UK heart disease and stroke death rates now lower than cancer

"Heart disease deaths now lower than cancer – but obesity crisis means this may not last," the Daily Mirror reports. A major review of European trends in cardiovascular disease deaths found that UK cancer deaths overtook cardiovascular deaths in 2014.

Cardiovascular disease (CVD) is an umbrella term used to refer to conditions that affect the heart or blood vessels, such as coronary heart disease and stroke.

Researchers looked at available data on the health burden of CVD and associated mortality across Europe. It found that CVD is still the most common cause of death across Europe as a whole – accounting for 45% of all deaths. In countries in Eastern Europe, such as Ukraine, CVD remains a significant public health issue.

However in certain Western European countries, including the UK, cancer deaths now overtake CVD deaths.

The statistics from a study such as this can never be 100% accurate. Also, it cannot answer why death rates may be changing – for example whether due to better population lifestyle, earlier diagnoses, or better and earlier treatments; or possibly a combination of all three.

The Mirror is right to strike a note of caution. The current obesity epidemic in the West could lead to an upturn in CVD deaths in the years ahead.

Where did the story come from?

The study was carried out by researchers from University of Oxford and Deakin University in Australia, and was funded by the British Heart Foundation.

The study was published in the peer-reviewed European Heart Journal.

While the UK media's reporting was accurate, many of the headlines, such as The Times' "Cancer kills more people than heart disease" could give the impression that this was a global, or at least, Europe-wide trend. In fact this trend was only seen in 10 European countries.

What kind of research was this?

This was a review describing the cardiovascular disease (CVD) burden within Europe in 2013.

CVD is reported to be the most common cause of death worldwide. This study is said to be the fourth in a series of papers, giving an updated look at the numbers of people affected by CVD, treatment and mortality burden. The researchers said that "all data included here are updated from previous publications and we present prevalence statistics for the first time". The European Cardiovascular Disease Statistics 2012 report is said to be the source for statistics on disease burden in Europe.

This isn't therefore a systematic review in the formal sense where the researchers have searched literature databases to identify relevant articles. The specific methods by which they identified studies aren't described. 

What did the research involve?

The researchers present statistics from a number of data sources, which were said to be chosen with consideration of data quality, coverage of European region, and selecting the most up-to-date. They aimed to get recent data for as many European countries as possible. They gave particular focus to the two common forms of CVD – coronary heart disease and stroke.

There were said to be no "ideal" data sources providing complete, up-to-date, high quality and representative data for all 53 European countries.

Mortality data came from the World Health Organization (WHO) mortality database (up to November 2015), and population size and age distribution was applied to this using the 2013 European Standard Population (ESP); a statistical modelling tool used to estimate mortality and incidence of specific diseases.

Disease prevalence data came from the two-yearly European Social Survey, an ongoing survey looking at social trends.

The WHO's Health Statistics and Information Systems informed on the associated burden of disease. This provides data in terms of disability-adjusted life years (DALYs) – years of healthy, good quality life lost due to the condition. They also looked at the WHO European Region's Health for All Database to gain information on the burden to health services, including hospital admissions, length of stay, and the proportion of people who die within 30 days of admission for heart attack or stroke.

What were the basic results?

Total prevalence of CVD across Europe is around 1 in 10 people.

Latest data indicated that CVD causes more than 4 million deaths per year across Europe, accounting for 45% of all deaths – making it the most common cause of death across Europe. Heart disease and stroke accounted for 1.8 and 1 million deaths, respectively.

More than three fifths of all CVD deaths are in over-75s, but twice as many men as women die from CVD before the age of 65. Of countries in the European Union (before 2004), deaths range from – for men – 75/100,000 in France to 481/100,000 in Finland for men and – for women – from 174/100,000 in France to 391/100,000 in Greece. Deaths were generally higher in countries that joined the EU later, such as Malta and Bulgaria, and in countries outside of the EU.

However, CVD mortality rates have been falling by as much as 25 to 50% over the past 10 years. Along with this decline, 12 countries now record more deaths from cancer each year for men, and two countries for women – even though cancer still accounts for less than half the number of CVD across Europe as a whole. This includes the UK which in 2013 recorded 87,511 cancer deaths in men 79,935 CVD deaths in men. Cancer deaths haven't overtaken CVD deaths for women in the UK. The two countries with higher cancer deaths in women were Denmark and Israel (also countries with higher cancer rates in men).

DALYs lost to CVD were highest in Ukraine, with other Eastern European countries also having high rates. The highest hospitalisation rates were in Belarus, with Latvia having the highest associated fatality rate.

How did the researchers interpret the results?

The researchers conclude: "Mortality statistics show that CVD remains the most common cause of death in Europe, accounting for 45% of all deaths … More than 4 million people die from CVD across Europe every year, with 1.4 million of these deaths before the age of 75 years. There remains evidence of wide inequalities across Europe in the burden of CVD mortality and the changes in rates of death from these diseases."

Conclusion

This valuable research informs on the burden of cardiovascular disease and associated mortality across European countries.

It demonstrates that CVD is still the most common cause of death across Europe, but rates have been falling over the past 10 years. This fall means that in several European countries, including the UK, cancer rates now overtake CVD death rates in men. Generally, CVD disability and burden of disease seems to be greater in Eastern European countries.

The WHO mortality data and population data are quite up-to-date and should be reliable, though as the researchers say, there was a lack of high quality and representative data covering all 53 European countries. Therefore these figures should still be taken as estimates and may not be completely accurate.

Also, this study can only provide statistics – not answer why. CVD mortality rates could be falling due to various reasons – healthier population lifestyles, earlier diagnoses, earlier and more effective treatments – but these are only possibilities, we don't know the exact causes. Similarly with the overtake in cancer mortality, this study doesn't provide data on changes in cancer mortality rates, so we don't know whether these have increased, stayed the same or decreased over the same period.

For any individual, while it's not possible to change genetic factors that may be associated with increased CVD or cancer risk, you may be able to reduce your risk of all of these chronic diseases by following healthy lifestyle recommendations – eating a balance diet, taking regular physical activity, not smoking and limiting your alcohol consumption.