The majority of countries have seen on-going steady reductions in heart disease death rates in both sexes and most age groups, including among younger people – despite increases in obesity and diabetes during this period.
However, heart disease remains a leading cause of death in Europe and the study’s researchers say their analysis shows little evidence for the hypothesis that the reduction in deaths from coronary heart disease (CHD) might be beginning to plateau among younger Europeans.
There is significant variation between individual countries, with evidence of a levelling off in some countries and increases in heart disease deaths among some age groups in other countries. ‘It’s clear that there are some countries in which trends are cause for concern, where overall rates of decrease in CHD mortality do appear to have slowed, and a small number of countries in which CHD mortality rates have begun to increase significantly in recent years in younger subpopulations,’ explained Dr Melanie Nichols, a Research Associate from the British Heart Foundation Health Promotion Research Group (BHF HPRG) in Oxford.
‘In addition,’ she pointed out, ‘we should emphasise that cardiovascular disease remains the leading cause of death in Europe, and it is important that we continue to focus efforts on primary prevention, including reducing smoking, improving diets and physical activity levels.’
With her colleagues in the Oxford research group, Dr Nichols looked at trends in deaths from coronary heart disease between 1980 and 2009 in both sexes and four age groups: under 45, 45-54, 55-64 and 65 and over. They found that almost all EU countries had a large and significant decrease in death rates from CHD over the last three decades in both men and women when all ages were considered together. Denmark, Malta, The Netherlands, Sweden and the UK had the largest decreases in mortality for both sexes during this time. The exceptions to these significant decreases were among men in Hungary, Latvia, Lithuania and Poland, where the decreases were small, and in Romania where there was an increase. Among women, decreases were found in Greece, Hungary, Lithuania, Poland, Romania and Slovakia. There was some evidence that the downward trends were beginning to plateau in those aged under 45 among men and women in Italy, Latvia, Lithuania and the UK, among men in Poland and Slovakia, and among women in the Czech Republic and France.
In the 45-54 age group, there was evidence of a possible plateau in both sexes in Latvia and the UK, and also in Lithuania among women and Sweden, Austria, the Czech Republic and Slovakia among men. In Greece, women aged 45-54 showed a significant increase in death rates. Dr Nichols said: ‘Overall, across the EU, rates of death from coronary heart disease have continued to fall in most age groups in most countries. There are some exceptions, however, and there remain wide disparities across Europe in both the absolute rates of death from heart disease and the rates of improvement.’
The study authors state that the increase in risk factors for coronary heart disease, such as smoking, obesity and diabetes, could still have an impact on death rates in years to come but felt ‘there may still be time for public health policy and action to have an impact on these risk factors.’ The team also add that continuing future research is crucial to monitor trends in CHD risk factors and mortality across the EU and to examine the relationships between preventable risk factors and CHD among younger adults.
With funding from the British Heart Foundation (BHF), the study arises from the European Heart Health Strategy II project (EuroHeart II), which has received co-funding from the European Union, in the framework of the Health Programme.
Dr Melanie Nichols joined the BHF HPRG in October 2011 to lead the Oxford work package within the EuroHeart II programme, which aimed to describe and document the burden of CHD across Europe and geographic variations in coronary heart disease trends across the member states of the EU.
She has now returned to Deakin University in Australia as a Research Fellow at the World Health Organisation (WHO) Collaborating Centre for Obesity Prevention at Deakin. Her research interests include the epidemiology of chronic disease risk factors, inequalities in health, the role of communities and environments on lifestyle and chronic disease and evaluation of complex interventions to prevent chronic disease.