New research reported at a European heart conference this week points to large disparities in rates of death due to heart disease among 16 European countries, with the UK showing up among the losers in many of the league tables: the report also highlights huge inequalities in those countries’ cardiovascular disease prevention policies.

The report comes from the EuroHeart mapping project and is being presented on Thursday 10 September at the European Conference Combating heart disease and stroke: Planning for a Healthier Europe that is being held this week at the Residence Palace in Brussels. The conference, which is work package 5 of the EuroHeart Project, is organized by the European Heart Network and the European Society of Cardiology.

The results of the EuroHeart mapping project show that while heart disease is the leading cause of death in Europe, rates of death are falling in most, but not all, countries.

The project is a three-year programme that analyzed cardiovascular health and disease prevention policies in 16 European countries: Belgium, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Norway, Slovakia, Slovenia, The Netherlands and the UK.

The key results showed that:

  • Highest rates of death from coronary heart disease among men under the age of 65 were in Hungary (105 per 100,000 population), Estonia (104) Slovakia (74), Greece (50), Finland (48) and UK (44).

  • For women under 65 these figures were Hungary (28), Estonia (20), Slovakia (19), UK (11), Greece (10) and Belgium (9).

  • Lowest rates of death from coronary heart disease among men under the age of 65 were in France (17), Netherlands (22), Italy (25) and Norway (27).

  • For women under 65 these figures were Iceland (3), France (3), Slovenia (5) and Italy (5).

Responding to the report, Betty McBride, Director of Policy & Communications at the British Heart Foundation said that compared to other countries in Europe, the UK remains in the “red zone when it comes to tackling premature death from heart disease”.

“The report highlights that national strategies are key to tackling heart disease. As our current strategy for England reaches its original ‘sell by date’ this is another stark reminder to the Government that we need a renewed vision for the next ten years if we are going to win the fight against the UK’s biggest killer,” she added.

The BHF is one of 41 charities in the Cardio and Vascular coalition that is calling on the UK government to renew its strategic framework for cardiovascular disease and push for further improvements and innovations over the next 10 years.

The EuroHeart mapping project also shows that the pattern of risk factors for heart and cardiovascular diseases reflects that of the mortality figures, with for instance rates of cigarette smoking being the highest in Greece (46 per cent), Estonia (42), Slovakia (41), Germany (37) and Hungary (37).

The pattern is also reflected to a certain extent in the way the rates of death due to coronary heart disease have changed over the years: in Finland they fell by 76 per cent between 1972 and 2005 whereas in Greece they went up by 11 per cent.

In 9 of the 16 EU countries covered by the research, rates of death to coronary heart disease have gone down more slowly for women than for men.

The report also reveals some striking disparities among the 16 countries in terms of national policy and legislation covering prevention of coronary heart disease, such as:

  • All countries appear to have some public health legislation on tobacco control and food but in Denmark and Greece there are none that cover coronary heart disease in particular.

  • Belgium, Estonia, Finland, France, Iceland, Italy and Slovenia appear to have five policies covering cardiovascular health promotion, corononary heart disease, high blood pressure, stroke and high lipids (including cholesterol), while Greece has one.

  • Denmark and Greece appear to have no national guidelines on cardiovascular disease, while all the other countries have national guidelines on coronary heart disease and high blood pressure, with three, Belgium, Finland and Ireland reporting they endorsed the exisiting European guidelines.

  • 12 countries reported having national guidelines on obesity, while most countries, apart from Denmark and Greece, reported having national guidelines on preventing high lipids, diabetes and stroke.

  • Only France, Germany and Ireland reported having national recommendations for emergency first aid that includes CPR plus training in the use of and access to external defibrillators.

Susanne Logstrup, who is the director of the European Heart Network, and also a joint co-ordinator with the European Society of Cardiology of the EuroHeart project, said that what these findings show is that:

“Most countries have taken legislative action and have policy measures in place for public health, coronary heart disease, tobacco, food and physical activity.”

However although most countries appear to have some kind of targets for prevention, how they relate to surveillance, reporting of progress and evaluation is not very clear.

“Only in about half the participating countries could we identify budgets allocated to policy and programme implementation,” said Logstrup.

Although the researchers cannot conclude that there is a clear link between prevention policies (or lack of) and death rates, in some countries, such as Greece, “the association is striking”, she added.

The clearest links by a long way between introduction of national measures and impact on heart health appears to be between smoking bans and acute coronary events. The European Society of Cardiology cited the following examples recently:

  • In February 2008 the French reported having 15 per cent fewer emergency admissions for heart attacks: this was just one year after they banned smoking in public places.

  • Researchers in Rome, Italy, found that acute coronary events dropped by 11.2 per cent after the capital introduced a ban on public smoking in January 2005.

  • In Ireland, where smoking in public was banned in 2004, researchers found emergency admissions for acute coronary events went down 11 per cent in the following year, and the reduction was sustained through the year after that as well.

  • In Scotland, the number of people admitted to hospital for heart attacks dropped by 17 per cent after Scotland’s ban on public smoking came into force in March 2006.

  • A recent pooled analysis of eight studies found that smoking bans result in an immediate drop of 19 per cent in acute heart attack events.

Not all countries have the same type of smoking ban. For example, in Ireland and the UK, it is illegal to smoke in any enclosed public space or workplace, including bars and restaurants, while in Italy, Malta, Sweden, Latvia, Finland, Slovenia, France and the Netherlands (note some of these countries were not in the EuroHeart Project) there are special provisions that allow people to smoke in enclosed smoking rooms in public places and workplaces.

Source: European Society of Cardiology, BHF.

Written by: Catharine Paddock, PhD