European Society of Cardiology: cardiovascular disease statistics 2021
Authors: Timmis Adam , Vardas Panos , Townsend Nick , Torbica Aleksandra , Katus Hugo , De Smedt Delphine , Gale Chris P. , Maggioni Aldo P. , Petersen Steffen E. , Huculeci Radu , Kazakiewicz Dzianis , de Benito Rubio Victor , Ignatiuk Barbara , Raisi-Estabragh Zahra , Pawlak Agnieszka , Karagiannidis Efstratios , Treskes Roderick , Gaita Dan , Beltrame John F. , McConnachie Alex , Bardinet Isabel , Graham Ian , Flather Marcus , Elliott Perry , Mossialos Elias A. , Weidinger Franz , Achenbach Stephan ,   European Society of Cardiology, Mimoza Lezha , Artan Goda , Aurel Demiraj , Chettibi Mohammed , Hammoudi Naima , Vardanyan Katarine , Pepoyan Sergey , Sisakian Hamayak , Scherr Daniel , Siostrzonek Peter , Metzer Bernhard , Mustafayev Isah , Jahangirov Tofig , Rustamova Yasmin , Mitkovskaya Natalya , Shibeka Natalya , Stelmashok Valeriy , De Pauw Michel , Lancellotti Patrizio , Claeys Marc , Kušljugić Zumreta , Džubur Alen , Smajić Elnur , Tokmakova Mariya , Traykov Vassil , Milicic Davor , Pasalic Marijan , Pavasovic Sasa , Christodoulides Theodoros , Papasavvas Ilias , Eftychiou Christos , Linhart Aleš , Táborský Miloš , Hutyra Martin , Sørensen Jacob Thorsted , Andersen Mads Jønsson , Kristensen Steen Dalby , Abdelhamid Magdy , Shokry Khaled , Kampus Priit , Laine Mika , Niemelä Matti , Iung Bernard , Cohen Ariel , Leclercq Christophe , Trapaidze Dali , Etsadashvili Kakhaber , Aladashvili Alexander , Bestehorn Kurt , Baldus Stephan , Zeiher Andreas M. , Kanakakis John , Patrianakos Alexandria , Chrysohoou Christina , Csanádi Zoltán , Becker Dávid , Járai Zoltán , Hrafnkelsdóttir Þórdís Jóna , Maher Vincent , Crowley Jim , Dalton Barbra , Wolak Arik , Assa Eyal Ben , Zafrir Barak , Murrone Adriano , Spaccarotella Carmen , Urbinati Stefano , Salim Berkinbayev , Orazbek Sakhov , Ayan Abdrakhmanov , Bajraktari Gani , Poniku Docor Afrim , Erkin Mirrakhimov , Saamay Abilova , Kurban Kalysov , Erglis Andrejs , Jegere Sanda , Bajare Iveta , Mohammed Malek , Sarkis Antoine , Saadeh Georges , Šlapikas Rimvydas , Lapinskas Tomas , Čelutkienė Jelena , Ellafi Khaled , El Ghamari Fathi , Beissel Jean , Banu Cristiana , Felice Tiziana , Xuereb Robert , Popovici Mihail , Lisii Dorin , Rudi Victor , Boskovic Aneta , Rabrenovic Miroslav , Ztot Samir , Abir-Khalil Saadia , Meeder J.G. , van Rossum A.C. , Elsendoorn M. , Kostov Jorgo , Kostovska Elizabeta Srbinovska , Kedev Sasko , Angel Kristin , Mjølstad Ole Christian , Bleie Øyvind , Gierlotka Marek , Dąbrowski Rafał , Jankowski Piotr , Baptista Sérgio Bravo , Ferreira Jorge , Gil Victor , Badila Elisabeta , Gaita Dan , Popescu Bogdan A. , Shlyakhto Evgeny , Zvartau Nadezhda , Kotova Evgenia , Foscoli Marina , Zavatta Marco , Stojkovic Sinisa , Tesic Milorad , Juricic Stefan , Kaliská Gabriela , Hatala Robert , Hlivák Peter , Fras Zlatko , Bunc Matjaž , Pernat Andrej , Cequier Ángel , Anguita Manuel , Muñiz Javier , Johansson Bengt , Platonov Pyotr , Carballo David , Rüdiger-Stürchler Marjam , Tanner Felix C. , Shebli Hussam Eddin , Kabbani Samer , Abid Leila , Faouzi Addad , Abdessalem Salem , Aytekin Vedat , Atar Ilyas , Kovalenko V. , Nesukay E. , Archbold Andrew , Tayal Upasana , Wilkinson Chris , Kurbanov Ravshanbek , Fozilov Khurshid , Mirmaksudov Mirakhmadjon , Boateng Dennis , Daval Ghislain , Momotyuk Ganna , Sebastiao David 
Published: December 2021

Abstract

Aims
This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries.

Methods and results
Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures.

Conclusion
Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.