European Society of Cardiology: Cardiovascular Disease Statistics 2019
Authors: Timmis Adam , Townsend Nick , Gale Chris P , Torbica Aleksandra , Lettino Maddalena , Petersen Steffen E , Mossialos Elias A , Maggioni Aldo P , Kazakiewicz Dzianis , May Heidi T , De Smedt Delphine , Flather Marcus , Zuhlke Liesl , Beltrame John F , Huculeci Radu , Tavazzi Luigi , Hindricks Gerhard , Bax Jeroen , Casadei Barbara , Achenbach Stephan , Wright Lucy , Vardas Panos ,   European Society of Cardiology, Mimoza Lezha , Artan Goda , Aurel Demiraj , Chettibi Mohammed , Hammoudi Naima , Sisakian Hamayak , Pepoyan Sergey , Metzler Bernhard , Siostrzonek Peter , Weidinger Franz , Jahangirov Tofig , Aliyev Farid , Rustamova Yasmin , Manak Nikolay , Mrochak Aliaksandr , Lancellotti Patrizio , Pasquet Agnès , Claeys Marc , Kušljugić Zumreta , Dizdarević Hudić Larisa , Smajić Elnur , Tokmakova Mariya Petkova , Gatzov Plamen Marinov , Milicic Davor , Bergovec Mijo , Christou Christos , Moustra Hera Heracleous , Christodoulides Theodoros , Linhart Ales , Taborsky Milos , Hansen Henrik Steen , Holmvang Lene , Kristensen Steen Dalby , Abdelhamid Magdy , Shokry Khaled , Kampus Priit , Viigimaa Margus , Ryödi Essi , Niemelä Matti , Rissanen Tuomas T , Le Heuzey Jean-Yves , Gilard Martine , Aladashvili A , Gamkrelidze A , Kereselidze Maia , Zeiher A , Katus H , Bestehorn K , Tsioufis Costas , Goudevenos John , Csanádi Zoltán , Becker Dávid , Tóth Kálmán , Jóna Hrafnkelsdóttir Þórdís , Crowley James , Kearney Peter , Dalton Barbra , Zahger Doron , Wolak Arik , Gabrielli Domenico , Indolfi Ciro , Urbinati Stefano , Imantayeva Gulnara , Berkinbayev Salim , Bajraktari Gani , Ahmeti Artan , Berisha Gezim , Erkin Mirrakhimov , Saamay Abilova , Erglis Andrejs , Bajare Iveta , Jegere Sanda , Mohammed Malek , Sarkis Antoine , Saadeh Georges , Zvirblyte Ruta , Sakalyte Gintare , Slapikas Rimvydas , Ellafi Khaled , El Ghamari Fathi , Banu Cristiana , Beissel Jean , Felice Tiziana , Buttigieg Sandra C , Xuereb Robert G , Popovici Mihail , Boskovic Aneta , Rabrenovic Miroslav , Ztot Samir , Abir-Khalil Saadia , van Rossum A C , Mulder B J M , Elsendoorn M W , Srbinovska-Kostovska Elizabeta , Kostov Jorgo , Marjan Bosevski , Steigen Terje , Mjølstad Ole Christian , Ponikowski Piotr , Witkowski Adam , Jankowski Piotr , Gil Victor Machado , Mimoso Jorge , Baptista Sérgio , Vinereanu Dragos , Chioncel Ovidiu , Popescu Bogdan A , Shlyakhto Evgeny , Oganov Raphael , Foscoli Marina , Zavatta Marco , Dikic Ana Djordjevic , Beleslin Branko , Radovanovic Mina Radosavljevic , Hlivák Peter , Hatala Robert , Kaliská Gabriela , Kenda Miran , Fras Zlatko , Anguita Manuel , Cequier Ángel , Muñiz Javier , James Stefan , Johansson Bengt , Platonov Pyotr , Zellweger Michael Johannes , Pedrazzini Giovanni B , Carballo David , Shebli Hussam Eddin , Kabbani Samer , Abid Leila , Addad Faouzi , Bozkurt Engin , Kayıkçıoğlu Meral , Erol Mustafa Kemal , Kovalenko Volodymyr , Nesukay Elena , Wragg Andrew , Ludman Peter , Ray Simon , Kurbanov Ravshanbek , Boateng Dennis , Daval Ghislain , de Benito Rubio Víctor , Sebastiao David , de Courtelary Paola Thellung , Bardinet Isabel 
Published: November 2019

Abstract

Aims
The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets.

Methods and results
In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures.

Conclusion
A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.