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Setting strategic policies for better heart health is crucial

Submitted by on 12 Apr 2018 – 16:39

Cardiovascular disease (CVD) accounts for 45 percent of all deaths in Europe, causing over 3.9 million deaths each year in the member states of the World Health Organization (WHO) European Region, of which 1.8 million deaths occur in the EU accounting for 37 percent of all deaths.  Susanne Logstrup, Director, European Heart Network says now is the time to set strategic policies to manage cardiac health in Europe

In 2015, there were more than 11 million new cases of CVD in Europe as a whole, of which 6.1 million new cases were in the EU. More than 85 million people across Europe are living with CVD; of these almost 49 million people are in the EU.


Comparing the CVD mortality burden across individual European countries reveals substantial variation.

Within the EU, among men, the percentage of all deaths due to CVD ranges from 23 percent in France to 60 percent in Bulgaria, while in women, the burden ranges from 25 percent in Denmark to 70 percent in Bulgaria.

Outside the EU, mortality varies significantly. CVD causes 24 percent in Israel and 59 percent in Ukraine of all deaths respectively, among men; and among women the burden varies from 25 percent in Israel to 75 percent in Ukraine.


Over the past 30 years, mortality rates from coronary heart disease have been declining in most Northern and Western European countries in both males and females; and since around 2000 to 2005, age-standardised death rates from coronary heart disease have also been falling in Central and Eastern regions. But between 1990 and 2015, most European countries reported an increase in the number of new CVD cases.

However, age-standardised prevalence rate has fallen in most European countries, though with greater decreases in Northern, Western and Southern European countries compared to Central and Eastern European countries.

Economic burden

CVD is estimated to cost the EU economy €210 billion a year. Of this, just under €111 billion is the cost to the healthcare systems. This represents a total annual cost per capita of €218.  Per capita costs vary over sevenfold between EU member states – from €48 per capita/year in Bulgaria to €365 in Finland.

Production losses due to CVD mortality and morbidity cost the EU almost €54 billion, representing 26 percent of total cost of those diseases, with 58 percent of this cost due to premature death (€32 billion) and 42 percent due to illness (€23 billion) in those of working age.

An additional important cost is that of informal care, which amounts to €45 billion.

CVD – a star candidate for intervention

CVD should be a top health priority. The data presented above shows that remarkable reduction in CVD mortality can be achieved. It also shows that CVD remains the number one cause of death and that there is still a significant mortality gap between countries in Europe. Stronger focus on addressing CVD can successfully reduce mortality further and close the gap between Northern, Western and Southern European countries on the one hand and Central and Eastern European countries on the other.

Strategies to promote cardiovascular health need to address the whole population as well as those at high risk of and those already living with CVD.

This was acknowledged by the EU member states in the 2004 Council Conclusions on promoting heart health. It is echoed in the European Heart Health Charter and in the 2007 EP Resolution on action to tackle cardiovascular disease.

Population-based interventions

WHO estimates that 80 percent of premature deaths from CVD can be avoided by controlling three main behavioural risk factors: tobacco, unhealthy diet and physical inactivity.

EU regulatory interventions related to food and tobacco, in particular, extend to all EU member states; such interventions have the potential to reduce health inequalities in the EU as inequalities in mortality from CVD account for almost half of the excess mortality in lower socio-economic groups in most European countries.

Unsurprisingly, EHN has a strong focus on policymakers, especially at the EU level, to effect changes in policies that can achieve a small reduction in risk factors across a population of more than 500 million, thus reducing the number of people at risk.

It is our view that EU decision makers could do a much better job of conceiving policies that promote environments conducive to healthy lifestyles, which will help improve behavioural risk factors and stem the development of the medical risk factors that increase risk of CVD.

One obvious area for the EU intervention is setting mandatory EU-wide upper limits for industrially produced trans fatty acids (TFAs). The evidence for cutting deaths from heart disease by limiting prevalence of TFAs is overwhelming.

Such a regulatory intervention is wholly feasible, as shown by the move already made in five EU member states; it is a clear example of the EU using its competence to regulate the internal market to achieve simultaneously a large cardiovascular health benefit.

Prevention and treatment

The EHN and its members together have explored how to identify people who are at high risk of developing CVD and the benefits of doing so. We also work together on how best to support people living with CVD and invest in research. EHN members have funded – and continue to fund – research that has been instrumental in reducing deaths from CVD, controlling risk factors and improving patients’ quality of life.

A role for the EU

In 2007, the EHN together with the European Society of Cardiology, the European Commission and the WHO Regional Office for Europe developed the European Heart Health Charter, which was supported by 15 European organisations. Today, 10 years after its launch, we believe there is a need to review it and to look into how EU action could be deployed to alleviate the CVD burden; for instance taking a clue from EU action on cancer. EU action on CVD to support EU member states could include an in-depth comparison of cardiovascular strategies/plans, looking at their resources, implementation and results. The EU could also play an important role in the provision of better quality data that is comparable across the EU. This could potentially be funded through the EU’s research programmes.