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In Europe overall, as in the rest of the world, cardiovascular (CV) disease remains the number one cause of death. But in 12 western European countries, cancer now kills more people than CV disease.
The finding, which likely presages a major shift in disease burden in high-income countries, is among the highlights of the latest European epidemiology findings published in the European Heart Journal.
"The displacement of CV disease as number one is due to substantial reductions in both the incidence and case fatality rates from CV disease in several high-income countries and is a testament of how much more we know about CV disease prevention and treatment and the impact of high-quality research and their findings being translated into practice (even if partial), said Salim Yusuf, MD, DPhil, of McMaster University in Hamilton, Ontario, who was not involved with this research.
"What a privilege to be a cardiologist during a period in which we have demonstrated such remarkable progress against cardiovascular disease," said Harlan Krumholz, MD, of Yale. "We should be glad to cede the top spot and work hard to decrease the burden of cardiovascular disease much further. Success will be when these conditions are considered rare and even notable. It will continue to take efforts on behaviors, environments, health care, stress – and the science of atherosclerosis itself. Meanwhile, the disparities show that progress is not uniform and that we need to particularly help others to find the strategies that can mitigate the burden of CV disease where it remains the leading threat."
Overall, the new paper reported, 4 million people die each year from CV disease in Europe, representing 45% of all deaths, including 1.8 million deaths from coronary heart disease and 1 million from cerebrovascular disease. Most CV deaths occur in elderly patients, but 1.4 million occur in people under the age of 75 and 700,00 in people under 65.
There was a wide variation in the rate of CV disease in different European countries. In men, for instance, the death rate per 100,000 people (adjusted for age) ranged from 275 in France and 480 in Finland to 1,299 in Bulgaria and 1,544 in the Ukraine. In most countries, the death rate has "experienced substantial declines" since 2003. It should be noted, however, that epidemiologists now anticipate that some of these declines will likely be slowed or even reversed as a result of the rise in obesity and diabetes.
In 12 countries deaths from cancer now outnumber deaths from CV disease. This trend began in 1998 with France and has now spread to Spain, Belgium, Denmark, Italy, Luxembourg, The Netherlands, Portugal, Slovenia, the U.K., Norway and Israel.
"These figures highlight the wide inequalities between European countries in deaths from CV disease," said the first author of the paper, Nick Townsend, PhD, of the University of Oxford, in a press release. "The highest numbers of deaths from CVD tend to be seen in Eastern European countries."
"Although we have seen progress across Europe in the prevention and treatment of CV disease, leading to decreases in mortality from it, it is clear that such progress is not consistent across the continent. With higher mortality from CV disease still found in Eastern Europe and non-EU countries, it is clear that the progress that has been made in Western Europe and most EU countries is yet to be achieved equally throughout the region," said Townsend.
In his comments on the report, Yusuf said the the "findings are consistent with Canadian data as well as data from several high-income countries in our PURE study. However, CV disease is still the number one cause of premature deaths in most middle-income and low-income countries with much lower rates of cancer deaths."
Yusuf anticipated how these trends will likely play out in the future:
"In the next few decades, I expect age-adjusted CV disease mortality to decline in many more countries with further declines in several countries which have already experienced a decline such as the U.K., Canada or the U.S. We will see a decline in tobacco-related cancers in men in most high-income countries as tobacco use declines, with the same pattern in women a decade or two later.
"In low- and middle-income countries, we may see an increase in cancers over the next few decades as tobacco use is not declining at the same rate in several countries, and the effects of the last two decades of tobacco use have their full impact. While control of CV disease is challenging and not inexpensive, the control of cancer deaths will be even more challenging and their treatments will be more expensive than treatment of CV disease. In the future the costs of treating cancer will be a major concern.
"We will be witnessing many different transitions and the shift in ranking on what leads to the greatest disease burden will be seen worldwide in the next few decades."