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 and results 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. Across ESC member countries, the prevalence of obesity (body mass index >_30 kg/m 2) 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% [interquartile range (IQR) 22.523.1%] vs. 15.7% (IQR 14.521.1%)}, diabetes [7.7% (IQR 7.110.1%) vs. 5.6% (IQR 4.87.0%)], and among males smoking [43.8% (IQR 37.448.0%) vs. 26.0% (IQR 20.931.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.010.8) vs. 16.7% (IQR 13.919.7%)]. 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 (IQR 56558115)] compared with high-income [2235 (IQR 18963602)] 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.
Original language | English |
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Pages (from-to) | 12-85 |
Number of pages | 74 |
Journal | European Heart Journal |
Volume | 41 |
Issue number | 1 |
Early online date | 10 Dec 2019 |
DOIs | |
Publication status | Published - 1 Jan 2020 |
Bibliographical note
Funding Information:Conflict of interest: Professor Gale reports grants from Abbott Diabetes, grants from BMS, personal fees and non-financial support from Bayer, personal fees and non-financial support from AstraZeneca, personal fees from Vifor Pharma, personal fees and non-financial support from Novartis, from null, outside the submitted work. Dr Torbica reports personal fees from European Society of Cardiology, during the conduct of the study. Dr Torbica has a consultancy agreement with the European Society of Cardiology, which also covers her contribution to this publication. Petersen reports personal fees, non-financial support and other from Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada, outside the submitted work. Dr Maggioni reports personal fees from Bayer, personal fees from Fresenius, personal fees from Novartis, outside the
Funding Information:
submitted work. L.Z. is funded by the MRCSA and the NRF and the MRCUK through the Dfid African Research Leader Scheme. Dr Tavazzi reports personal fees from Servier, personal fees from CVIE Therapeutics, outside the submitted work. Dr Hindricks reports research grants from the Heart Center Leipzig from Abbott/ St. Jude Medical and Boston Scientific. No personal payments for these services have been received. Dr Bax reports personal fees from Abbott Vascular, personal fees from Boehringer Ingelheim, grants from Generel Electric, grants from Biotronic, grants from Edwards, grants from Boston Scientific, grants from Medtronic, outside the submitted work. Dr Casadei reports other fees from Roche Diagnostics, outside the submitted work. Dr Vardas reports personal fees from Menarini International, personal fees from Dean Medicus, personal fees from Servier, personal fees from European Society of Cardiology, personal fees from Hygeia Hospitals Group, outside the submitted work. Other authors have nothing to disclose.
Publisher Copyright:
© The Author(s) 2019.
Keywords
- Cardiovascular disease
- European society of cardiology
- Health infrastructure
- Mortality • morbidity
- Risk factors
- Service provision
- Statistics
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine