Professor Joep Perk of Linnaeus University, and a member of the European Society of Cardiology, speaks to Editor Laura Evans about the importance of reducing cardiovascular diseases in Europe and how this can be achieved.
In Europe, cardiovascular diseases cause over 4 million deaths and over 1.9 million deaths in the European Union, which equates to 47% of all deaths in Europe and 40% in the EU. According to the European Heart Network, 1 death rates from cardiovascular heart disease (CHD) are generally higher in Central Europe, whereas death rates from stroke are much higher in Central and Eastern Europe. Overall CVD is estimated to cost the European Union economy €196bn a year.
Cardiovascular diseases are all the diseases of the heart and circulation, including coronary heart disease (angina and heart attack), heart failure, congenital heart disease and stroke. There are many factors that increase the risk of developing a cardiovascular disease including; smoking, weight gain, diet, and lack of exercise.
Member of the European Society of Cardiology, and Clinical cardiologist and Professor of Health Sciences at Linnaeus University, Professor Joep Perk speaks to Laura Evans about the problems cardiovascular diseases can cause throughout Europe, and what more could be done to decrease fatalities.
“If we go back some way in time, cardiovascular diseases were fairly uncommon in the beginning of the past century,” Professor Perk begins.
“In Western Europe they started to show up in the 1930s and 40s and culminate around 1970 and 1980. In Western European countries there has been a steady decrease over the past 20-30 years. Research has shown that, of the 6-year increase in life expectancy between 1970 and 2000, 65% of the increase – or almost 4 full years – is due to reductions in CVD mortality alone. As positive as this scenario is, heart disease remains the leading cause of death and the new epidemic has the potential to threaten the advances made to date. Europe is currently facing a series of emerging trends, such as the growing ageing population, that could create new challenges for healthcare systems.”
“In Sweden, premature and early mortality in heart diseases has reduced to a third of what we had in the 1980s, which is a tremendous difference. At the same time as we see this lowering in Western Europe, we see some parts of Eastern Europe still experiencing problems.”
Professor Perk explains there are some areas of Europe where cardiovascular disease is still rife. For example in Eastern Europe, the problem seems to be bigger than Western Europe, which Perk believes is due to lifestyle differences.
“Cardiovascular diseases are becoming a problem in middle and low income countries like India, Pakistan and Brazil, with 80% more early cardiovascular deaths being recorded.
“It is very much to do with public health; smoking, physical activity, what you eat, stress and our sleeping habits. In several Western European countries we have seen two thirds of a drop in mortality over the past 25 years, which is due to the fact that people are smoking less, and are slightly more physically active. “A country like Bulgaria for example has a huge problem. People are getting fatter, they are smoking more, move around less, and have more stressful lives which leads to a direct increase in mortality.”
The difference in mortality rates has a lot to do with developed countries having more effective treatment to hand. For underdeveloped nations, mortality rates are higher due to effective treatments or quality of care not being available, as Professor Perk explains.
“If you look at the risk factors, the number of people overweight and smoking is a bigger problem in richer countries. In poor countries, the quality of care, especially the follow up, is still undeveloped. For example, if you have a heart attack in Bangladesh, the survival rate is far worse than if you had one in the UK. If you look at the risk level for the average British citizen who is overweight and less active, when they have a heart attack they still have a better chance of surviving than the lean non-smoker in Bangladesh.”
Cardiovascular diseases remain the prime cause of premature deaths under the age of 75, and Professor Perk believes if we can tackle the problem head on, 80% of all cardiovascular diseases could be eradicated which is a huge achievement in itself.
Perk believes that education and legislation could play a key part in eradication. If people had the correct information and knowledge about these diseases, mortality rates could be a lot less.
“On a political level – more legislation on smoking, the amount of salt in food, access to fresh fruit and vegetables and physical activity is needed,” said Professor Perk. The EACPR issued an interesting paper about this.2
“People need to be informed that heart attacks are something that at least 80% of people can influence through their own behaviour. We recently conducted a study and discovered the basic knowledge on how people could prevent this disease is lacking. There is a need for good public knowledge so people can take responsibility for their own health.
“On these 2 levels (public and personal) we can further eradicate cardiovascular disease. We know there is a significant difference of cardiovascular disease between the higher and lower income countries. If you make fruit and vegetables a lot cheaper, you give people with less resources a better chance of getting anti-oxidants into their diet, which can help to keep you healthy.”
Perk believes it is important to try and eradicate cardiovascular problems now, in order to prevent the next generation from developing the diseases.
“The main aim is to help the next generation who I would like to see active in sports. They have a body that has a reasonable guarantee to get to 90 years old. We have lots of children that are failing at school, they don’t sleep enough, and they don’t eat the right foods, and that is one of the main challenges in Europe.
“Because I am professor of health science I work mainly on trying to transfer the knowledge we already have. We need to educate people and tell them these diseases are a waste of our time and we don’t need them.”
2 Population-level changes to promote cardiovascular health. Eur J Prev Cardiol. 2012 May 9.
Professor Joep Perk
Clinical cardiologist and Professor of Health Sciences
Linnaeus University, Sweden, and member of the European Society of Cardiology