by 2030 and will likely involve older and more complex patients such as those with major co-morbidities. In the 27 countries of the EU, the societal economic burden of CVD was estimated to be € 186 billion in 2006, and 192 billion in 2007 (European Cardiovascular Disease 2008). The estimated economic burden not only included health care consumption (€ 110 billion) but also the opportunity costs and productivity losses associated with unpaid care, premature death and absence from work due to illness. Previous work using similar methodology estimated the cost of CVD at €169 billion for the 25 countries of the EU in 2003 (Eur Heart J 2006; 27 (13):1610-1619). With the ongoing trend, in 10 years from now (2010)  in the 27 countries of the EU,  the yearly  economic burden could  reach  € 250 billion (more than €30 billion in Italy). On the other side in 10 years 20 million EU citizens could die (around 2.4 million in Italy: 1.3 million women and 1.1 million men).
Countries have a legal and moral obligation to achieve the highest standard of Cardio Vascular health care for citizens and to improve national health care systems accordingly.

February 16, 2010


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Antonio Arteaga 2010-03-15 17:14:48 As working in Latino America with a strong influence of the medical statements of the United State of North America(I had my postgraduate in USA)I am pleased to hear about de European guidelines,that offer an alternative view about the strategies in cardiovascular prevention. I am begining to teach to post-graduates students the European guidelines in cardiovascular prevention and I hope that your information continue.

CVD morbidity and mortality W.E. Feeman, Jr, MD 2010-03-15 17:20:07 CVD (I prefer the term atherothrombotic disease[ATD] because it is more mechanistic) morbidity and mortality will not be impacted significantly until its risk factors can be presented to physicians and the public in general in a simplified form that is easy to understand and that affords a simple, easily available treatment protocol. The reaason that ATD has declined recently, in my opinion, is that just such an approach has been accomplished with the leading cause of ATD, namely cigarette smoking. The curves describing the decline in ATD mortality and the decline in cigaqrette smoking run parallel. Cigarette smoking leads to earlier age of onset of ATD and earlier age of death in ATD. The main risk factors for ATD are cigarette smoking, dyslipidemia, and hypertension. These form the final common pathway for ATD, though they may be influenced by diabetes mellitus and obesity. In my database 95% of all ATD patients have at least one of these risk factors. The rest of the so-called risk factors are in reality triggers to set off events in patients with ATD (ie, air polution) or markers of patients who already have ATD (ie, hsCRP). Unhealthy diet can, in some but not all, enhance the causative risk factors noted above. We must get away from focusing on LDL-cholesterol. A state of dyslipidemia exists, in my opinion, when the balance between the atherogenic lipids (mainly LDL) and the anti-atherogenic lipids (mainly HDL-cholesterol) favor the accumulation of cholesterol in the arterial wall, in the sub-intimal space. This balance is best examined by use of lipid ratios, and I have advocated the use of the Cholesterol Retention Fraction (CRF, or [LDL-HDL]/LDL) on this website in the past. When all three major ATD risk factors are properly treated (see my position paper on this website from 2009) there will be a marked reduction in ATD morbidity and mortality in Europe as already exists in my practice. Even dementia is virtually non-existant, probably because treatment of the major ATD risk factors reduces the vascular component of dementia.

Acute MI predictions Eros 2010-03-24 20:48:59 This is truly a devastating disease. I was struck by the 25% increase in Acute MI events by 2030. Could you explain where you found or calculated that number. I have been trying to find it myself for a project of mine using WHO data, but I do not see Acute MI events as a category in WHOs Global Burden of Disease data. Thanks.

Answer to your comment "Acute MI predictions" Health Europe Committee 2010-04-12 11:49:57 Dear Doctor, thank you for your question. You can find more details in the "Atherosclerosis" Supplement 10 (2009), 3 - 21, pages 4 and 5. Please visit www.healtheurope.org site, Section "Links": Health Policy Issues in Multiple Risk Factor Management in Cardiovascular Diseases http://www.healtheurope.org/images/lin ks/ATHEROSCLEROSIS%20-%2011%20Maggio%202009.pdf Best regards

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