The burden of cardiovascular disease in Europe: are there lessons for the UK?

A compelling report from the Organisation for Economic Cooperation and Development (OECD) highlights the grave health and economic impacts that cardiovascular disease (CVD) continues to have on the health of Europeans and makes recommendations for mitigating them. Are there any parallels between this analysis and CVD health in England and policies for improving it?

Despite remarkable declines in CVD mortality since the 1970s, CVD remains the leading cause of morbidity and mortality in the European Union (EU), affecting about 62 million people and causing one in three of all deaths in 2022. Inequalities in CVD mortality across the EU are wide, with higher rates in Central and Eastern European countries, for example, an almost sevenfold variation between France and Bulgaria. Inequalities in CVD risk factors, prevalence, treatment, morbidity and mortality between and within EU countries remain wide and hinder improvements in population health. Since 2010, slowing progress in reducing CVD mortality has contributed to significantly slower improvements in life expectancy across many EU countries.

Much of this narrative applies to England. CVD remains among the leading killers, responsible for about a quarter of all premature deaths and one fifth of the life expectancy gap between the most and least deprived areas. As in several Eastern European EU countries, CVD mortality increased during the Covid-19 pandemic. Compared with European peers, life expectancy in the UK is low and showed the least improvement since 2010, with slowing progress in CVD mortality being a significant contributor.

The economic and social burden of CVD

The economic and social burden of CVD is immense. It is driven by premature morbidity and mortality, lost productivity, working lives cut short, and high health and social care costs. The economic cost of CVD in the EU is EUR 282 billion (£246 billion), almost 2% of the region’s GDP, exceeding that of cancer. The total costs of CVD to the UK – both direct (medical and non-medical) and indirect (long-term care, loss of economic productivity) – were estimated at £29 billion in 2021/22. Significantly, premature mortality (people under 75) from CVD in England is at the same level as a decade ago, having increased during the Covid-19 pandemic (see Figures 1a and 1b). CVD is therefore a significant obstacle to health gains in people of working ages, especially in men who have double the mortality rate of women. That means CVD prevention offers considerable potential for both health improvement and wider economic benefits in England and across the channel. Given the overall disease and economic burden of CVD in England, a coherent plan for tackling it is urgently needed.

An evolving epidemiological environment

OECD notes that the case for strengthening policies for preventing, managing and treating CVD has been reinforced by an evolving epidemiological environment. For example:

• Although there have been impressive reductions in the prevalence of some CVD risk factors such as smoking, some others are becoming more common including obesity, diabetes and hypertension. Environmental risk factors such as air pollution are becoming more widespread and extreme heat and cold weather conditions more frequent too.

• With advances in CVD care and reductions in mortality, increasing numbers of people are living with chronic cardiovascular conditions such as heart failure and vascular dementia, and co-morbidities such as depression are common. Population ageing is further increasing the prevalence of multimorbidities. OECD’s Patient Reported Indicator Surveys (PaRIS) show that 82% of primary care patients aged 45 years or older in participating countries suffer from two or more chronic conditions.

• Widening health inequalities, including in CVD risk factors, morbidity and mortality, are impeding improvements in population health and life expectancy.

• The Covid-19 pandemic was a sobering reminder of the CVD risks from respiratory viruses. Periodic severe seasons of influenza or other respiratory infections, including Covid-19, remain a public health hazard, especially in ageing populations. People with CVD are at greater risk of developing serious complications of and dying from such respiratory viruses. In turn, as with Covid-19, influenza and pneumonia can trigger acute cardiovascular events like heart attack and stroke.

A framework for prevention and management

OECD notes that, while significant progress has been made in tackling CVD in EU countries, most still face challenges and significant gaps remain in the timeliness, quality and accessibility of care and tackling inequalities. Its framework for CVD prevention and management is structured around two policy areas covering the CVD pathway, with cross-cutting principles of efficiency, equity, resilience and sustainability:

• Population-level prevention: cross-sector primary prevention strategies for tackling factors that increase people’s risk of CVD. More than three quarters of CVD deaths in the EU are linked to risks that can be reduced. That includes metabolic risks such as hypertension, obesity and diabetes; behavioural risks including smoking and poor diets; and environmental risks such as air pollution.

• Health system-level care delivery: high quality primary care for secondary prevention to enable early detection, diagnosis and management of CVD and its risk factors. This includes health checks, screening for metabolic risk factors, improving health literacy and support for self-management. The framework also encompasses the rest of the CVD pathway, including access to specialist acute and post-acute care, rehabilitation and long-term integrated, person-centred care.

Policy developments in England

How do OECD’s proposals for tackling CVD align with policy developments in England? The government’s 10 Year Health Plan for England, a plan for making the NHS ‘fit for the future’, aims for three shifts in the NHS, from:

• sickness to prevention, focusing in particular on strengthening secondary prevention to delay the onset of morbidity, with primary prevention measures such as tackling smoking and obesity etc. described as improving health ‘in the long term’.

• hospital to community, with more care and services delivered through community-based Neighbourhood Health Centres and pharmacies

• analogue to digital, with the power of digital technologies, NHS health data and apps, AI and genomic science deployed to improve health care delivery and outcomes.

Although the plan relates to the NHS overall, the three shifts resonate with OECD’s recommendations for CVD, for example, enhancing the use of digital technologies and electronic patient health data in reshaping CVD prevention and management in the EU. The plan also identifies CVD as an ‘early priority’. To support achievement of the government’s ambition to reduce premature deaths from heart disease and stroke by 25% within a decade, a Modern Service Framework for CVD due in 2026 will identify evidence-based interventions for CVD prevention and care, standards for delivery, and potential areas for innovation.

Much depends on how well these policies are implemented in England and the scaling up of complementary public health strategies to reduce the prevalence of CVD and its risk factors at both national and local levels. However, action on prevention overall thus far falls short of the government’s promised ‘prevention revolution’, and a cross-government plan to address the wider social and economic causes of ill health as recommended by the OECD is yet to materialise.