European Heart Journal (2014) 35, 2929–2933 doi:10.1093/eurheartj/ehu378
Cardiovascular disease in Europe 2014: epidemiological update The epidemiological statistics of 2012 have been updated by members of The Nuffield Department of Population Health, University of Oxford, UK Melanie Nichols 1,2, Nick Townsend 1*, Peter Scarborough 1, and Mike Rayner 1 1 British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK; and 2Population Health Strategic Research Centre, Faculty of Health, Deakin University, Geelong, Australia
cause a large number of premature deaths in Europe, with 1.48 million deaths before the age of 75 caused by CVD, equating to 37% of premature deaths. These data also highlight that the burden of CVD mortality continues to show large geographic inequalities throughout Europe. Although mortality rates increase with age in all countries, there are many countries throughout Europe in which the mortality rate for younger age groups is higher than that found for older ages in other countries. For example, we find that there were three countries (Belarus, the Russian Federation, and Ukraine) where men aged 50 –54 years old had a higher risk of dying from CHD than 75 –79-year-old men in France. This is also the case for men aged 55 –59 years in Kazakhstan and Kyrgyzstan. These statistics show a worrying and persistent inequity across Europe in CHD and CVD mortality and pan-European efforts to improve the identification, treatment, and prevention of CVD must be developed if we are to counter these differences and to reduce the burden of CVD across the continent. Indeed, findings from the EuroHeart II project suggest that up to one-third of CHD mortality could be avoided by effectively reducing smoking prevalence and intake of salt and saturated fat, and that these risk factors should become policy priorities within Europe as a whole. Additionally, the data presented here highlight the need for good-quality comprehensive data to be collected and made available across Europe so that such interventions can be better targeted and between-country comparisons can be made with confidence.
References References are available as Supplementary material at European Heart Journal online.
* Corresponding author. Email: [email protected] Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on March 4, 2015
In September last year the European Heart Journal (EHJ) published Cardiovascular disease in Europe: epidemiological update,1 an overview on the current burden of cardiovascular disease (CVD) within Europe. This paper was based on the European Cardiovascular Disease Statistics 2012 2 report, the fourth in a series of Europe-wide compendia that aimed to bring together the most up-to-date statistics available on a range of issues related to CVD. The report and paper, along with a further study of trends in Coronary Heart Disease3 (CHD), also published in the EHJ, resulted from The EuroHeart II project, which was led by the European Heart Network (EHN) and the European Society of Cardiology. EuroHeart II ran from March 2011 until February 2014 and received co-funding from the European Union in the Framework of the Health Programme. Despite the project having ended, researchers from the British Heart Foundation Centre on Population Approaches for NonCommunicable Disease Prevention (BHF CPNP), University of Oxford, UK and the Population Health Strategic Research Centre, Deakin University, Australia, who produced the original report and paper have updated the statistics to provide a current overview of the burden of CVD within Europe. Gaining access to up-to-date statistics on the burden, distribution, causes and effects of CVD, and its subtypes and risk factors in Europe is key in assisting health professionals, policy makers, medical researchers, and others to understand and act on the many complex issues in the prevention and management of CVD. This update to key data in relation to mortality and morbidity from CVD across Europe shows that CVD remains the leading cause of death in Europe, and despite recent decreases in mortality rates in many countries, it is still responsible for over 4 million deaths per year. This is close to half of all deaths in Europe, with the proportion of total deaths attributable to CVD in Europe greater for women (51%) than men (42%). Cardiovascular disease also continues to
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Heart disease and stroke decline in Europe Deaths from heart disease and stroke are declining overall in Europe, but at differing rates, according to research published in the European Heart Journal. 1 Just under a million men died before the age of 75 and half a million before the age of 65. Half a million women died before the age of 75 and just over 200 000 before the age of 65. Three in every ten deaths of Europeans aged under 65 were caused by CVD, as were 37% of all deaths occurring before the age of 75. Dr Townsend said: ‘The proportion of women who die from cardiovascular disease is much greater than men: 51% of women died compared to 42% of men. This difference is driven mainly by a higher rate of stroke and other cardiovascular diseases among women. There was very little difference in the rates of coronary heart disease between men and women: 20% versus 21% respectively’. Overall, the researchers say that CVD death rates are declining in most, but not all European countries. Trends have also been downwards for what are known as ‘case fatality rates’—the percentage of people who are diagnosed with a condition and die from the illness within a given period. In the 25 countries for which there were data, there was an average annual reduction in people dying after being admitted to hospital with a heart attack of 5% in the past 5 years. On the other hand, the rates of people hospitalized for CVD have increased, probably reflecting the impact of increasing numbers of elderly people in the population. In their paper, the authors conclude: ‘Worldwide, there have been few moments in history during which non-communicable diseases (NCDs) have enjoyed such a prominent place in the world’s attention, with cardiovascular disease at the forefront of the activity. Despite this, there has been little commitment at the national or regional level to greater monitoring and reporting of risk factors and outcomes for cardiovascular disease. It is clear that, in many countries of Europe, CVD mortality has continued to decrease substantially in recent years, and will make a large contribution to achieving this goal. In these (predominantly high-income) countries, a ‘tipping point’ is rapidly approaching, when cancer deaths will outnumber cardiovascular disease deaths, particularly among men’. ‘In many other countries, however, the CVD burden dwarfs that of cancer, and a large proportion of the populations will lose their lives prematurely to heart disease and stroke’. ESC Press office Andros Tofield
References References are available as Supplementary material at European Heart Journal online.
Downloaded from by guest on March 4, 2015
The research, which provides an update for 2014 on the burden of cardiovascular disease (CVD) in Europe, shows that mortality from CVD in different countries varies enormously. For some eastern European countries, including Russia and Ukraine, the death rate from coronary heart disease for 55–60-year-olds is greater than the equivalent rate in France for people 20 years older. The age-adjusted CVD death rates for men and women of all ages were six-fold higher in Russia than in France. In 2010 in Russia 915 men and 517 women died per 100 000 of the population, whereas the equivalent rates in France were 150 and 87 per 100 000, respectively. In the UK, the CVD death rates for 2010 were 205 and 129 per 100 000 men and women, respectively. Overall, CVD remains the single, greatest cause of death among Europeans than any other disease, and, in many countries, causes twice as many deaths as cancer. However, the researchers, led by Dr Melanie Nichols, a research associate from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention at the University of Oxford (UK) and senior research fellow at Deakin University, Australia, found that there were some countries where cancer was now causing more deaths than heart disease in men (Belgium, Denmark, France, Israel, Luxembourg, The Netherlands, Portugal, Slovenia, Spain, and San Marino). For the first time, cancer has also overtaken CVD as the main cause of death among women in a European country: Denmark. Co-author, Dr Nick Townsend, senior researcher at the BHF Centre on Population Approaches for Non-Communicable Disease Prevention, said: ‘The reason why cancer has overtaken cardiovascular disease as the main cause of death in these countries is due to the fact that fewer people develop cardiovascular disease and, in those who do, fewer die from it. This is probably due to improvements in the behavioural risk factors associated with CVD, however, increases in some risk factors, such as rising levels of obesity, suggest that these decreasing trends may be in danger of reversing’. Dr Nichols and her colleagues in the Oxford research group looked at trends in deaths from CVD over a period of 10 years to the most recent year available (2010–12 for most countries) for 52 out of 53 European countries (there were no data for Andorra). They looked at the total number of deaths for all ages, and also at those that could be classified as ‘premature’: those before the age of 65 and those before the age of 75. Data from the latest available year showed that there were just over 4 million deaths (1.9 million men and 2.2 million women) from CVD, close to half of all deaths in Europe. This was made up of 1.8 million deaths from coronary heart disease, 1 million from cerebrovascular disease (stroke) and 1.2 million from other CVDs.
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Estimating an individual person’s course of coronary artery calcification A CAC Calculator App to estimate future coronary artery calcium scores is discussed by the developers from the University Hospital Essen, Germany progression or, whether progression of coronary artery calcification is faster than the expected natural course. Furthermore, it could, in many cases, support the conclusion that a second scan is not necessary It must be noted that the tool is based on data from a Caucasian, urban population in Germany. Other populations may follow other percentiles and therefore the App should be used with adequate caution. The App is available in versions for Microsoft Windows and Android. Conflict of interest: none declared.
Downloaded from by guest on March 4, 2015
The coronary artery calcium (CAC) Calculator App uses the biological hypothesis that individual CAC progression follows crosssectional percentiles with increasing age. These percentiles were determined from the baseline CAC measurements in the German Heinz Nixdorf Recall Study. In this study, participants were randomly selected from a general urban population. They underwent sequential non-contrast-enhanced electron beam computed tomography (CT) of the heart at baseline and after 5 years follow-up, in order to evaluate the progression of CAC.1 It was proposed and tested positive that individual subjects’ CAC scores closely follow the gender-specific baseline percentiles, which present as exponentially increasing curves with age. This allows for the estimation of future CAC scores. The tool first determines the age- and gender-specific percentile of the CAC score for an individual, using a two-stage process which employs as few approximations as possible. This process yields the baseline percentile and the corresponding intercept and slope for CAC on the logarithmic scale as a function of age. Then linear extrapolation along the individual percentile to a later age results in an individual prediction of CAC. Therefore, based on the initial CAC score, the age, the gender, and the computed corresponding percentile, the App estimates the CAC score for future time-points. Alternatively, from the estimated percentile, it can be predicted at which age a critical CAC value (e.g. 400) will be reached. The App not only provides estimation of future CAC scores but also displays graphics, clearly depicting the patient’s individual percentile as well as the future time course. The Windows App is available for demonstration as supplementary material. This CAC Calculator App may help clinicians interpret their patients CAC scores and determine those that in the future will reach CAC thresholds associated with unfavourable risk, such as a CAC score of 400. It may therefore help with patient communication, when the physician and the patient can together evaluate the patient’s individual course of CAC progression, which in turn may improve patient’s adherence to risk factor modifications, for example, via lifestyle changes. It may also be used to plan the time schedule for a second CAC measurement, which can disclose whether patient adherence to risk factor modification and medication have slowed down CAC
References References and CAC app are available as Supplementary material at European Heart Journal online.
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CardioPulse
The CardioScape Project An European Union-funded research project reveals where the money for cardiovascular research in Europe comes from and what it is spent on
Prof. David A. Wood, MD, CardioScape Scientific Coordinator
Prof. Frans Van de Werf, MD, CardioScape Steering Committee Chair
Cardiovascular disease—a grouping of diseases that affects the structure and/or function of the heart and blood vessels, including heart disease and stroke—is the number one killer in Europe, claiming over 4 million lives in Europe and 1.9 million lives per year in the European Union (EU). Cardiovascular disease is also estimated to cost the EU economy almost E196 billion a year (European Society of Cardiology, European Heart Network. European Cardiovascular Disease Statistics, 2012 Edition. http://www.escardio.org/about/Documents/ EU-cardiovascular-disease-statistics-2012.pdf). The rising life expectancy coupled with adverse trends in major cardiovascular risk factors could lead to a doubling in the absolute incidence of CVD by 2050. (EU Report: Cardiovascular Diseases in the European Union, 2009.) The availability of adequate and effective funding is thus crucial to tackling the CVD burden by discovering innovative medical solutions. Yet, the CardioScape project revealed that funding for this area of research is not the highest. ‘Only’ E1 billion was awarded for CVD research in the EU between 2010 and 2012. Striking disparities also exist at the national level in terms of both public and private research financing. In the UK, where research funds for CVD are highest, E300 million were spent over the period 2010– 12. In the same years, Finnish funders only allocated E800 000 to cardiovascular research. Of course, wealthiest countries score highest in terms of funding. Regrettably, this means that the level of CVD research funding is inversely proportional to CVD mortality rates: Eastern and Central European countries, where CVD causes up to 50% of deaths, have little if any funding available for cardiovascular research. For instance, in Bulgaria, Croatia, Estonia and Lithuania no funding ≥E100 000 per project was made available by funding bodies over the period 2010– 2012.
CardioScape interestingly revealed that though EU research funding represents a mere 5% of total investment by EU Member States in European R&D in all disciplines, the money spent by the EU for cardiovascular research—E320 million—is far from being negligible and positions the European Commission as the top funding organization in Europe followed by the British Heart Foundation (E120 million) and the UK Wellcome Trust (E104 million). In addition to sourcing information on research that has been previously undertaken in this area, the project partners mapped available funding sources including grants, trusts, venture capital, and angel funds, across all EU28 countries; the aim being to establish the extent of duplication across national research programmes, identify funding gaps that reduce opportunities for innovation, highlight areas where coordination can be improved, and define future funding priorities and strategies for CVD research in Europe. This information, together with access to the CardioScape database populated with over 2400 projects from the EU28 countries, was made available to the public at the CardioScape conference in Brussels, on 17 September 2014. On this occasion, the European Society of Cardiology, project coordinator, together with PNO, project partner, presented the project findings along with recommendations for furthering the European research activity in this field. The event was attended by medical professionals, academics, and other stakeholders including medical research organizations with an interest in cardiology as well as EU and national policymakers. Acknowledging CardioScape’s conclusion, Prof. David Wood, the project’s Scientific Coordinator, together with Prof. Frans Van de Werf, Chair of the CardioScape Scientific Committee, said: ‘The results of the project will enable to comprehensively understand current cardiovascular research landscape in Europe. It will help
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Cardiovascular disease (CVD) is the number one killer in Europe, claiming 5 000 lives per day. The availability of adequate and effective funding is crucial to tackle the CVD burden by discovering innovative medical solutions. During 23 months the FP7-funded project ‘CardioScape’ carried out a survey of the CVD research landscape in Europe, including research carried out in 2010– 12 with funding ≥ E100 000 per project. It revealed that striking disparities exist in terms of both public and private research spending. On 17 September 2014, the project’s findings, along with recommendations for furthering European research activity in this field, were presented in Brussels at a selected audience comprising academia, funders, as well as EU and national policymakers.
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encourage future collaboration between researchers, avoid duplication and assist funders to make informed decisions about where to invest their funds. Funding bodies and researchers are now encouraged to continue adding to the CardioScape database to inform others of their cardiovascular research and to look for partners. Ultimately, this will ensure that every Euro is efficiently invested to serve science and patients, and also to significantly contribute to a healthier and more productive European society’.
The outcomes of the CardioScape project and its database are available at www.cardioscape.eu. Frans Van de Werf, MD, PhD, FESC University of Leuven, Belgium, [email protected] David A. Wood, MD, PhD, FESC—Imperial College London, UK, [email protected]
In memoriam Magda Heras Fortuny, MD, PhD, editor-in-chief, Revista Espan˜ola de Cardiologı´a
Antoni Bayes-Genis, Pablo Avanzas, Leopoldo Pe´rez de Isla, Juan Sanchis Associate Editors, Revista Espan˜ola de Cardiologı´a [email protected]
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
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Magda Heras departed from us on 3 August 2014, way too early, way too sudden. She fought with strength during two long years against a dreadful cancer that finally took her away. During this period she always kept faith in medicine, she always kept up her innate optimism, and she always kept faith in a future with family, friends, and colleagues. During 24 – 26 April, Magda attended the XVI International Symposium on Ischemic Heart Disease in Seville even though she had a severe relapse that required new chemotherapy. She was not there to receive compassion; she attended the meeting to chair a round table of clinical cases with some of her innumerable friends and professional colleagues who were invited to the discussion: Bernard Gersh, Marco Valgimigli, Robert Klautz, and Dominick Angiolillo. More recently in June, the Editorial Board of Revista Espan˜ola de Cardiologı´a had a scheduled regular meeting with Magda in Madrid. She was weak and conscious that the disease was progressing, yet she was happy to be in active discussion with Revista’s family, including Iria, Eva, Marı´a, and her associate editors (us). We were part of Magda’s family, that is the way she treated us, close, warm, charming, sympathetic . . . yet she was very much on top of everything, a true
perfectionist and actively thinking about new projects for the forthcoming years. Magda was a small woman with a huge heart. Magda Heras was born in June 1953, graduated from Medical School in 1978 and received her PhD in Medicine in 1986. Then, she spent the 2 years 1987– 89 as a research fellow at the Atherosclerosis and Thrombosis Laboratory of the Mayo Clinic. Ever since her return to Barcelona, she worked as a staff member in the Cardiology Department of the Hospital and then as a senior consultant in cardiology from 2005. In addition, she was an associate professor in cardiology at the University of Barcelona (UB) since 2006 and soon thereafter became a fellow of the ESC, AHA and ACC. Magda participated in several task forces of the ESC, and was an active member of the Working Groups on Acute Cardiac Care, Thrombosis and Vascular Biology, and Cardiovascular Pharmacology and drug therapy of the ESC. She received numerous research grants and research awards, published 200 peer-reviewed articles in international journals, 27 book chapters and directed 7 PhD doctoral theses. She had the ability to incorporate in her hectic daily life a touch of sincerity and honesty in everything she did. Dr Bernard Gersh, Mayo Clinic, USA adds: “She was a great personal friend and a wonderful person.” We will miss her. She was our boss, our friend, our colleague, our family. We will mourn her loss. May she rest in peace.
Cardiovascular disease in Europe 2014: epidemiological update The epidemiological statistics of 2012 have been updated by members of The Nuffield Department of Population Health, University of Oxford, UK Melanie Nichols 1,2, Nick Townsend 1*, Peter Scarborough 1, and Mike Rayner 1 1 British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK; and 2Population Health Strategic Research Centre, Faculty of Health, Deakin University, Geelong, Australia
cause a large number of premature deaths in Europe, with 1.48 million deaths before the age of 75 caused by CVD, equating to 37% of premature deaths. These data also highlight that the burden of CVD mortality continues to show large geographic inequalities throughout Europe. Although mortality rates increase with age in all countries, there are many countries throughout Europe in which the mortality rate for younger age groups is higher than that found for older ages in other countries. For example, we find that there were three countries (Belarus, the Russian Federation, and Ukraine) where men aged 50 –54 years old had a higher risk of dying from CHD than 75 –79-year-old men in France. This is also the case for men aged 55 –59 years in Kazakhstan and Kyrgyzstan. These statistics show a worrying and persistent inequity across Europe in CHD and CVD mortality and pan-European efforts to improve the identification, treatment, and prevention of CVD must be developed if we are to counter these differences and to reduce the burden of CVD across the continent. Indeed, findings from the EuroHeart II project suggest that up to one-third of CHD mortality could be avoided by effectively reducing smoking prevalence and intake of salt and saturated fat, and that these risk factors should become policy priorities within Europe as a whole. Additionally, the data presented here highlight the need for good-quality comprehensive data to be collected and made available across Europe so that such interventions can be better targeted and between-country comparisons can be made with confidence.
References References are available as Supplementary material at European Heart Journal online.
* Corresponding author. Email: [email protected] Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on March 4, 2015
In September last year the European Heart Journal (EHJ) published Cardiovascular disease in Europe: epidemiological update,1 an overview on the current burden of cardiovascular disease (CVD) within Europe. This paper was based on the European Cardiovascular Disease Statistics 2012 2 report, the fourth in a series of Europe-wide compendia that aimed to bring together the most up-to-date statistics available on a range of issues related to CVD. The report and paper, along with a further study of trends in Coronary Heart Disease3 (CHD), also published in the EHJ, resulted from The EuroHeart II project, which was led by the European Heart Network (EHN) and the European Society of Cardiology. EuroHeart II ran from March 2011 until February 2014 and received co-funding from the European Union in the Framework of the Health Programme. Despite the project having ended, researchers from the British Heart Foundation Centre on Population Approaches for NonCommunicable Disease Prevention (BHF CPNP), University of Oxford, UK and the Population Health Strategic Research Centre, Deakin University, Australia, who produced the original report and paper have updated the statistics to provide a current overview of the burden of CVD within Europe. Gaining access to up-to-date statistics on the burden, distribution, causes and effects of CVD, and its subtypes and risk factors in Europe is key in assisting health professionals, policy makers, medical researchers, and others to understand and act on the many complex issues in the prevention and management of CVD. This update to key data in relation to mortality and morbidity from CVD across Europe shows that CVD remains the leading cause of death in Europe, and despite recent decreases in mortality rates in many countries, it is still responsible for over 4 million deaths per year. This is close to half of all deaths in Europe, with the proportion of total deaths attributable to CVD in Europe greater for women (51%) than men (42%). Cardiovascular disease also continues to
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Heart disease and stroke decline in Europe Deaths from heart disease and stroke are declining overall in Europe, but at differing rates, according to research published in the European Heart Journal. 1 Just under a million men died before the age of 75 and half a million before the age of 65. Half a million women died before the age of 75 and just over 200 000 before the age of 65. Three in every ten deaths of Europeans aged under 65 were caused by CVD, as were 37% of all deaths occurring before the age of 75. Dr Townsend said: ‘The proportion of women who die from cardiovascular disease is much greater than men: 51% of women died compared to 42% of men. This difference is driven mainly by a higher rate of stroke and other cardiovascular diseases among women. There was very little difference in the rates of coronary heart disease between men and women: 20% versus 21% respectively’. Overall, the researchers say that CVD death rates are declining in most, but not all European countries. Trends have also been downwards for what are known as ‘case fatality rates’—the percentage of people who are diagnosed with a condition and die from the illness within a given period. In the 25 countries for which there were data, there was an average annual reduction in people dying after being admitted to hospital with a heart attack of 5% in the past 5 years. On the other hand, the rates of people hospitalized for CVD have increased, probably reflecting the impact of increasing numbers of elderly people in the population. In their paper, the authors conclude: ‘Worldwide, there have been few moments in history during which non-communicable diseases (NCDs) have enjoyed such a prominent place in the world’s attention, with cardiovascular disease at the forefront of the activity. Despite this, there has been little commitment at the national or regional level to greater monitoring and reporting of risk factors and outcomes for cardiovascular disease. It is clear that, in many countries of Europe, CVD mortality has continued to decrease substantially in recent years, and will make a large contribution to achieving this goal. In these (predominantly high-income) countries, a ‘tipping point’ is rapidly approaching, when cancer deaths will outnumber cardiovascular disease deaths, particularly among men’. ‘In many other countries, however, the CVD burden dwarfs that of cancer, and a large proportion of the populations will lose their lives prematurely to heart disease and stroke’. ESC Press office Andros Tofield
References References are available as Supplementary material at European Heart Journal online.
Downloaded from by guest on March 4, 2015
The research, which provides an update for 2014 on the burden of cardiovascular disease (CVD) in Europe, shows that mortality from CVD in different countries varies enormously. For some eastern European countries, including Russia and Ukraine, the death rate from coronary heart disease for 55–60-year-olds is greater than the equivalent rate in France for people 20 years older. The age-adjusted CVD death rates for men and women of all ages were six-fold higher in Russia than in France. In 2010 in Russia 915 men and 517 women died per 100 000 of the population, whereas the equivalent rates in France were 150 and 87 per 100 000, respectively. In the UK, the CVD death rates for 2010 were 205 and 129 per 100 000 men and women, respectively. Overall, CVD remains the single, greatest cause of death among Europeans than any other disease, and, in many countries, causes twice as many deaths as cancer. However, the researchers, led by Dr Melanie Nichols, a research associate from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention at the University of Oxford (UK) and senior research fellow at Deakin University, Australia, found that there were some countries where cancer was now causing more deaths than heart disease in men (Belgium, Denmark, France, Israel, Luxembourg, The Netherlands, Portugal, Slovenia, Spain, and San Marino). For the first time, cancer has also overtaken CVD as the main cause of death among women in a European country: Denmark. Co-author, Dr Nick Townsend, senior researcher at the BHF Centre on Population Approaches for Non-Communicable Disease Prevention, said: ‘The reason why cancer has overtaken cardiovascular disease as the main cause of death in these countries is due to the fact that fewer people develop cardiovascular disease and, in those who do, fewer die from it. This is probably due to improvements in the behavioural risk factors associated with CVD, however, increases in some risk factors, such as rising levels of obesity, suggest that these decreasing trends may be in danger of reversing’. Dr Nichols and her colleagues in the Oxford research group looked at trends in deaths from CVD over a period of 10 years to the most recent year available (2010–12 for most countries) for 52 out of 53 European countries (there were no data for Andorra). They looked at the total number of deaths for all ages, and also at those that could be classified as ‘premature’: those before the age of 65 and those before the age of 75. Data from the latest available year showed that there were just over 4 million deaths (1.9 million men and 2.2 million women) from CVD, close to half of all deaths in Europe. This was made up of 1.8 million deaths from coronary heart disease, 1 million from cerebrovascular disease (stroke) and 1.2 million from other CVDs.
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Estimating an individual person’s course of coronary artery calcification A CAC Calculator App to estimate future coronary artery calcium scores is discussed by the developers from the University Hospital Essen, Germany progression or, whether progression of coronary artery calcification is faster than the expected natural course. Furthermore, it could, in many cases, support the conclusion that a second scan is not necessary It must be noted that the tool is based on data from a Caucasian, urban population in Germany. Other populations may follow other percentiles and therefore the App should be used with adequate caution. The App is available in versions for Microsoft Windows and Android. Conflict of interest: none declared.
Downloaded from by guest on March 4, 2015
The coronary artery calcium (CAC) Calculator App uses the biological hypothesis that individual CAC progression follows crosssectional percentiles with increasing age. These percentiles were determined from the baseline CAC measurements in the German Heinz Nixdorf Recall Study. In this study, participants were randomly selected from a general urban population. They underwent sequential non-contrast-enhanced electron beam computed tomography (CT) of the heart at baseline and after 5 years follow-up, in order to evaluate the progression of CAC.1 It was proposed and tested positive that individual subjects’ CAC scores closely follow the gender-specific baseline percentiles, which present as exponentially increasing curves with age. This allows for the estimation of future CAC scores. The tool first determines the age- and gender-specific percentile of the CAC score for an individual, using a two-stage process which employs as few approximations as possible. This process yields the baseline percentile and the corresponding intercept and slope for CAC on the logarithmic scale as a function of age. Then linear extrapolation along the individual percentile to a later age results in an individual prediction of CAC. Therefore, based on the initial CAC score, the age, the gender, and the computed corresponding percentile, the App estimates the CAC score for future time-points. Alternatively, from the estimated percentile, it can be predicted at which age a critical CAC value (e.g. 400) will be reached. The App not only provides estimation of future CAC scores but also displays graphics, clearly depicting the patient’s individual percentile as well as the future time course. The Windows App is available for demonstration as supplementary material. This CAC Calculator App may help clinicians interpret their patients CAC scores and determine those that in the future will reach CAC thresholds associated with unfavourable risk, such as a CAC score of 400. It may therefore help with patient communication, when the physician and the patient can together evaluate the patient’s individual course of CAC progression, which in turn may improve patient’s adherence to risk factor modifications, for example, via lifestyle changes. It may also be used to plan the time schedule for a second CAC measurement, which can disclose whether patient adherence to risk factor modification and medication have slowed down CAC
References References and CAC app are available as Supplementary material at European Heart Journal online.
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CardioPulse
The CardioScape Project An European Union-funded research project reveals where the money for cardiovascular research in Europe comes from and what it is spent on
Prof. David A. Wood, MD, CardioScape Scientific Coordinator
Prof. Frans Van de Werf, MD, CardioScape Steering Committee Chair
Cardiovascular disease—a grouping of diseases that affects the structure and/or function of the heart and blood vessels, including heart disease and stroke—is the number one killer in Europe, claiming over 4 million lives in Europe and 1.9 million lives per year in the European Union (EU). Cardiovascular disease is also estimated to cost the EU economy almost E196 billion a year (European Society of Cardiology, European Heart Network. European Cardiovascular Disease Statistics, 2012 Edition. http://www.escardio.org/about/Documents/ EU-cardiovascular-disease-statistics-2012.pdf). The rising life expectancy coupled with adverse trends in major cardiovascular risk factors could lead to a doubling in the absolute incidence of CVD by 2050. (EU Report: Cardiovascular Diseases in the European Union, 2009.) The availability of adequate and effective funding is thus crucial to tackling the CVD burden by discovering innovative medical solutions. Yet, the CardioScape project revealed that funding for this area of research is not the highest. ‘Only’ E1 billion was awarded for CVD research in the EU between 2010 and 2012. Striking disparities also exist at the national level in terms of both public and private research financing. In the UK, where research funds for CVD are highest, E300 million were spent over the period 2010– 12. In the same years, Finnish funders only allocated E800 000 to cardiovascular research. Of course, wealthiest countries score highest in terms of funding. Regrettably, this means that the level of CVD research funding is inversely proportional to CVD mortality rates: Eastern and Central European countries, where CVD causes up to 50% of deaths, have little if any funding available for cardiovascular research. For instance, in Bulgaria, Croatia, Estonia and Lithuania no funding ≥E100 000 per project was made available by funding bodies over the period 2010– 2012.
CardioScape interestingly revealed that though EU research funding represents a mere 5% of total investment by EU Member States in European R&D in all disciplines, the money spent by the EU for cardiovascular research—E320 million—is far from being negligible and positions the European Commission as the top funding organization in Europe followed by the British Heart Foundation (E120 million) and the UK Wellcome Trust (E104 million). In addition to sourcing information on research that has been previously undertaken in this area, the project partners mapped available funding sources including grants, trusts, venture capital, and angel funds, across all EU28 countries; the aim being to establish the extent of duplication across national research programmes, identify funding gaps that reduce opportunities for innovation, highlight areas where coordination can be improved, and define future funding priorities and strategies for CVD research in Europe. This information, together with access to the CardioScape database populated with over 2400 projects from the EU28 countries, was made available to the public at the CardioScape conference in Brussels, on 17 September 2014. On this occasion, the European Society of Cardiology, project coordinator, together with PNO, project partner, presented the project findings along with recommendations for furthering the European research activity in this field. The event was attended by medical professionals, academics, and other stakeholders including medical research organizations with an interest in cardiology as well as EU and national policymakers. Acknowledging CardioScape’s conclusion, Prof. David Wood, the project’s Scientific Coordinator, together with Prof. Frans Van de Werf, Chair of the CardioScape Scientific Committee, said: ‘The results of the project will enable to comprehensively understand current cardiovascular research landscape in Europe. It will help
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Cardiovascular disease (CVD) is the number one killer in Europe, claiming 5 000 lives per day. The availability of adequate and effective funding is crucial to tackle the CVD burden by discovering innovative medical solutions. During 23 months the FP7-funded project ‘CardioScape’ carried out a survey of the CVD research landscape in Europe, including research carried out in 2010– 12 with funding ≥ E100 000 per project. It revealed that striking disparities exist in terms of both public and private research spending. On 17 September 2014, the project’s findings, along with recommendations for furthering European research activity in this field, were presented in Brussels at a selected audience comprising academia, funders, as well as EU and national policymakers.
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encourage future collaboration between researchers, avoid duplication and assist funders to make informed decisions about where to invest their funds. Funding bodies and researchers are now encouraged to continue adding to the CardioScape database to inform others of their cardiovascular research and to look for partners. Ultimately, this will ensure that every Euro is efficiently invested to serve science and patients, and also to significantly contribute to a healthier and more productive European society’.
The outcomes of the CardioScape project and its database are available at www.cardioscape.eu. Frans Van de Werf, MD, PhD, FESC University of Leuven, Belgium, [email protected] David A. Wood, MD, PhD, FESC—Imperial College London, UK, [email protected]
In memoriam Magda Heras Fortuny, MD, PhD, editor-in-chief, Revista Espan˜ola de Cardiologı´a
Antoni Bayes-Genis, Pablo Avanzas, Leopoldo Pe´rez de Isla, Juan Sanchis Associate Editors, Revista Espan˜ola de Cardiologı´a [email protected]
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
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Magda Heras departed from us on 3 August 2014, way too early, way too sudden. She fought with strength during two long years against a dreadful cancer that finally took her away. During this period she always kept faith in medicine, she always kept up her innate optimism, and she always kept faith in a future with family, friends, and colleagues. During 24 – 26 April, Magda attended the XVI International Symposium on Ischemic Heart Disease in Seville even though she had a severe relapse that required new chemotherapy. She was not there to receive compassion; she attended the meeting to chair a round table of clinical cases with some of her innumerable friends and professional colleagues who were invited to the discussion: Bernard Gersh, Marco Valgimigli, Robert Klautz, and Dominick Angiolillo. More recently in June, the Editorial Board of Revista Espan˜ola de Cardiologı´a had a scheduled regular meeting with Magda in Madrid. She was weak and conscious that the disease was progressing, yet she was happy to be in active discussion with Revista’s family, including Iria, Eva, Marı´a, and her associate editors (us). We were part of Magda’s family, that is the way she treated us, close, warm, charming, sympathetic . . . yet she was very much on top of everything, a true
perfectionist and actively thinking about new projects for the forthcoming years. Magda was a small woman with a huge heart. Magda Heras was born in June 1953, graduated from Medical School in 1978 and received her PhD in Medicine in 1986. Then, she spent the 2 years 1987– 89 as a research fellow at the Atherosclerosis and Thrombosis Laboratory of the Mayo Clinic. Ever since her return to Barcelona, she worked as a staff member in the Cardiology Department of the Hospital and then as a senior consultant in cardiology from 2005. In addition, she was an associate professor in cardiology at the University of Barcelona (UB) since 2006 and soon thereafter became a fellow of the ESC, AHA and ACC. Magda participated in several task forces of the ESC, and was an active member of the Working Groups on Acute Cardiac Care, Thrombosis and Vascular Biology, and Cardiovascular Pharmacology and drug therapy of the ESC. She received numerous research grants and research awards, published 200 peer-reviewed articles in international journals, 27 book chapters and directed 7 PhD doctoral theses. She had the ability to incorporate in her hectic daily life a touch of sincerity and honesty in everything she did. Dr Bernard Gersh, Mayo Clinic, USA adds: “She was a great personal friend and a wonderful person.” We will miss her. She was our boss, our friend, our colleague, our family. We will mourn her loss. May she rest in peace.
