Cardiovascular diseases

Key facts

• Cardiovascular diseases (CVDs) are the leading cause of death and disability in the WHO European Region. An estimated 4.2 million people in Europe died from CVDs in 2019, representing more than 2 in 5 (42.5%) of all deaths. This is the highest proportion of all the WHO regions.
• Over 8 in 10 (82%) CVD deaths in Europe in 2019 were from heart attacks and strokes.
• The burden of CVDs in the Region is higher among men, especially in the eastern parts compared to the central and western parts.
• High blood pressure - also called hypertension - is the leading risk factor driving the CVD burden. It caused almost a quarter (24%) of Europe's CVD deaths in 2019.
• Most CVDs can be prevented by addressing risk factors and the environments that promote and encourage them.
• Risk factors include tobacco use, unhealthy diet (high amounts of salt and trans fats and low amounts of fruits and vegetables), air pollution, obesity, physical inactivity, diabetes, harmful use of alcohol and socioeconomic deprivation.
• Once CVDs develop, it is important to detect them as early as possible in order to reduce harm through management with counselling and medicines.

What are CVDs?

CVDs are a group of disorders of the heart and blood vessels. They include:

• coronary heart disease - a disease of the blood vessels supplying the heart muscle;
• cerebrovascular disease - a disease of the blood vessels supplying the brain;
• peripheral arterial disease - a disease of the blood vessels supplying the arms and legs;
• rheumatic heart disease - damage to the heart muscle and valves from rheumatic fever, caused by streptococcal bacteria;
• congenital heart disease - birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth; and
• deep vein thrombosis and pulmonary embolism - blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events, mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on inner blood-vessel walls. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.

What are the symptoms of CVDs?

Often there are no symptoms of underlying blood vessel disease; in these cases, a heart attack or stroke may be the first sign. This is why prevention and early detection of blood vessel disease is so important for the Region and globally.

How can the burden of CVDs be reduced?

Prevention

As CVDs and other major noncommunicable diseases (NCDs) share common modifiable risk factors, prevention must be integrated into population approaches. Focusing on effective and affordable prevention and management of a combination of risk factors for CVDs all at once can prevent disability and death and improve quality of life. Health policies that create conducive environments for making healthy choices affordable and available are essential for enabling healthier lives and sustainable changes.

CVDs also have a number of wider underlying determinants that reflect the major forces driving social, economic and cultural change: commercial products and practices, urbanization, and population ageing. Other determinants include poverty, stress and hereditary factors.

Treatment

Effective measures are available for people at high risk of CVDs to reduce their chances of having a heart attack or stroke, such as drug therapies and counselling. However, many such interventions are not being implemented effectively and consistently in the Region.

Medicines and technologies should be available and affordable for those who experience an acute event such as a heart attack or stroke. In these situations, prompt pre-hospital and hospital management is crucial to avoid disability and death. Following acute events, medicines and counselling should be available to reduce the risk of further events alongside access to rehabilitation services and follow-up in primary health care.

The inclusion of risk assessment and management interventions in universal health coverage packages is crucial to effectively control CVDs and reduce harm. For example, evidence has shown that hypertension programmes can be implemented efficiently and cost-effectively in primary health care, which will ultimately result in reduced occurrence of coronary heart disease and strokes.

WHO response in Europe

The WHO Regional Office for Europe uses a comprehensive approach, including surveillance, to support countries to develop policies and strategies related to CVDs, with a focus on high-burden countries.

Collaborating with partners and Member States, WHO has developed tools related to treatment, medicines, devices and wider health system measures to ensure access to effective, integrated prevention and control of CVDs.

Effective strategies need to simultaneously focus on population-level health promotion and disease prevention, target those at high risk, maximize population coverage with effective treatment and care, and tackle the wider determinants of health. The Regional Office provides technical assistance with the implementation of these interventions and helps countries to demonstrate their impact.

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