European Society of Cardiology: Cardiovascular Disease Statistics 2019
Adam Timmis, Nick Townsend, Chris P Gale, Aleksandra Torbica, Maddalena Lettino, Steffen E Petersen, Elias A Mossialos, Aldo P Maggioni, Dzianis Kazakiewicz, Heidi T May, Delphine De Smedt, Marcus Flather, Liesl Zuhlke, John F Beltrame, Radu Huculeci, Luigi Tavazzi, Gerhard Hindricks, Jeroen Bax, Barbara Casadei, Stephan Achenbach, Lucy Wright, Panos Vardas, European Society of Cardiology, Lezha Mimoza, Goda Artan, Demiraj Aurel, Mohammed Chettibi, Naima Hammoudi, Hamayak Sisakian, Sergey Pepoyan, Bernhard Metzler, Peter Siostrzonek, Franz Weidinger, Tofig Jahangirov, Farid Aliyev, Yasmin Rustamova, Nikolay Manak, Aliaksandr Mrochak, Patrizio Lancellotti, Agnès Pasquet, Marc Claeys, Zumreta Kušljugić, Larisa Dizdarević Hudić, Elnur Smajić, Mariya Petkova Tokmakova, Plamen Marinov Gatzov, Davor Milicic, Mijo Bergovec, Christos Christou, Hera Heracleous Moustra, Theodoros Christodoulides, Ales Linhart, Milos Taborsky, Henrik Steen Hansen, Lene Holmvang, Steen Dalby Kristensen, Magdy Abdelhamid, Khaled Shokry, Priit Kampus, Margus Viigimaa, Essi Ryödi, Matti Niemelä, Tuomas T Rissanen, Jean-Yves Le Heuzey, Martine Gilard, A Aladashvili, A Gamkrelidze, Maia Kereselidze, A Zeiher, H Katus, K Bestehorn, Costas Tsioufis, John Goudevenos, Zoltán Csanádi, Dávid Becker, Kálmán Tóth, Þórdís Jóna Hrafnkelsdóttir, James Crowley, Peter Kearney, Barbra Dalton, Doron Zahger, Arik Wolak, Domenico Gabrielli, Ciro Indolfi, Stefano Urbinati, Gulnara Imantayeva, Salim Berkinbayev, Gani Bajraktari, Artan Ahmeti, Gezim Berisha, Mirrakhimov Erkin, Abilova Saamay, Andrejs Erglis, Iveta Bajare, Sanda Jegere, Malek Mohammed, Antoine Sarkis, Georges Saadeh, Ruta Zvirblyte, Gintare Sakalyte, Rimvydas Slapikas, Khaled Ellafi, Fathi El Ghamari, Cristiana Banu, Jean Beissel, Tiziana Felice, Sandra C Buttigieg, Robert G Xuereb, Mihail Popovici, Aneta Boskovic, Miroslav Rabrenovic, Samir Ztot, Saadia Abir-Khalil, A C van Rossum, B J M Mulder, M W Elsendoorn, Elizabeta Srbinovska-Kostovska, Jorgo Kostov, Bosevski Marjan, Terje Steigen, Ole Christian Mjølstad, Piotr Ponikowski, Adam Witkowski, Piotr Jankowski, Victor Machado Gil, Jorge Mimoso, Sérgio Baptista, Dragos Vinereanu, Ovidiu Chioncel, Bogdan A Popescu, Evgeny Shlyakhto, Raphael Oganov, Marina Foscoli, Marco Zavatta, Ana Djordjevic Dikic, Branko Beleslin, Mina Radosavljevic Radovanovic, Peter Hlivák, Robert Hatala, Gabriela Kaliská, Miran Kenda, Zlatko Fras, Manuel Anguita, Ángel Cequier, Javier Muñiz, Stefan James, Bengt Johansson, Pyotr Platonov, Michael Johannes Zellweger, Giovanni B Pedrazzini, David Carballo, Hussam Eddin Shebli, Samer Kabbani, Leila Abid, Faouzi Addad, Engin Bozkurt, Meral Kayıkçıoğlu, Mustafa Kemal Erol, Volodymyr Kovalenko, Elena Nesukay, Andrew Wragg, Peter Ludman, Simon Ray, Ravshanbek Kurbanov, Dennis Boateng, Ghislain Daval, Víctor de Benito Rubio, David Sebastiao, Paola Thellung de Courtelary, Isabel Bardinet, Adam Timmis, Nick Townsend, Chris P Gale, Aleksandra Torbica, Maddalena Lettino, Steffen E Petersen, Elias A Mossialos, Aldo P Maggioni, Dzianis Kazakiewicz, Heidi T May, Delphine De Smedt, Marcus Flather, Liesl Zuhlke, John F Beltrame, Radu Huculeci, Luigi Tavazzi, Gerhard Hindricks, Jeroen Bax, Barbara Casadei, Stephan Achenbach, Lucy Wright, Panos Vardas, European Society of Cardiology, Lezha Mimoza, Goda Artan, Demiraj Aurel, Mohammed Chettibi, Naima Hammoudi, Hamayak Sisakian, Sergey Pepoyan, Bernhard Metzler, Peter Siostrzonek, Franz Weidinger, Tofig Jahangirov, Farid Aliyev, Yasmin Rustamova, Nikolay Manak, Aliaksandr Mrochak, Patrizio Lancellotti, Agnès Pasquet, Marc Claeys, Zumreta Kušljugić, Larisa Dizdarević Hudić, Elnur Smajić, Mariya Petkova Tokmakova, Plamen Marinov Gatzov, Davor Milicic, Mijo Bergovec, Christos Christou, Hera Heracleous Moustra, Theodoros Christodoulides, Ales Linhart, Milos Taborsky, Henrik Steen Hansen, Lene Holmvang, Steen Dalby Kristensen, Magdy Abdelhamid, Khaled Shokry, Priit Kampus, Margus Viigimaa, Essi Ryödi, Matti Niemelä, Tuomas T Rissanen, Jean-Yves Le Heuzey, Martine Gilard, A Aladashvili, A Gamkrelidze, Maia Kereselidze, A Zeiher, H Katus, K Bestehorn, Costas Tsioufis, John Goudevenos, Zoltán Csanádi, Dávid Becker, Kálmán Tóth, Þórdís Jóna Hrafnkelsdóttir, James Crowley, Peter Kearney, Barbra Dalton, Doron Zahger, Arik Wolak, Domenico Gabrielli, Ciro Indolfi, Stefano Urbinati, Gulnara Imantayeva, Salim Berkinbayev, Gani Bajraktari, Artan Ahmeti, Gezim Berisha, Mirrakhimov Erkin, Abilova Saamay, Andrejs Erglis, Iveta Bajare, Sanda Jegere, Malek Mohammed, Antoine Sarkis, Georges Saadeh, Ruta Zvirblyte, Gintare Sakalyte, Rimvydas Slapikas, Khaled Ellafi, Fathi El Ghamari, Cristiana Banu, Jean Beissel, Tiziana Felice, Sandra C Buttigieg, Robert G Xuereb, Mihail Popovici, Aneta Boskovic, Miroslav Rabrenovic, Samir Ztot, Saadia Abir-Khalil, A C van Rossum, B J M Mulder, M W Elsendoorn, Elizabeta Srbinovska-Kostovska, Jorgo Kostov, Bosevski Marjan, Terje Steigen, Ole Christian Mjølstad, Piotr Ponikowski, Adam Witkowski, Piotr Jankowski, Victor Machado Gil, Jorge Mimoso, Sérgio Baptista, Dragos Vinereanu, Ovidiu Chioncel, Bogdan A Popescu, Evgeny Shlyakhto, Raphael Oganov, Marina Foscoli, Marco Zavatta, Ana Djordjevic Dikic, Branko Beleslin, Mina Radosavljevic Radovanovic, Peter Hlivák, Robert Hatala, Gabriela Kaliská, Miran Kenda, Zlatko Fras, Manuel Anguita, Ángel Cequier, Javier Muñiz, Stefan James, Bengt Johansson, Pyotr Platonov, Michael Johannes Zellweger, Giovanni B Pedrazzini, David Carballo, Hussam Eddin Shebli, Samer Kabbani, Leila Abid, Faouzi Addad, Engin Bozkurt, Meral Kayıkçıoğlu, Mustafa Kemal Erol, Volodymyr Kovalenko, Elena Nesukay, Andrew Wragg, Peter Ludman, Simon Ray, Ravshanbek Kurbanov, Dennis Boateng, Ghislain Daval, Víctor de Benito Rubio, David Sebastiao, Paola Thellung de Courtelary, Isabel Bardinet
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 and results: 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. 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% [interquartile range (IQR) 22.5-23.1%] vs. 15.7% (IQR 14.5-21.1%)}, diabetes [7.7% (IQR 7.1-10.1%) vs. 5.6% (IQR 4.8-7.0%)], and among males smoking [43.8% (IQR 37.4-48.0%) vs. 26.0% (IQR 20.9-31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0-10.8) vs. 16.7% (IQR 13.9-19.7%)]. 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 5655-8115)] compared with high-income [2235 (IQR 1896-3602)] 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.
Keywords: Cardiovascular disease; European Society of Cardiology; Health infrastructure; Morbidity; Mortality; Risk factors; Service provision; Statistics.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
Source: PubMed