Cardiovascular disease (CVD) kills four million people a year in Europe, and nearly two million in the European Union. It is the leading cause of death in Europe, accounting for nearly half of all fatalities. It is the top killer worldwide, too, ending the lives of some 17 million people a year.
Its impact far outstrips the other leading non-communicable diseases – such as cancer, diabetes and chronic respiratory diseases. And it imposes a huge economic burden, too. Across the European Union, its total cost to the economy is estimated at nearly €200 billion a year – far above the entire EU annual budget of €140bn.
There is wide recognition of the risks of heart disease, there are many effective measures that can be taken against it, and there are evident benefits in reducing its incidence. But surprisingly, there are striking gaps both in prevention and treatment.
Many developed countries – and many European countries – are seeing a slight decline in the proportion of deaths related to CVD, and some are showing success in slowing its growth in absolute terms. Changes in lifestyle, wider understanding of prevention, and advances in diagnosis and treatment are all helping to improve the situation. There has been real progress in reducing mortality in many countries, but there are still major challenges, according to Harry Hemingway, professor of clinical epidemiology at University College London.
The disease continues to ravage society, and is likely to do so until measures of prevention and treatment are more widely accepted and implemented. There are multiple challenges in winning that acceptance. Although many of the risk factors are clearly identified, it is difficult to dissuade people from smoking or drinking excessively, and it is difficult to persuade them to eat more healthily or to exercise more.
Although monitoring can spot people at risk of a first attack, and effective acute response services can save lives, statistics show that incidence and survival differ from country to country and even region to region. And although the importance of secondary prevention – that is, reducing the chances of further disease in people who have survived an episode of CVD – is well recognised, implementation of secondary prevention measures varies, even across Europe.
“We know what works and what makes sense in preventing CVD,” says Professor Roberto Bertollini, the senior scientist at the World Health Organization Europe, and its representative in Brussels. He cites the “best buys” in reducing the disease’s impact: lifestyle changes, interventions such as reducing salt, rehabilitation… “But we have to make sure they are used,” he says, and this is a priority for the WHO.
The challenge is so serious that the United Nations and the WHO have in recent years set targets to reduce non-communicable diseases over the next ten years – with CVD prominent in their campaign. EU member states have signed up to these targets. But progress depends on a combined response – from the population at large, from general practitioners, from cardiologists, from the suppliers of medical hardware, and also policymakers.
“Never before has the community been better placed…to overcome the challenge”, concludes a recent report from the World Heart Foundation. “This”, says Srinath Reddy, president of the federation, “is because the UN and the WHO agenda has imparted new political and strategic momentum, and solutions exist in terms of treatment and prevention regimes. It is a real opportunity for the cardiovascular community.”