Cardiovascular disease prevention: national policies differ widely across EU, study shows
On 10 September, the EuroHeart mapping project, co-financed through the EU's Public Health Programme, presented the results of their three-year study of heart health promotion and cardiovascular disease (CVD) prevention measures in several European countries. The study revealed significant inequalities in both national prevention policies and levels of cardiovascular mortality. CVD is the main cause of death and disability in Europe. But according to the World Health Organization (WHO), a modest reduction in blood pressure, obesity and tobacco use across the population would cut CVD incidence in half. The EuroHeart mapping project ('Mapping and analysis of national plans, policies and measures impacting on cardiovascular health promotion and CVD prevention across Europe') was launched in 2007 by the European Heart Network and the European Society of Cardiology to determine specific areas of intervention that would most help prevent avoidable deaths and disability. In the project's latest study, EuroHeart researchers collected comprehensive information on policies, plans and measures that impact both the promotion of cardiovascular health and the prevention of CVD in 16 European countries. The data were collected via structured questionnaires, and helped the partners to identify differences and gaps in policies and actions as well as to determine the essential elements of national strategies. One of the main findings was that while heart disease remains the leading cause of death in Europe, mortality rates are falling in most countries. However, the researchers also uncovered huge differences between countries in both the rate of cardiovascular mortality and in national prevention programmes. Hungary, Estonia, Slovakia and Greece had the highest rates of mortality from coronary heart disease (CHD) in men and women under 65. The lowest rates for men under 65 were seen in France, the Netherlands, Italy and Norway, while for women in the same age group, the lowest rates were in Iceland, France, Slovenia and Italy. Risk-factor prevalence such as smoking was also calculated, and the countries with the highest risk profiles also had a high rate of CHD. For example, the highest rates of smoking were found in Greece (46%), Estonia (42%), Slovakia (41%), Germany (37%) and Hungary (37%). The incidence of premature deaths from CHD was noticeably different between countries. For instance, rates in Finland declined by 76% between 1972 and 2005, while in the same period in Greece, mortality rates increased by 11%. All participating countries have some type of legislation in place addressing public health, tobacco control and food. However, while Belgium, Estonia, Finland, France, Iceland, Italy and Slovenia have several policies in place that promote cardiovascular health and address CHD, hypertension, stroke and hyperlipidaemia, Greece has just one. Denmark and Greece both reported having no national guidelines within the broad context of CVD; all other countries had national guidelines for the management of hyperlipidaemia, diabetes and stroke prevention. Most of the countries (with the exception of Denmark, Greece and Slovenia) had obesity guidelines. France, Germany and Ireland were the only countries that reported having recommendations for emergency first-aid. 'The broader WHO's Europe [region] presents even greater gaps between its 53 countries, which have been increasing over the past 20 years,' stated Nata Menabde, WHO Deputy Regional Director for Europe. 'We are observing a difference up to 10 times in death rates from ischaemic hearth diseases in men below 65 years of age. On the other side of the coin, we see that some countries have been able to put in place successful policies to reduce this burden.' WHO/Europe and the European Commission are working together with all Member States to strengthen health systems in Europe and tackle the root causes of CVD, such as smoking, obesity, alcohol use and lack of physical activity. Susanne Logstrup, Director of the European Heart Network, noted that the new findings show that most countries have taken legislative action and have policy measures in place addressing public health, specifically coronary heart disease, tobacco use, food consumption and physical activity. She added that 'only in about half the participating countries could we identify budgets allocated to policy and programme implementation'. The study revealed that smoking bans significantly impacted the incidence of acute coronary events. For example, in February last year the French authorities announced a 15% decrease in emergency admissions for heart attack just 1 year after the public ban on smoking came into effect. Researchers in Italy and Ireland have observed a reduction of acute coronary events of approximately 11% since implementing smoking bans a few years ago. Interestingly, the number of people admitted to hospital for heart attacks fell by 17% in the year after Scotland's smoking ban took effect in March 2006. The EuroHeart project runs until March 2010. In addition to the above mapping and analysis, its objectives include mobilising support for cardiovascular health promotion and cardiovascular disease prevention, investigating issues concerning CVD in women, improving prevention practices at primary care level and implementing and adapting European guidelines on CVD prevention to national settings.