Definition of cardiovascular diseases

Cardiovascular diseases are a group of disorders of the heart and blood vessels, and include diseases of the heart, vascular diseases of the brain and diseases of blood vessels.

They constitute a vast group of disorders. Many of them are related to a process called atherosclerosis and include:

• Coronary heart disease – disease of the blood vessels supplying the heart muscle;
• Cerebrovascular disease – disease of the blood vessels supplying the brain;
• Peripheral arterial disease – disease of blood vessels supplying the arms and legs.

Other cardiovascular diseases, which are not always related to atherosclerosis include rheumatic heart disease (damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria), congenital heart disease (malformations of heart structure existing at birth), cardiomyopathies and cardiac arrythmias ( WHO 2011 (pdf), WHO 2017 ).

Prevalence of cardiovascular diseases in the EU

The occurrence of cardiovascular diseases in the EU can be quantified using data from hospital discharges for in-patients with diseases of the circulatory system ( Eurostat 2017 ). These data are presented in Table 1. In addition, estimates point to almost 63 million people with cardiovascular diseases in the EU in 2019 ( GBD 2019 ). Table 2 provides an indication of the prevalence of cardiovascular disease per country.

Table 1: Hospital discharge rates for in-patients with diseases of the circulatory system in the EU in 2017 (or latest available) 

Table 2: Age standardised prevalence rates of cardiovascular disease per 100000 in the EU in 2019 

Factors related to cardiovascular disease risk

Cardiovascular diseases can be attributed to multiple risk factors. These risk factors can be divided in non-modifiable and modifiable (in that they can be prevented).

The main non-modifiable risk factors for cardiovascular disease are advanced age, family history of cardiovascular disease, gender and race ( WHO 2007 (pdf)). However, the majority of cardiovascular disease is preventable through the management of modifiable risk factors the most important of which are as smoking, alcohol consumption, physical inactivity, unhealthy diets, psychosocial factors such as low socioeconomic status, mental ill health, and psychosocial stress such as life stress, social isolation and anxiety; and environmental factors such as air pollution ( WHO 2004 ).

Such risk factors, also lead to metabolic conditions such as overweight/obesity, raised blood pressure, raised blood glucose (diabetes), and abnormal plasma lipid profile (dyslipidaemia) which are related to atherosclerosis and in turn to an increased risk of cardiovascular disease ( WHO 2004 , WHO 2013 ).

A number of national and international institutions have examined the role of modifiable risk factors in the development of cardiovascular disease, examples of their statements and opinions are listed in Table 3.

Table 3: Risk factors related to cardiovascular disease 

Disease and economic burden related to cardiovascular diseases

The Global Burden of Disease (GBD) 2019 study estimated that cardiovascular diseases represent the leading cause of disability and premature death at global and EU level. In the EU in 2019, almost 2 million deaths and more than 29 million DALYs (Disability Adjusted Life Years) were attributed to cardiovascular diseases.

View visualisation: Disability- Adjusted Life Years attributed to Cardiovascular diseases map 

View visualisation: Mortality attributed to Cardiovascular diseases map 

In addition, the GBD 2019 study reports that almost 5% of deaths and 3.6% of DALYs attributed to CVDs were due to low physical activity; 11.6% of deaths and 17.7% of DALYs due to smoking; 17.5 % of deaths and 22.4 % of DALYS due to high body mass index, 33.6% of deaths and 35% of DALYs due to suboptimal diet and 3% of deaths and 4% of DALYs due to alcohol use.

The total cost of CVD in the EU was estimated at €210 billion in 2015, including €111 billion in health care costs, €45 billion in providing informal care, and €54 billion in productivity losses (EHN 2017).

Policies related to the prevention of cardiovascular diseases

Most countries in the EU have Action Plans and policies in place addressing cardiovascular diseases and their risk factors. Moreover, many international health organisations have published action plans and provide policymakers with recommended interventions to address non communicable diseases and their risk factors ( WHO 2017 (pdf)).

In terms of primary prevention of cardiovascular diseases, countries consider actions related to improving the diet and increasing physical activity levels of the population, decreasing exposure to alcohol and smoking, and preventing the development of metabolic conditions such as obesity, type 2 diabetes, and hypertension.

Moreover, through information and educational campaigns countries aim to inform the population about cardiovascular disease, their risk factors and their symptoms. Early detection of individuals at high risk or those with metabolic risk factors such as hypertension, type 2 diabetes or dyslipidaemia, is also part of these action plans.

The EU and national governments have also taken various measures in the form of policies, legislation or recommendations in order to address smoking through regulation of tobacco products (packaging, labelling, ingredients), creation of smoke free environments, restriction of advertising of tobacco products and increasing access to smoke cessation services ( EC Tobacco , WHO Framework Convention on Tobacco Control ).

Measures have been adopted to reduce the environmental impact on health and achieve levels of air quality that do not result in risks to human health (EC 2008European Commission Clean Air Policy Package). The “Clean Air Policy Package for Europe” aims to achieve full compliance with existing air quality legislation by 2020 and further improve Europe’s air quality by 2030 and thereafter.

Summaries of policy recommendations addressing factors related to the risk of cardiovascular disease are listed in this Health Promotion and Disease Prevention Knowledge Gateway. There are also several examples of best practices and associated health promotion interventions for the prevention of cardiovascular diseases in the Public Health Best Practice portal of the European Commission (EC 2019).