Cardiovascular diseases are the leading cause of mortality globally, casting a dark shadow over Europe, where they account for a staggering 45% of all deaths. Within the European Union, this statistic persists at 37%, requiring €210 billion in health-care expenditure annually. Cardiovascular disease should be recognised as an urgent and formidable public health challenge, which demands our immediate attention.
To tackle the burden of cardiovascular disease in Europe effectively, comprehensive actions must be tailored to the specific needs of each country and region, considering the marked variations in prevalence and outcome of cardiovascular diseases across Europe. For example, the risk of dying from ischaemic heart disease is 11 times higher for women in Lithuania than France, and for men, eight times higher compared with France. This stark contrast represents just one facet of the intricate mosaic that constitutes the disease burden in Europe, emphasising the crucial need for targeted interventions and policies.
To assess the current state of knowledge regarding cardiovascular disease disparities across Europe and to identify the most formidable barriers, The Lancet Regional Health—Europe convened a panel of distinguished experts. Their mission: to scrutinize the most prominent variations in cardiovascular disease outcomes across the continent with the aim of crafting recommendations to bridge these disparities. The key steps and considerations for such an effort included: risk factors assessment, healthcare access and quality, socioeconomic determinants, and cultural and ethnic factors.
Considering the profound diversity of European regions, encompassing disparities in socioeconomic status and health-care coverage, the assessment was divided into a four-paper Series on ‘Variations in cardiovascular disease outcomes across Europe’. Each paper in this Series delves into a relatively homogeneous region, casting a discerning eye on Nordic countries, the UK, western and southern Europe, and eastern Europe. These in-depth examinations have provided insights poised to inform and shape the formulation and implementation of tailored policies.
In Nordic countries, despite their relative socioeconomic equality, a socioeconomic gradient exists in cardiovascular risk factors, which is similar to other nations. People with low socioeconomic status, severe mental illness, or migrant backgrounds often receive inadequate cardiovascular care, resulting in poorer outcomes. Current policies fall short in addressing these challenges, necessitating targeted interventions to manage cardiovascular risk factors and attain equality in this region.
The UK grapples with stark inequalities in National Health Service care and outcomes for cardiovascular conditions such as myocardial infarction, heart failure, atrial fibrillation, and aortic stenosis. Disparities in care delivery among health service providers further lead to variations in health outcomes. Data shows delayed diagnoses and less guideline-recommended treatment for older individuals and women, compared with their younger and male counterparts. National policies must urgently target these disparities in cardiovascular care and outcomes based on age, gender, ethnicity, and geography.
In Western and South European nations, there have been substantial declines in the age-standardized mortality rate over the last 29 years. Average rates are now somewhat higher in South European countries, with Western Europe allocating twice as much healthcare spending and higher rates of cardiovascular-related procedures. Risk factor exposures vary slightly, with the exception of physical activity, which is higher in western Europe, and dietary factors, which are healthier in southern Europe. However, the prevalence of obesity has surged in all countries. Therefore, prioritising prevention strategies to combat obesity and address dietary disparities is essential to reducing the cardiovascular disease mortality gap between nations in western and southern Europe.
Life expectancy in eastern Europe is significantly lower than that in the rest of Europe, primarily due to varying rates of ischaemic heart disease deaths, with the highest burden in northeastern Europe. Not only are rates of ischaemic heart disease deaths higher in this region, but fatalities also occur at younger ages, posing a substantial risk to public health with implications for health-care systems, workforce productivity, and societal wellbeing. Access and health-care delivery also vary widely across nations in eastern Europe. For example, despite similar health-care spending, 30-day mortality rates after acute myocardial infarction varies substantially from 9.2% in Estonia to 4.7% in Poland. There is an urgent need for improved data reporting and analysis to understand the determinants of cardiovascular health in eastern Europe.
The findings of these Series papers underscore the importance of crafting policies that cater to each country's unique circumstances rather than applying a one-size-fits-all approach. Their recommendations should not merely be seen as suggestions but as a potent call to action, inspiring countries to set concrete goals to tackle cardiovascular disease disparities and diligently monitor their progress. In an era where highly preventable risk factors are surging at alarming rates, imposing immense burdens on social, economic, and health-care systems, it is imperative for health systems to swiftly adapt to the evolving disease landscape. This work ushers in a more pragmatic approach to cardiovascular health and its associated inequalities, one that integrates local realities and population-specific strategies.