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31st August 2023
The total cost of cardiovascular disease (CVD) in the EU reached an estimated €282bn in 2021, according to new research presented at the European Society of Cardiology (ESC) Congress 2023.
Cardiovascular healthcare accounted for €130bn (46%) of the expenditure, while productivity losses associated with absenteeism and retirement due to illness and disability (5%) and premature death (12%) were estimated at €15bn and €32bn, respectively.
This is the first study to use Europe-wide patient registries and surveys rather than relying on assumptions and, for the first time, includes the costs of long-term social care, which accounted for €25bn (9%) of the total.
A wide variation between countries was identified in the proportion of healthcare budgets spent on CVD, ranging from 6% in Denmark to 19% in Hungary.
The total cost of CVD equated to €630 per EU citizen, varying from €381 in Cyprus to €903 in Germany.
A collaboration between the ESC and the UK’s University of Oxford, this was the most comprehensive and up-to-date analysis of the economic costs of CVD to EU society since 2006.
Study author Dr Ramon Luengo-Fernandez, associate professor at the University of Oxford, said: ‘CVD had a significant impact on the EU27 economy, costing a total of €282bn in 2021. That’s equivalent to 2% of Europe’s GDP and is significantly more than the entire EU budget itself [€186.6bn in 2023], used to fund research, agriculture, infrastructure and energy across the Union.’
In the study, healthcare included primary care, emergency care, hospital care, outpatient care and medications, while social care included long-term institutionalised care, and care at home.
The main contributor to the expenditure was hospital care at €79bn, representing 51% of CVD-related care costs, and CVD medications accounted for €31 billion (20%). Residential nursing care home costs totalled €15bn (9%).
Informal care, which includes the work or leisure time, valued in monetary terms, that relatives and friends gave up to provide unpaid care accounted for €79bn (28%) of the costs. The research found 7.5 billion hours of unpaid care were provided by relatives and friends for patients with CVD.
What’s more, million working-days were lost in the EU in 2021 because of CVD illness and disability, while 1.7 million people died due to CVD across the EU, representing 1.3 million working-years lost.
ESC board member and study author Professor Victor Aboyans, head of cardiology at University Hospital Limoges in France, said: ‘This study underscores the urgent need to act collectively on the European scale to better combat the cardiovascular risk of European citizens, in particular through regulations for better cardiovascular prevention and investment in research.
‘By choosing not to invest in cardiovascular disease we are simply deferring the cost. These data force us to ask the question: do we invest in cardiovascular health today or be forced to pay more at a later stage?’
Professor Panos Vardas, chief strategy officer of the European Heart Agency, added: ‘It is evident that there is significant fragmentation among EU countries in terms of cardiovascular disease healthcare expenditures. This necessitates a re-evaluation by the EU as a whole, and the 27 EU countries individually, to better address the outstanding needs and invest more effectively in supporting those suffering from cardiovascular disease.’
22nd June 2023
Almost 100,000 more people have died with cardiovascular disease in England than expected in the three years since the pandemic began, a new analysis from the British Heart Foundation (BHF) shows.
The data up to this month shows an average 500 additional deaths a week involving cardiovascular disease since the start of the pandemic.
A range of factors are likely to contribute to the figures, which came from the Office for Health Improvement and Disparities (OHID), including Covid-19 itself, extreme pressure on the NHS and disrupted healthcare as well as changing patient behaviour and worsening population health, the charity said.
It noted that the number of patients waiting for time-sensitive cardiac care was at a record high of nearly 390,000 at the end of April in England, while average ambulance response times for heart attacks and strokes have consistently been above 30 minutes since the beginning of 2022.
The analysis found at 96,540 excess deaths involving cardiovascular disease between March 2020 and May this year – more than any other disease group.
Rates also changed over time with Covid-19 infection driving high numbers of excess deaths involving cardiovascular disease in the first year where more than 50% of the higher than expected deaths occurred.
Excess deaths involving cardiovascular disease then dropped significantly in the second year of the pandemic before increasing again in year three by 13,000.
In the third year of the pandemic, the number of excess deaths involving cardiovascular disease outnumbered the number of deaths where cardiovascular disease was mentioned but where Covid-19 was the underlying cause by around 19,400 deaths, the BHF said.
The charity warned the UK Government must take charge of the increasingly urgent cardiovascular disease crisis.
Dr Charmaine Griffiths, BHF chief executive, said: ‘It is deeply troubling that so many more people with cardiovascular disease have lost their lives over the last three years. My heart goes out to every family who has endured the pain of losing a loved one, all too often in distressing circumstances.
‘For years now, it has been clear that we are firmly in the grip of a heart and stroke care emergency. If little changes, we could continue to see a sustained rise in death rates from cardiovascular conditions that undoes decades of scientific progress to reduce the number of people who die of a heart attack or stroke.’
Dr Sonya Babu-Narayan, associate medical director at the BHF and consultant cardiologist, said Covid-19 no longer fully explains the significant numbers of excess deaths involving cardiovascular disease.
‘Other major factors are likely contributing, including the extreme and unrelenting pressure on the NHS over the last few years.
This story was originally published by our sister publication Pulse.
30th May 2023
Consuming one to three serving of chocolate per week is enough to lower women’s risk of death, findings from a recent study suggest.
Focusing on post-menopausal women, free of cardiovascular disease (CVD) and cancer at baseline when enrolled in the study during 1993 through to 1998, the cohort were followed until March 2018. The outcomes of interest were all-cause mortality and cause-specific mortality from CVD, cancer and dementia.
Women’s intake of chocolate was categorised based on the intake frequency of a 1oz serving of chocolate as: none, less than one serving per week (<1 serving/wk), one to three serving per week (1-3 servings/wk), four to six servings per week (4-6 servings/wk) and more than one serving per day (≥1 serving/d).
Over 1,608,856 person-years of follow-up, there were a total of 25,388 deaths, which included 7,069 deaths from CVD, 7,030 from cancer and 3,279 from dementia. In multivariable adjusted analysis, compared to those who did not eat chocolate, the hazard ratio (HR) for all-cause mortality ranged from 0.95 (95% CI 0.92 – 0.98) for <1 serving/wk to 0.93 (95% CI 0.89 – 0.96) for 1-3 serving/wk (p for trend = 0.02).
For CVD mortality, the association was only significant for 1-3 servings/wk (HR = 0.88, 05% CI 0.82 – 0.95). In contrast, dementia mortality was significantly lower for both <1 serving/wk and 1-3 servings/wk.
Overall, there was no significant effect of chocolate intake on cancer mortality, but, in subgroup analysis, lung cancer mortality was significantly lower but only for 1-3 servings/wk (HR = 0.82, 95% CI 0.70 – 0.96).
The authors recognised how their analysis did not consider the different types of chocolate in their analysis, for example dark chocolate has purported health benefits, and this could have impacted on their findings. They also accepted that residual confounding could not be excluded, in other words, the findings could be due to other factors not considered.
A modest and inverse association between eating chocolate and mortality from all causes and cause-specific mortality from cardiovascular disease, cancer and dementia has previously been found in an analysis of data from Women’s Health Initiative (WHI) by US researchers.
Chocolate is known to contain a high content of the saturated fat, stearic acid and antioxidant flavonoids with the latter component likely responsible for a cardioprotective effect. Moreover, evidence from a meta-analysis of prospective studies, suggests that moderate consumption of chocolate is associated with a decreased risk of coronary heart disease (CHD), stroke and diabetes. But not all studies have concurred with this analysis. One, for instance, undertaken in women, was unable to find an association between chocolate intake and the risk of CHD and stroke. As well as potential cardiovascular benefits, it seems there is also an inverse relationship between regular intake of chocolate and a lower risk of cognitive decline.
26th April 2023
A heart healthy lifestyle reduces the risk of cancer which suggests that both conditions share risk factors. This relationship appears to be bi-directional such that cancer patients with CVD risk factors have an increased chance of an adverse cardiac event. Some evidence also points to atherosclerotic CVD itself being a risk for the development of cancer. However, whether all forms of CVD increase cancer risk and if there is a relationship with the cancer type remains unclear.
In the current study, researchers sought to investigate the association between both atherosclerotic and non-atherosclerotic cardiovascular disease with the development of cancer. In a retrospective examination of an insurance claims database, the team identified patients initially free from cancer. These individuals were then categorised as having either atherosclerotic cardiovascular disease or non-atherosclerotic disease. This latter group had for instance, valvular heart disease, arrhythmias or congenital heart disease. In their analysis, the researchers made adjustments for age, sex, diabetes, hypertension, chronic kidney disease and hyperlipidaemia.
CVD and cancer risk
There were a total 27,195,088 individuals with data for analysis. Those with CVD had a 12% higher risk of developing cancer than those without the disease. (Hazard ratio, HR = 1.12, 95% CI 1.11 – 1.13). This risk was elevated for both atherosclerotic disease (HR = 1.20) and non-atherosclerotic disease (HR = 1.11).
Both forms of cardiovascular disease also linked to a higher incidence of a number of cancers. For example, atherosclerotic cardiovascular disease increased the risk of lung cancer more than two-fold (HR = 2.78). But this was slightly lower for non-atherosclerotic CVD (HR = 1.73).
Citation
Bell CF et al. Risk of Cancer After Diagnosis of Cardiovascular Disease. J Am Coll Cardiol CardioOnc. 2023
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