The European Heart Journal has published the results of a 12-country study investigating the burden of cardiovascular disease (CVD) in Europe. The study updates CVD and coronary heart disease (CHD) mortality, morbidity, and treatment figures for the European region and Israel in 2013.
Implications | The Europe-wide study provides further evidence of a decline in CVD and CHD deaths – mainly in men – for Belgium, Denmark, France, Italy, Israel, Luxembourg, the Netherlands, Norway, Portugal, Slovenia, Spain, and the United Kingdom. |
Outlook | CVD has declined as a leading cause of death; the study demonstrates that cancer has replaced CVD as the leading cause of death in men in parts of Western Europe. The trends are observed in relation to the 12 countries mentioned; these are attributed a combination of factors, among which are improvements in the prevention and management of CVD, as well as the availability of innovative pharmaceutical treatments. A further contributing factor is likely to include better and earlier access to drug treatments. However, the European Heart Journal notes that CVD remains a major public health issue across Europe, and notes that geographic differences continue to exist in the region in relation to CVD deaths. |
The European Heart Journal has published a large-scale research study suggesting that cardiovascular disease (CVD) has been overtaken by cancer as the leading cause of death in 10 Western European Union (EU) countries (as well as Israel and Norway); the epidemiological study, published on the 15 August, is available to view in full here. A wide set of treatment disparities and patient outcomes appear to exist across several European countries that were the focus of the research. In particular, researchers catalogued 87,511 cancer deaths in men compared with 79,935 CVD deaths in men in the United Kingdom (in 2013); this trend is not replicated in women in that country, for whom cancer has not surpassed CVD deaths. In France, male CVD deaths were calculated at 64,659 versus 92,375 for cancer (2011 – latest figures available). There were 67,711 cancer deaths and 53,487 CVD deaths reported for Spanish men (2013); statistically, the highest proportion and number of CVD deaths continue to occur in Eastern Europe.
The peer-reviewed data on the health burden of CVD versus cancer – as well as associated mortality figures – show that CVD continues to be the most common cause of death across the European region (equivalent to an estimated 45% of all deaths). However, for the 12 Western European countries that are the focus of this study, there is emerging evidence of a change in health trends, with cancer deaths now surpassing CVD-related deaths. This trend was mainly observed in men; Israel and Denmark were exceptions in showing that the mortality rate for cancer had also overtaken the mortality rate for CVD in women.
The multi-source study also reported prevalence data for CVD across Europe. According to the figures presented, the latest prevalence rates for CVD in the region are about one-in-ten of the population; despite decreases in CVD mortality rates, the authors of the report note that there were 1.4 million premature deaths annually (that is, before the age of 75) across Europe as a whole. There are an estimated 700,000 deaths annually from CVD for individuals under the age of 65 in Europe, with 900,000 men and 500,000 women estimated to die from CVD in the region annually. The research also picked up sharp cross-country inequalities in the rates for premature mortality. In Western Europe, 21.4% of deaths in individuals under the age of 75 were attributed to CVD; however, in all 28 EU member states, this figure was recorded at 26.0% of deaths in those under the age of 75, while in non-EU countries 35.8% of deaths in individuals aged under 75 were attributed to CVD. On that basis, CVD is estimated to account for four million deaths per annum across Europe, while coronary heart disease (CHD) and stroke accounted for 1.8 million and 1.0 million deaths respectively.
Outlook and implications
The research on the burden of CVD and the up-to-date, reliable mortality data can provide valuable insight for public health authorities across Europe. The statistics presented are estimates, but nevertheless should prove useful in terms of conducting cross-country comparisons, including examining different treatment approaches to CVD at a national level. The authors of the report have noted that further study is required into the causes of the falling CVD mortality rates in some countries. However, the factors involved in this trend are likely to include earlier diagnosis regimens, and improved access to innovative medicines in Western European countries.
The report is also significant through its provision of estimates on disability-adjusted life years (DALYS) for CVD. This research shows that on a country-by-country basis, the number of DALYS lost to CVD is substantially higher in Eastern Europe: by this measure, Bulgaria (167 per 1000) and Latvia (153 per 1000) are ranked highest, while Ireland (35 per 1000), Iceland (32 per 1000), and Israel (26 per 1000) recorded the lowest rates.
The study is potentially relevant given the high price of new cholesterol-lowering PCSK9 inhibitors Repatha (evolocumab; Amgen, US) and Praluent (alirocumab; Sanofi, France and Regeneron, US), combined with the pressure this exerts upon budgetary resources in a number of Eastern European countries. National payors and insurers may attempt to utilise the mortality data as a negotiation tool when discussing prices with drug makers in some Eastern European countries, particularly given the challenges posed to healthcare budgets from chronic diseases and the large CVD patient population. It is certain that rising rates of obesity will ensure that CVD continues to be a major cause of mortality in Western Europe – and indeed the current healthcare trends in CVD may eventually be reversed.