Heart disease death rates continue to fall across Europe

Almost all EU countries showed a large and significant decrease in death rates from coronary heart disease over the last three decades.

The UK was among the countries that saw the largest decreases in mortality during this time, along with Denmark, the Netherlands, Sweden and Malta.

However, the researchers emphasise that heart disease remains a leading cause of death. Heart disease and stroke cause over 1.9 million deaths a year in the European Union, or 40% of all deaths.

And there was significant variation between individual countries, with some evidence of a levelling off in heart disease deaths among younger age groups in some countries – including the UK.

'It is clear that there are some countries in which trends are cause for concern, where overall rates of decrease in coronary heart disease mortality do appear to have slowed,' said Dr Melanie Nichols of the British Heart Foundation Health Promotion Research Group at the University of Oxford.

The Oxford University research group looked at trends in deaths from coronary heart disease between 1980 and 2009 in both men and women in four age groups: under 45, 45-54, 55-64, and 65 and over. The research is published in the European Heart Journal.

It has been suggested that improvements in death rates among younger people might be beginning to plateau, as the gains from fewer people smoking are increasingly cancelled out by recent upward trends in obesity, diabetes and other risk factors for heart disease.

The researchers saw no evidence for that across Europe as a whole, where there have been ongoing steady reductions in rates of heart disease deaths in all age groups.

However, in the UK there was evidence that the downward trends were beginning to flatten out among those aged under 45, and also in Italy, Latvia and Lithuania.

The same pattern was seen in the 45-54 age group in Latvia and the UK.

Similar evidence was seen for men under 45 in Poland and Slovakia, women under 45 in the Czech Republic and France, and men aged 45-54 in Sweden, Austria, the Czech Republic and Slovakia.

In Greece, women aged 45-54 showed a constant and significant increase in death rates.

The researchers were unable to look at any of the reasons for differences between countries, and Dr Nichols points out that their results could be affected by differences in the way countries record and code data.

Dr Nichols, who is now working as a research fellow at Deakin University, Australia, said: 'In a small number of countries there is some evidence that the decreasing trends may be slowing, including among younger age groups, probably due to increases in risk factors such as obesity and diabetes. These countries are, however, clearly in the minority.'

The researchers say that while increases in smoking, obesity and diabetes among younger people could have an impact on heart death rates in years to come, there may still be time for public health policy to have an impact.

Dr Nick Townsend of the British Heart Foundation Health Promotion Research Group at the University of Oxford says that while it does look as though the UK is not doing quite as well as some other countries, comparisons between nations are difficult.

He points out that in British under-45s, the fall-off in the rate of decrease in heart deaths has been there for a long period. He said: 'The plateauing started in 1997 for males and 1986 for females. There have still been steady decreases since then, they just weren't as large as the decreases before.

'We do still appear to have higher death rates for men under 45 when compared to many countries, including both France and Germany. But we have also had a greater percentage decrease since 1980 – although we did start with much higher death rates.

'For women, current death rates are not that different between the three countries. And again we have had a greater percentage decrease than both Germany and France.

'Having said that, it is also very noticeable that we have high obesity prevalence compared with many countries in Europe, and we are also above EU and European averages in the prevalence of diabetes.'

Dr Townsend believes policy-makers need to take a public health population-level approach to encourage healthy behaviour, targeting dietary choice and physical activity and creating healthy environments that make healthy choices easy and unhealthy choices difficult.

The researchers' positions at the University of Oxford are funded by the British Heart Foundation. The study arises from the European Heart Health Strategy II project, which received funding from the European Union.

Simon Gillespie, chief executive of the British Heart Foundation, said: 'The picture of heart disease mortality may be improving but we’re an awful long way from back-patting and hand-clapping. More than two million people are battling coronary heart disease in the UK and, while our work in science labs and improving prevention and care has made a huge difference, that's two million people too many.

'After such rapid and far-reaching reforms to our healthcare system, it's now vitally important that politicians and clinicians don't lose sight of the fact that coronary heart disease is still the UK's single biggest killer. We must continue our efforts to make sure that no one dies prematurely of heart disease.'