European Society of Cardiology: Cardiovascular Disease Statistics 2019
Research article
Abstract
Aims
The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets.
Methods
In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries.
Results
Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved.
The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension 23.8% vs. 15.7% (IQR 14.5–21.1%)}, diabetes 7.7% vs. 5.6%, and among males smoking 43.8% vs. 26.0% although among females smoking was less common in middle-income countries 8.7% vs. 16.7%.
Across ESC member countries alcohol consumption was more than three times higher in males compared with females, and almost twice as high in high-income compared with middle income countries. Since 2010 consumption has declined by nearly 9% in middle-income countries but in high-income countries little change has occurred.
There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income (7160) compared with high-income (2235) countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%).
Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures.
Conclusion
A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.
Burden of alcohol use
Alcohol consumption remains a leading cause of premature death in the USA where it is responsible for 1 in 10 deaths among working-age adults. In the EU, alcohol use is the third biggest cause of premature death after tobacco and hypertension with alcohol dependence estimated to be responsible for more than 60% of all alcohol-attributable mortality.
National statistics: Data for 2016 show that 66.6% (IQR 41.973.3%) of people aged 15 years or more, living in ESC member countries had consumed alcohol in the previous 12 months, with a median consumption of 10.2 L/capita/year. There were large differences between countries, with consumption ranging from <4 L/capita/year in Israel, Algeria, Azerbaijan, Egypt, Lebanon, Libya, Morocco, Syria, Tunisia, and Turkey, to >12 L/capita/year in Belgium, France, Germany, Latvia, Portugal, Slovenia, Bulgaria, Republic of Moldova, and Romania. Cultural and religious factors are likely to contribute to the very low alcohol consumption in many Middle East and North African countries.
Stratification by gender: Across all ESC member countries, data for 2016 show that fewer females (55.1%) than males (79.4%) had consumed alcohol in the previous 12 months. Median consumption among females (4.1 L/capita/year) was accordingly lower compared with males (16.8 L/capita/year) and this was a consistent finding across nearly all ESC member countries. Age-standardized median prevalence rates for heavy episodic alcohol use were likewise lower in females (15.0%)compared with males (47.4%). Rates 60% or more were recorded for males in Czech Republic, Estonia, Latvia, Lithuania, Luxembourg, and Slovenia. Rates tended to be high among females in these same countries and exceeded 30% for females in Latvia, Lithuania, and Luxembourg.
Stratification by national income status: In 2016, the median prevalence of alcohol consumption in the previous 12 months was 72.7% in high-income countries, which was almost double the prevalence in middle-income countries (37.5% Accordingly, median alcohol consumption was higher in high-income [11.5 (9.412.5) L/capita/year] compared with middle-income countries [7.0 (1.410.1) L/capita/year] for both females and males. Nevertheless, there was considerable variation with consumption in high-income countries ranging from 3.8 L/capita/year in Israel to 15.0 L/capita/year in Lithuania and in middle-income countries from 0.3 L/capita/year in the Syrian Arab Republic to 15.2 L/capita/year in Republic of Moldova. Heavy episodic alcohol use showed a similar pattern with prevalence rates higher in high-income [35.7% (31.439.9%)] compared with middle-income [19.2% (1.327.2%)] countries for both females and males, although there was considerable variation by country.
WHO non-communicable disease targets: The WHO has called fora 10% relative reduction in the harmful use of alcohol, to be achieved by 2025 (reference to 2010). Paired 2010/2016 data show that median alcohol consumption across ESC member countries has declined by 8.9% from 11.2 L/capita/year to 10.2 L/capita/year. The decline was limited almost exclusively to middle-income countries where consumption declined by 8.6% compared with an increase of 0.4% in high-income countries. These data suggest that if current trends continue the WHO alcohol target is feasible, particularly for middle-income countries.