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Epidemiology of IHD

Epidemiology of ischaemic heart disease (IHD)

Cardiovascular disease (CVD) is the most common cause of death in Europe, accounting for more than 4 million deaths each year. This corresponds to 45% of all deaths; 49% among women and 40% among men. Coronary heart disease (CHD) and cerebrovascular disease are the most common causes of cardiovascular death, and CHD accounts for 1.8 million deaths, corresponding to 19% and 20% of all deaths in men and women respectively. Notably, twice as many men than women under the age of 75 years die from CHD. There are considerable differences in the CVD burden across Europe with an almost five-fold increase from lowest to highest. Overall, the burden of CVD is larger in Eastern European countries with higher age-adjusted CVD death rates and disability adjusted life years attributed to CVD [1,2].

CVD has declined rapidly in almost all Western European countries, with a reduction of up to 30-50% in the last 10 years in some countries. The decline is observed in both men and women, and the majority can be attributed to improvements in primary and secondary prevention. However, not all risk factors show a beneficial trend. While smoking rates and population cholesterol levels have gone down, obesity and diabetes are increasing. This causes some concern as to whether the beneficial development in the recent decades will continue or not. Psychosocial stress, such as depression, anxiety and burn-out, which are now recognized as important contributors to CVD incidence and prognosis, are not declining. Also, disparities in CVD mortality, both east-west, socioeconomic and other disparities remain high.

Since 1995-1996, the cross-sectional EUROASPIRE (European Action on Secondary and Primary Prevention to Reduce Events) study has evaluated the European prevention effort in patients <80 years with coronary disease (i.e. coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome). In the most recent cohort, EUROASPIRE IV (2012-2013), 78 centres from 24 European countries were included, 16,426 medical records were reviewed and 7,998 patients were interviewed. The median time between index event and interview was 1.34 years [3].

EUROASPIRE documented that cardiovascular risk factors still go undiagnosed: 19% of the participants had newly diagnosed diabetes, while 35% had known diabetes  [4]. In 2004, the Euro Heart Survey on diabetes and the heart determined that in patients with acute CHD, 22% had newly diagnosed diabetes, 32% had known diabetes and 36% had impaired glucose regulation. In patients with stable CHD, the proportions were 14%, 30%, and 37%, respectively [5].

Risk factor control in secondary prevention remains suboptimal. Based on medical records, 77.8% of the participants in EUROASPIRE IV had hypertension and 72.8% had dyslipidaemia. At the time of the interview, 42.7% had a blood pressure ≥ 140/90 and only 19.5% had LDL cholesterol ≤ 1.8 mmol/L [3]. Further, 82.1% were overweight (BMI>25 kg/m2), and 37.6% were obese (BMI > 30 kg/m2). Central obesity (waist circumference ≥102 cm in men or ≥88 cm in women) was observed in 58.2% of the participants. These numbers have increased compared to the prior EUROASPIRE cohorts I-III.  While the majority reported increased physical activity after the event, only 40.1% reported vigorous physical activity for at least 20 minutes once a week or more. Thirty percent were smokers and only half had stopped smoking at the time of the interview. Most smokers had received advice to stop smoking. Of the 50.7% advised to participate in a cardiac rehabilitation programme, 81.3% attended at least half the sessions [3].

Thus, while preventive cardiology has been a great success as shown by the decline in CVD mortality, there is still ample room for improvement. Registry studies have found that 18% of patients who suffered a myocardial infarction, suffer recurrent events within the first year [6]. It has been estimated that this could be more than halved if secondary prevention measures were more rigorously implemented.

In a concerted effort to implement secondary prevention measures, many countries and organisations have developed information websites. The following links may prove useful for CVD Prevention in individual countries. 

EAPC Prevention in your Country

Country reports provided by National CVD Prevention Coordinators in ESC Member Countries.

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Additional links

Country Link
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[1] Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe - Epidemiological update 2015. Eur Heart J 2015;36:2696–705.

[2] Townsend N, Wilson L, Bhatnagar P, et al. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J 2016:1–14. doi:10.1093/eurheartj/eht356.

[3] Kotseva K, Wood D, De Bacquer D, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016;23:636–48.

[4] Gyberg V, De Bacquer D, De Backer G, et al. Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. Cardiovasc Diabetol 2015;14:133.

[5] Bartnik M, Rydén L, Ferrari R, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 2004;25:1880–90.

[6] Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: Nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J 2015;36:1163–70a.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

The ESC Prevention of Cardiovascular Disease programme is supported by AMGEN, AstraZeneca, Ferrer for good, and Sanofi and Regeneron in the form of educational grants.