Cardiovascular diseases statistics


Data extracted in October 2016. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: October 2017.

This article presents an overview of European Union (EU) statistics related to cardiovascular diseases and focuses on the following aspects: cardiovascular health and mortality, cardiovascular healthcare and the availability of specialist healthcare personnel and equipment.

Cardiovascular diseases are the leading cause of death in the EU. They cover a broad group of medical problems that affect the circulatory system (the heart, blood vessels and arteries), often resulting from atherosclerosis — the abnormal build-up of plaque that is made of, among others, cholesterol or fatty substances — that is deposited on the inside walls of a person’s arteries. Some of the most common diseases that affect the circulatory system include ischaemic heart disease (heart attacks) and cerebrovascular diseases (strokes).

This article is one of a set of statistical articles concerning health status in the EU which forms part of an online publication on health statistics.

Table 1: Causes of death — diseases of the circulatory system, residents, 2013
Source: Eurostat (hlth_cd_aro) and (hlth_cd_asdr2)
Table 2: Standardised death rates — diseases of the circulatory system, residents, 2013
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_asdr2)
Figure 1: Share of the population aged 15 and over reporting that they had high blood pressure, by sex, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_cd1e)
Figure 2: Hospital discharge rates for in-patients with diseases of the circulatory system, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)
Table 3: In-patient average length of stay for diseases of the circulatory system, 2009 and 2014
(days)
Source: Eurostat (hlth_co_inpst)
Table 4: Surgical operations and procedures performed related to diseases of the circulatory system, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 5: Cardiovascular related healthcare personnel and equipment, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_spec) and (hlth_rs_equip)

Main statistical findings

Deaths from cardiovascular diseases

Almost 2 million deaths in the EU-28 from diseases of the circulatory system

Diseases of the circulatory system place a considerable burden on healthcare systems and government budgets. Indeed, in 2013 there were 1.9 million deaths resulting from diseases of the circulatory system in the EU-28, which was equivalent to 37.5 % of all deaths — considerably higher than the second most prevalent cause of death, cancer (malignant neoplasms; 26.0 %).

Diseases of the circulatory system are one of the main causes of mortality in each of the EU Member States (as shown in Table 1): they accounted for close to two thirds (65.5 %) of all deaths in Bulgaria, down to just one quarter of the total in Denmark (24.3 %) and France (25.0 %).

Across the EU-28, a higher proportion of women (40.5 %) died from diseases of the circulatory system than men (34.4 %). The largest gap between the sexes was recorded in two of the Baltic Member States, namely Lithuania and Estonia, where the proportions of women dying from diseases of the circulatory system were between 17 and 18 percentage points higher than those for men. The gender imbalance was also relatively large in Latvia, Romania, Slovenia and Croatia, and was observed in all except two of the EU Member States: in the United Kingdom the share among men of deaths attributed to diseases of the circulatory system was 1.9 percentage points higher than the share among women and in Denmark this difference was 0.7 percentage points.

Greece, Spain, Luxembourg, Portugal and Cyprus recorded the lowest gender difference in standardised death rates for diseases of the circulatory system

Standardised death rates are calculated as a weighted average of age-specific death rates and therefore improve comparability both over time and between countries. The EU-28’s standardised death rate for diseases of the circulatory system was 383 deaths per 100 000 inhabitants in 2013, with the rate for men some 1.4 times as high as that for women.

Standardised death rates for diseases of the circulatory system were systematically higher for men than for women in 2013 across all of the EU Member States, although the differences between the sexes were relatively low compared with most other causes of death. Across the Member States, the lowest absolute differences between men and women for standardised death rates for diseases of the circulatory system were recorded in Greece, Spain, Luxembourg, Portugal and Cyprus.

Deaths in younger ages can be considered as premature. Indeed, Table 1 shows that deaths from diseases of the circulatory system become more prevalent at advanced ages. While this was true for the vast majority of all causes of death, the standardised death rate for diseases of the circulatory system among those aged 65 and over in the EU-28 was 38 times as high as the standardised death rate for persons aged less than 65; this can be compared with the same ratio for all causes of death, where the standardised death rate for those aged 65 and over was 20 times as high as for persons aged less than 65. Note that the risk of women dying from diseases of the circulatory system was relatively low before the age of 65 and that the vast majority of deaths among women from these diseases occurred after the age of 65.

Standardised death rates for men were consistently higher than those for women for all forms of diseases of the circulatory system

A more detailed analysis of causes of death for diseases of the circulatory system is presented in Table 2. EU-28 standardised death rates for men in 2013 were overall higher than those for women for each of the six causes of death presented. Gender differences were most pronounced for ischaemic heart diseases (codes I20–I25) — where the standardised death rate for men in the EU-28 was 1.8 times as high as the corresponding rate for women; the difference between the sexes was less marked for other heart diseases (codes I30–I51), cerebrovascular diseases (codes I60–I69) and other diseases of the circulatory system (the remainder of codes I00–I99, not elsewhere covered).

Some of the highest standardised death rates for ischaemic heart diseases were recorded in the Baltic Member States: Lithuania recorded the highest rate in 2013 for both men and women, followed — in different orders for men and women — by the Czech Republic, Estonia, Croatia, Latvia, Hungary, Romania and Slovakia. By contrast, the lowest standardised death rates were recorded in France, followed — again in different orders for men and women — by Denmark, Spain, Portugal and the Benelux Member States.

Standardised death rates for cerebrovascular diseases in Bulgaria were almost seven times as high as in France

In 2013, the highest standardised death rates for cerebrovascular diseases were recorded in Bulgaria, Romania, Latvia, Lithuania, Croatia, Hungary and Slovakia, as well as in Greece for women. By contrast, the lowest rates were recorded in France, Spain, Luxembourg, Austria and Belgium, with low rates for women also in Denmark and for men in the Netherlands, the United Kingdom and Cyprus; very low death rates were also recorded in Switzerland. As for all diseases of the circulatory system, there were large variations in standardised death rates for cerebrovascular diseases across the EU Member States, with death rates for both men and women in Bulgaria (where the highest rates were recorded) almost seven times as high as those in France (where the lowest rates were registered).

Self-reporting of hypertensive diseases

The persistent effect of high blood pressure in the arteries may lead to chronic failure of vital organs such as the heart, kidneys or brain. The data presented in Figure 1 are derived from the second wave of the European health interview survey (EHIS) which was conducted between 2013 and 2015 and which covered the population aged 15 years and over. The survey included questions on self-assessment of an individual’s health and data on hypertension which are available for all EU Member States, Norway and Turkey. The next wave of the survey will be conducted in 2019 and it will be run at regular five-year intervals afterwards.

A higher proportion of women reported that they had hypertensive diseases

The highest shares of self-reported hypertensive diseases among the population aged 15 and over were recorded in Hungary (31.9 %), Bulgaria (29.6 %), Latvia (29.4 %) Germany (28.5 %) and Lithuania (28.1 %). By contrast, the lowest shares were recorded in France (14.4 %), Sweden (16.2 %), the United Kingdom (16.4 %) and the Benelux countries (all below 17.0 %); Norway (12.7 %) and Turkey (16.1 %) also reported low shares.

An analysis by sex reveals that in most EU Member States a higher proportion of women (than men) reported that they had high blood pressure. The gender difference was often considerable, especially in the Baltic Member States, Romania, Portugal, Bulgaria and Slovakia, and also in Turkey.

There is a substantial age-gradient in the prevalence of hypertensive diseases, as the share of the population reporting high blood pressure increased dramatically between the age groups 35–44 and 65–74 years. In the EU-28, only 3.3 % of the population aged between 25 and 34 reported hypertensive diseases, while it was more than half of the population aged 75 years and over (52.2 %); this share ranged from 36.3 % in Belgium to 72.6 % in Bulgaria.

Cardiovascular healthcare

There has been a reduction in the number of deaths associated with diseases of the circulatory system across many EU Member States. These changes have occurred, at least in part, through the introduction of increased screening and new surgical procedures, the introduction of new forms of medication (for example, statins), as well as lifestyle changes for patients (for example, a reduction in the number of smokers).

The number of in-patients with diseases of the circulatory system discharged from hospitals across the EU was 11.4 million in 2014

Hospital discharges of in-patients treated for diseases of the circulatory system show a very large variation across the EU Member States. While absolute figures for discharges are clearly linked to the number of inhabitants in each country, the level of discharges may, among others, reflect the incidence of each disease and differences in healthcare systems, for example, screening, the balance between day care and in-patient treatment, or the availability of surgeons or hospital beds. In 2014, there were 11.4 million in-patients with diseases of the circulatory system discharged from hospitals across the EU (2013 data for Belgium, 2012 data for the Netherlands; no data for Greece).

Bulgaria recorded the highest ratio per inhabitant of hospital discharges for in-patients with diseases of the circulatory system

Bulgaria, Lithuania, Germany, Austria, Hungary, Latvia and Slovakia each reported more than 3 thousand in-patient discharges per 100 000 inhabitants among those treated for diseases of the circulatory system in 2014. Among these, Bulgaria and Lithuania recorded, by far, the highest ratios, close to 4.4 thousand in-patient discharges per 100 000 inhabitants (see Figure 2). Cyprus recorded the lowest ratio, some 889 in-patient discharges per 100 000 inhabitants, while Portugal, Ireland, the United Kingdom and Spain were the only other Member States with less than 1.5 thousand discharges per 100 000 inhabitants.

Across the EU in 2014 (2013 data for Belgium, 2012 data for the Netherlands; no data for Greece), in-patients with diseases of the circulatory system (ICD codes I00–I99) spent a total of 95.8 million days in hospital. By far the highest share was accounted for by German in-patients (30.1 % of the total), while Italy was the only other EU Member State recording a double-digit share (11.3 %).

In-patients with diseases of the circulatory system could expect to spend, on average, 12.3 days in hospital in Hungary

When patients are treated for a disease of the circulatory system they tend to spend a relatively lengthy period of time in hospital, reflecting the gravity of some of these conditions. Table 3 presents an analysis of the average length of hospital stays for in-patients treated for a disease of the circulatory system in 2009 or 2014. The first two columns show that the average length of stay ranged from 4.3 days in Bulgaria up to 12.3 days in Hungary. Finland, the Czech Republic, Malta and Austria also recorded relatively lengthy average stays in hospital for in-patients treated for diseases of the circulatory system (more than 10 days).

Among the EU Member States for which data are available (no data for Greece), the average length of a hospital stay for those treated for a disease of the circulatory system generally fell between 2009 and 2014; the largest reduction — 4.3 fewer days in hospital — was recorded in Finland, while the reductions between 1.0 and 1.5 days were reported for Ireland, the Czech Republic and Croatia. By contrast, the average time spent in hospital rose by 0.6 days in Hungary and 1.1 days in Malta; Portugal, Luxembourg, Italy and France were the only other Member States to record an increase in the average time spent in hospital by those treated for diseases of the circulatory system.

The remainder of Table 3 provides a more detailed analysis of the average length of hospital stays for in-patients treated for four different types of circulatory disease. On average, in-patients with cerebrovascular diseases (codes I60–I69) spent the highest number of days in hospital, followed by those treated for atherosclerosis (code I70).

Transluminal coronary angioplasty was the most common form of intervention for patients treated for cardiovascular diseases

Table 4 provides an overview of the rates (number per 100 000 inhabitants) of surgical operations and procedures conducted in hospitals for those treated for cardiovascular diseases. By far the most common was transluminal coronary angioplasty, a non-surgical procedure used to treat coronary arteries that have been narrowed, by feeding a deflated balloon through blood vessels until it reaches the site of the blockage before inflating the balloon to open up the artery (allowing blood to flow normally).

Across the 23 EU Member States for which data are available (the same as those for which rates are shown for 2014 in Table 4), there were over one million transluminal coronary angioplasty procedures conducted. Around 31 % of these (313 thousand procedures) took place in Germany, which was considerably higher than in any of the other EU Member States; France and Italy were the only other EU Member States to report in excess of 100 thousand procedures. Not only did Germany report the largest number of such operations, but also the most when taking account of the size of population: 386 transluminal coronary angioplasty procedures were performed in Germany per 100 000 inhabitants, considerably more than in Austria (277 per 100 000 inhabitants) which had the next highest ratio. This procedure was relatively uncommon in Portugal where it was conducted 117 times per 100 000 inhabitants and in Romania where the ratio was 95 per 100 000 inhabitants.

Just under 54 thousand heart bypasses were conducted in Germany in 2014

The next most common operation for patients treated for cardiovascular diseases was a bypass anastomosis for heart revascularisation — commonly referred to as heart bypass — a surgical procedure whereby arteries to the heart are replaced by blood vessels from another part of the body. There were just under 186 thousand heart bypass operations in 2014 (2013 data for Belgium) in the 23 EU Member States for which data are available. Germany again recorded the highest number of operations, at just under 54 thousand, and this was the second highest frequency when taking account of the population size (66.6 per 100 000 inhabitants), behind Denmark with 72.8 operations per 100 000 inhabitants. This procedure was least common in Spain, where it was performed on average 18 times per 100 000 inhabitants.

A carotid endarterectomy is an operation which aims to remove plaque from the inner lining of the carotid artery which extends from the aorta (the main artery leaving the heart) to the base of the skull, supplying blood to the brain. When taking account of the size of the population, this procedure was most common — among the 20 EU Member States for which recent data are available — in Austria, Germany and Belgium (2013 data), while it was least common in Luxembourg.

A femoropopliteal bypass is surgery conducted to bypass a diseased blood vessel around the knee. Luxembourg, Malta, Belgium (2013 data) and Lithuania reported the highest frequencies for this procedure, in all cases more than 25 such procedures per 100 000 inhabitants.

An abdominal aortic aneurysm is a weakened area in the wall of the aorta, which can result in a ballooning of the artery. The most common location for this complaint is in the abdominal region, especially the segment of the abdominal aorta below the kidneys (an infrarenal aneurysm). Relative to population size, this procedure was most frequently performed in Luxembourg, Denmark, Austria, France and the Czech Republic (2012 data), all with rates above 10.0 per 100 000 inhabitants.

Healthcare personnel and equipment

Greece, Italy and Cyprus had the highest number of specialist cardiologists per 100 000 inhabitants

In 2014, there were just under 52 thousand cardiology physicians in the 25 EU Member States for which data are available. The highest overall number of cardiologists was recorded in Italy (13.5 thousand), followed by France (6.9 thousand) and Germany (6.8 thousand). Cardiologists represented more than 7.0 % of all specialist practitioners in Cyprus, Italy and Greece in 2014, while they also accounted for over 5.0 % of all specialist practitioners in Poland, France, Bulgaria, Lithuania, Belgium and Luxembourg.

Generally, there were between 5 and 17 cardiologists per 100 000 inhabitants across those EU Member States for which data are available, with Greece (34 cardiologists per 100 000 inhabitants), Italy (22) and Cyprus (20) well above this range, and Ireland, Slovenia and Austria each recording ratios below this range.

Between 2009 and 2014 the ratio of cardiologists per 100 000 inhabitants rose in each of the EU Member States for which data are available (see Table 5), with the exceptions of Italy (where the ratio fell by 1 cardiologist per 100 000 inhabitants) and Belgium, Spain, France, Austria and the United Kingdom (where the ratio remained unchanged), However, Italy was the only country that reported a fall in the absolute number of cardiologists over the period under consideration.

Greece and Italy also recorded the highest ratio of haematology physicians per 100 000 inhabitants

Haematology covers the diagnosis and treatment of patients who have disorders of the blood. In 2014, across the 25 EU Member States for which data are available (see Table 5), the number of specialist haematology physicians ranged from less than 1 per 100 000 inhabitants in Luxembourg, to 5 or more in Bulgaria, the Czech Republic (2013 data), Spain, Greece and Italy; the latter two recorded the highest ratio, at 6 haematology physicians per 100 000 inhabitants.

Finland and Luxembourg had the highest angiography equipment rates

An angiography is similar to an x-ray picture and shows the internal condition of blood vessels or arteries; it is generally used to determine if patients have any abnormalities such as narrowing, blockages or bleeding. Among those EU Member States for which data are available for 2014 (2013 data for Belgium, Greece, Italy and Hungary; no data for Denmark, Ireland, the Netherlands, Austria, Sweden or the United Kingdom; note that data for Belgium, Germany, France and Portugal refers only to equipment in hospitals), the availability of angiography equipment in hospitals and providers of ambulatory (out-patient) health care ranged from a low of 0.3 pieces of equipment per 100 000 inhabitants in Romania and 0.4 pieces of equipment per 100 000 inhabitants in Hungary to highs of 1.4 and 2.0 pieces of equipment per 100 000 inhabitants in Luxembourg and Finland.

Data sources and availability

Key concepts

An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care. An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.

The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised (rather than crude) death rate can be compiled which is independent of the age and sex structure of a population: this is done as most causes of death vary significantly by age and according to sex and the standardisation facilitates comparisons of rates over time and between countries.

Healthcare resources and activities

Statistics on healthcare resources (such as personnel and medical equipment) and healthcare activities (such as information on surgical operations and procedures and hospital discharges) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

For surgical operations and procedures the International Classification of Diseases — clinical modification (ICD-9-CM) is used:

  • Operations on the cardiovascular system (35–39);
  • Transluminal coronary angioplasty (36.01, 36.02 and 36.05);
  • Bypass anastomosis for heart revascularisation (36.1);
  • Carotid endarterectomy (38.12);
  • Femoropopliteal bypass (39.29);
  • Infrarenal aortic aneurysm repair (39.71–39.74).

For country specific notes on this data collection, please refer to this background information document.

For hospital discharges and the length of stay in hospitals, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used to classify data from 2000 onwards; Chapter IX covers diseases of the circulatory system:

  • Hypertensive diseases (0901);
  • Angina pectoris (0902);
  • Acute myocardial infarction (0903);
  • Other ischaemic heart disease (0904);
  • Pulmonary heart disease and diseases of pulmonary circulation (0905);
  • Conduction disorders and cardiac arrhythmias (0906);
  • Heart failure (0907);
  • Cerebrovascular diseases (0908);
  • Atherosclerosis (0909);
  • Varicose veins of lower extremities (0910);
  • Other diseases of the circulatory system (0911).

For country specific notes on this data collection, please refer to this background information document.

Health status

Self-reported statistics covering the health status of the population for a range of chronic diseases is provided by the European health interview survey (EHIS) which was conducted between 2006 and 2010. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions. The data presented in this article refer to the share of the population aged 15 and over reporting that they had been diagnosed by a medical doctor with high blood pressure (hypertension) which occurred in the 12 months prior to the survey.

Causes of death

Statistics on causes of death provide information on mortality patterns, supplying information on developments over time in the underlying causes of death. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Causes of death are classified according to the European shortlist (86 causes), which is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). Chapter IX of the ICD covers diseases of the circulatory system:

  • I00–I02 Acute rheumatic fever;
  • I05–I09 Chronic rheumatic heart diseases;
  • I10–I15 Hypertensive diseases;
  • I20–I25 Ischaemic heart diseases;
  • I26–I28 Pulmonary heart disease and diseases of pulmonary circulation;
  • I30–I52 Other forms of heart disease;
  • I60–I69 Cerebrovascular diseases;
  • I70–I79 Diseases of arteries, arterioles and capillaries;
  • I80–I89 Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified;
  • I95–I99 Other and unspecified disorders of the circulatory.

For country specific notes on this data collection, please refer to this background information document.

Context

Statistics concerning cardiovascular diseases are of particular significance insofar as these diseases are the principal cause of death within the EU. Increased prevention, especially for heart disease and strokes, has resulted in the number of people who face disability, reduced quality of life and premature death being reduced across most of Europe. Nevertheless, cardiovascular diseases continue to touch the lives of millions of Europeans each day.

The European Commission convened a conference in June 2005 to discuss the implementation of a set of Council conclusions on heart health, adopting the Luxembourg declaration. This established an agreement to pursue or strengthen cardiovascular disease prevention plans and to ensure that effective measures, policies, and interventions were put in place across all European countries, giving priority to lifestyle oriented interventions to reduce the burden of these diseases, including:

  • avoidance of tobacco consumption (zero tolerance);
  • adequate physical activity (at least 30 minutes per day);
  • healthy food choices;
  • avoidance of being overweight;
  • maintenance of blood pressure below 140/90 mmHg (millimetres of mercury);
  • maintenance of blood cholesterol below 5 mmol/l (millimoles per litre).

As part of this work, the European Commission and the World Health Organisation (WHO) requested the assistance of the European society of cardiology and the European heart network to set-up the European heart health charter, which was launched in June 2007. It states that cardiovascular disease is estimated to cost the EU economy EUR 169 billion per year (or an average of EUR 372 per inhabitant). The charter aims to substantially reduce the burden of cardiovascular disease in the EU and the WHO European region and to reduce inequities in disease burden within and between countries, by informing Europeans about the risk factors and costs associated with cardiovascular diseases.

See also

Online publications

Causes of death

Methodology

General health statistics articles

Further Eurostat information

Publications

Main tables

Database

Health status (hlth_state)
Self-reported chronic morbidity (hlth_srcm)
People reporting a chronic disease, by disease, sex, age and educational attainment level (%) (hlth_ehis_st1)
Health care resources (hlth_res)
Health care staff (hlth_staff)
Health care facilities (hlth_facil)
Health care activities (hlth_act)
Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)
Hospital discharges - National data (hlth_hosd)
Length of stay in hospital (hlth_hostay)
Operations, procedures and treatment (hlth_oper)
General mortality (hlth_cd_gmor)
Causes of death - Deaths by country of residence and occurrence (hlth_cd_aro)
Causes of death — Standardised death rate by residence (hlth_cd_asdr2)

Dedicated section

Methodology / Metadata

Source data for tables and figures (MS Excel)

External links