For the first time the ESC has brought together a vast array of data relating to cardiovascular disease (CVD) across its 56 member countries in the ESC Atlas of Cardiology. This data shows the incidence and prevalence of CVD, its cost to national economies, and the major gaps and disparities that exist between high and middle income countries.

ESC Atlas underlines the need to invest more resources in CV care but also to organise and utilise them better and more effectively.

The most comprehensive array of cardiovascular disease statistics from across Europe was published in European Heart Journal. This unique compendium, assembled by the European Society of Cardiology (ESC) focuses on the 56 ESC member countries and includes major risk factors for cardiovascular disease, disease prevalence and mortality in each.

The ESC Atlas of Cardiology also features novel data on health infrastructure and cardiovascular services, provided by ESC member national cardiac societies. Other information sources include the World Health Organization (WHO), the Institute for Health Metrics and Evaluation, and the World Bank.

“Across the ESC member countries, variation in the prevalence of major risk factors for CVD represents a failure of effective health policy and public education that condemns large populations to premature death from ischemic heart disease and stroke,” said first author, Adam Timmis, professor of clinical cardiology, Barts Heart Centre, Queen Mary University of London.

Analysis of data from middle and high income European countries revealed considerable inequalities in risk factor profiles and treatment facilities. “Little wonder that middle income countries generally have a higher prevalence of cardiovascular disease and mortality compared with high income countries,” said chief strategy officer of European Heart Agency, professor Panos Vardas.

However, the data show that unequal health outcomes are not an inevitable consequence of limited economic resource. For example, Bulgaria and Turkey—both middle income countries—report rates of cardiac catheterisation and coronary stenting that compare favourably with the best high income countries.

Professor Timmis added: “The Atlas makes clear that economic resources are not the only driver for delivery of equitable cardiovascular healthcare, some middle income ESC member countries reporting rates for interventional procedures and device implantations that match or exceed rates in wealthier high income member countries.”

Another example is the Russian Federation, which reports a fourfold higher death rate for stroke compared with Estonia despite similar per capita health expenditure.

The Atlas shows that the incident of cardiovascular disease continues to increase across nearly all European countries, despite declines in cardiovascular mortality. Professor Timmis said: “This no doubt reflects population growth and ageing because age-standardised data for men and women show consistent declines in cardiovascular disease prevalence across high income ESC member countries during the last 25 years.” In the middle income countries, the pattern is different with no clear evidence of decline during the same period. Indeed, just under half of these middle income countries recorded an increase in disease prevalence.

Deaths due to cardiovascular disease in Europe are higher in women (2.1 million) than men (1.7 million). Cardiovascular disease also accounts for a larger proportion of all deaths in women (49%) compared with men (40%). However, fewer women than men died prematurely (under 70 years of age) from cardiovascular disease. Among people under 65 years of age, cardiovascular disease remains the most common cause of premature death among men. In women, it is cancer.

Professor Timmis concluded: “By curating these data and presenting it on-line, we believe that the Atlas will become the go-to resource for all those interested in reviewing and working with national cardiovascular disease statistics across ESC member countries.” He added: “Atlas data will be of particular interest to policy makers, as it shows the failure of some middle income Eastern European countries to reorganise services and prioritise initiatives of proven value in other healthcare settings.”

Professor Fausto Pinto, author and ESC Immediate Past President, said: “As a comprehensive report of CVD statistics in ESC member countries, the Atlas meets WHO recommendations to develop surveillance and monitoring programmes to understand the international distribution of CVD and predict future trends. The report identifies targets for reducing the burden of CVD and delivering equitable healthcare across Europe.”

In documenting national cardiovascular disease statistics across ESC member countries the Atlas aims to:

• Provide individual ESC member countries with data for international benchmarking of cardiovascular risk factors, disease prevalence, healthcare delivery and outcomes.
• Provide insights into the inequalities across ESC member countries in cardiovascular disease and the infrastructure for its management.
• Provide policy makers with targets for reducing the prevalence of cardiovascular disease and improving its outcomes.
• Allow them to better appreciate what is working and what is not.
• Underpin the ESC’s ambitious mission “to reduce the burden of cardiovascular disease” not only in its member countries, but also in nation states around the world.