The prevalence of obesity in Europe has more than doubled over the past 35 years, with over one in five adults affected according to a paper published today in European Heart Journal, the flagship journal of the European Society of Cardiology (ESC).1
The third report from the ESC Atlas Project updates and expands upon the previous edition with cardiovascular disease (CVD) statistics to 2019, or the latest available year, for the 57 ESC member countries.2 For the first time the document provideanization (WHO) 2025 targets for non-communicable diseases.
An estimated 113 million people live with CVs data on sociodemographic and environmental risk factors for CVD and progress towards the World Health OrgD in ESC member countries. CVD is the most common cause of death in the region, accounting for 45% and 39% of fatalities in women and men, respectively. The report paints a picture of ageing populations and low birth rates. Between 1970 and 2019 the proportion of individuals aged over 65 years increased from a median 9.2% to 17.2%, and the median age increased from 29.6 to 41.1 years. Alongside this, between 1970 and 2018 fertility rates fell from 2.6 to 1.6, below the average of 2.1 live births per woman needed for population replacement.
Regarding the environment, while median particulate matter (PM)2.5 concentrations have decreased during the last 30 years, these declines were mainly limited to high-income countries. In 2019, median PM2.5 concentrations were over twice as high in middle-income, compared to high-income, ESC member countries and exceeded the EU air quality standard in 14 countries (all middle-income). Each year, an estimated 48,000 new cases of coronary heart disease occur across Europe due to environmental noise pollution.
Professor Adam Timmis, chair of the report writing team, said: "Sociodemographic and environmental risk factors receive relatively little attention from cardiologists but make a substantial contribution to the risk of CVD. Europe now has top-heavy populations and this will exacerbate the growing burden of CVD. The situation is compounded by increasing urbanisation which threatens heart health due to dirty air, noise, social deprivation and stress. It is estimated that up to 40% of people living in the EU are exposed to noise levels beyond the region's residential limits."
According to the WHO, noncommunicable diseases kill 41 million people each year, equivalent to 71% of all deaths globally. CVD accounts for most of these deaths (17.9 million annually), followed by cancer (9.3 million). The WHO has set targets for noncommunicable diseases to be met by 2025 but the evidence in today's report suggests that, across ESC member countries, most goals relating to heart health are unlikely to be achieved. For example, the WHO has called for a halt (with reference to 2010) to the rise in obesity. But between 2010 and 2016, the prevalence of obesity rose from 20.4% to 22.7% in women and from 19.2% to 22.2% in men. Similarly, the WHO has called for a halt (with reference to 2010) to the rise in diabetes but an analysis of paired 2010 and 2015 data from 26 countries showed a 32% increase in the median prevalence of diabetes from 2.6% to 3.4% during that period.
For blood pressure, the WHO target is a relative 25% reduction (compared to 2010) in the prevalence of elevated blood pressure by 2025. During 2010 to 2015 (or the most recent available data), the median age-standardised prevalence of elevated blood pressure across ESC member countries declined by just 3.4% – from 25.9% to 25.0%. The report's forecasts indicate little prospect of achieving the target in middle-income ESC member countries but a good prospect for high-income countries if current trends continue.
More than one in five adults in ESC member countries were regular daily smokers in 2019. Declines in the prevalence of smoking between 2010 and 2018 were largely confined to high-income countries where rates fell by 31.0% in women and 18.5% in men, while middle-income countries showed little change in men and an increase in women during that period. The document's forecasts suggest that the WHO target of a 30% relative reduction in tobacco use will likely be achieved in high-income countries if present trends continue but is unlikely to be met in middle-income countries.
The WHO has called for a relative reduction of at least 10% in the harmful use of alcohol. During 2010 to 2018 the median consumption of alcohol per capita across ESC member countries showed a decline from 5.1 to 4.5 litres in women and from 17.2 to 15.0 litres in men. Unless there is a change in the current trajectory, it is unlikely that this target will be met.
Professor Panos Vardas, a past ESC president and current chief strategy officer of the ESC's European Heart Agency in Brussels, said: "This report reveals that astonishing inequalities still exist between the 57 ESC member countries. While lifestyle changes provide a huge opportunity to address these gaps, more widespread access to novel therapies should also be a priority. As populations continue to age, the burden of heart disease will continue to grow and politicians must act now to safeguard their citizens."
In addition to the health burden, CVD places a significant financial and economic burden on healthcare budgets and societies across all ESC countries. Unfortunately, very few studies have systematically estimated the cost of CVD at an international level. According to European Heart Network estimates in 2015, CVD costs the EU economy a total of €210 billion a year.
Professor Aleksandra Torbica, the Atlas report's health economist, said: "With population ageing and rising costs of care, CVD is set to further erode national economies unless policymakers act now to protect their populations. This is particularly important for middle-income ESC member countries where rates of CVD are highest and national economies are least able to fund the soaring costs. Systematic and reliable data on the actual financial burden of CVD are essential to inform these policies."
Professor Hugo Katus, Chair of the ESC Advocacy Committee, concluded: "Despite the immense burden that CVD represents, it does not receive the attention that policy makers give to other diseases. This report enables local authorities to take stock of their country's performance and identify areas where bold action is needed, covering all aspects of cardiovascular care: prevention, detection, treatment and rehabilitation, if we are to meet the WHO targets."
Data from the COVID-19 pandemic will be detailed in a future report.
