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Rising obesity, diabetes affects CVD burden in Europe
The prevalence of obesity and diabetes across 56 European Society of Cardiology member countries has increased two- to threefold in 30 years, hampering efforts to reduce CVD burden, according to the ESC.
Although overall prevalence of smoking has declined, based on current trends, hypertension, alcohol consumption, obesity and diabetes are projected to miss the WHO 2025 target for these risk factors, according to the Cardiovascular Disease Statistics 2019 report published by the ESC’s Atlas Writing Group in the European Heart Journal.
“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,” Adam TimmisMD, PhD, professor of clinical cardiology at Barts Heart Centre, Queen Mary University, London, and colleagues wrote. “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 health care delivery, particularly in the middle-income countries of the ESC, where need is greatest.”
The report featured statistics on CVD mortality and behaviors and risk factors collected from 56 member countries of the ESC and stratified by sex and 2018 World Bank definitions of middle or high income.
CVD mortality
Researchers found that despite declining CVD mortality, in many ESC member countries it is still the most common cause of death, with ischemic heart disease attributed to 38% of CVD deaths in women and 44% in men.
Moreover, approximately 35% of all premature deaths in women living in middle-income countries are caused by CVD vs. 16% in high-income countries. In men, 36% of premature deaths in middle-income countries were attributed to CVD compared with 24% in high-income countries, according to the report.
“Not only do we find large variation in current measures for mortality, but recent trends in premature mortality differ between the ESC member countries,” the researchers wrote. “In large parts of the world mortality from CVD is on the increase and worryingly crude premature mortality rates and population-adjusted potential years of life lost are once again on the increase in a number of high- and middle-income ESC member countries, suggesting that they may struggle to obtain WHO targets of 25% reductions in premature mortality between 2010 and 2025.”
Behaviors and risk factors
Researchers also assessed eight behaviors and risk factors, identified in the INTERHEART study, attributable to the risk for acute MI.
Obesity: One in five adults in ESC member countries were obese ( 30 kg/m2) in 2016. Obesity increased from 9.6% in 1980 to 22.6% in 2016. Prevalence was similar in both high-income and middle-income countries.
Diabetes: More than one in 20 adults had diabetes, with prevalence increasing threefold during the last 25 years. Diabetes prevalence was also higher in middle-income countries compared with high-income countries.
Smoking: More than one in five adults smoked tobacco in 2014, according to the study. Smoking was less prevalent in women compared with men, especially in middle-income countries. Moreover, the prevalence of smoking between 1995 and 2014 declined from 28% to 21%.
BP: One in four individuals had elevated BP ( 140/90 mm Hg) in 2015. Systolic BP was higher in men compared with women and in middle-income vs. high-income ESC member countries. Additionally, from 1980 to 2015, the median age-standardized prevalence of high BP declined from 35.3% to 24.8%.
Alcohol: Alcohol consumption was nearly twice as high in high-income countries compared with middle-income countries and three times higher in men than women. Consumption declined nearly 9% since 2010 in middle-income countries but stagnated in high-income countries.
Cholesterol: About one in seven individuals had hypercholesterolemia ( 6.2 mmol/L) in 2009. Researchers noted that although both men and women had similar incidences of hypercholesterolemia, rates were lower in middle-income countries compared with high-income countries. Moreover, median cholesterol declined from 5.5 mmol/L to 5.1 mmol/L between 1980 and 2009.
Vegetable and fruit consumption: More than half of all adults in ESC member countries consumed at least one portion of both vegetables and fruit per day. Intake was higher in women than men.
Physical activity: One in three adults were graded as having insufficient physical activity. Prevalence of inactivity was slightly higher in women than men, and in high-income ESC member countries compared with middle-income countries.
“While the expense of modern cardiovascular technology is hard to prioritize in many countries, steps to tackle key risk factors represent a more realistic strategy for reducing CVD burden in middle-income countries as they are more dependent on organizational change than large financial investment,” the researchers wrote. “Risk factors and unhealthy behaviors are potentially reversible, and this provides huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO noncommunicable disease targets for 2025 are unlikely to be met across ESC member countries.” – by Scott Buzby
Disclosures: Timmis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.