Ischaemic Heart Disease is the leading cause of death in the EU

Ischaemic Heart Disease (IHD, also named coronary heart disease, CHD) is one of the main groups within the class of cardiovascular diseases (CVD), together with stroke. IHD is the most common single cause of death in the EU, accounting for 15-16% of deaths (latest available years). Both incidence and mortality from IHD are higher in Central and Eastern Europe than in most Western and Southern European countries. The rates for men are 2-3 times those for women.

IHD incidence and mortality are declining in most countries.

The scarce available comparable data on IHD incidence and attack rates suggest a decline in most countries. A decline in mortality from IHD is observed from 1980, in almost all European countries. Over the period 1994-2003, this decline ranged from 25% (Balkan Eastern) to 48% (Central Eastern Europe), for the age range 35-74. At least half of the decline can be attributed to improved prevention (aimed at the risk factors) and one third to improved treatment and care.

Many risk factors have been identified for IHD

The identified risk factors for IHD include both lifestyle and biological factors. Lifestyle risk factors include: smoking, an unhealthy diet (i.e. too much saturated fat and salt, excessive alcohol consumption, insufficient fruit and vegetable intake as well as not enough fish), and physical inactivity. Some environmental or background factors are also associated with a greater IHD risk, such as air polluting particles, psychosocial factors and low socio-economic status. The most important biological risk factors include: high blood pressure, high cholesterol, overweight, obesity, and diabetes. These factors are, however, also often connected to particular lifestyle choices.

IHD prognosis and survival rates are improving

The prognosis for IHD patients has improved over the past decades, due to better treatment possibilities. At the same time, this implies that increasing numbers of survivors are depending on continuous care and medication, and often experience impaired functional capacity or loss of full employment.

A combined primary prevention approach is the most effective

Primary prevention of IHD focuses on lifestyle issues, notably smoking, nutrition and physical activity. The most successful programmes are those that, in a consistent and continuous way, combine various different measures, such as education, campaigns aimed at individual citizens, the promotion of healthier environments (e.g. smoke-free public spaces, healthy schools), financial incentives (e.g. taxes), legislative measures (e.g. food labeling, restrictions on marketing to children of foods/drinks that are high in fats, salt and sugar and low in essential nutrients), and initiatives addressing groups such as the food industry.

Secondary prevention targets the general population or high-risk groups

For high cholesterol and hypertension (high blood pressure), secondary prevention implies the detection of cases, either in the general population or in high-risk groups. The latter refers to groups for which a number of other risk factors have already been identified. The entire spectrum of CVD risk factors should be taken into account when treating high cholesterol and hypertension.

Treatment of IHD is shifting to less invasive procedures

Improved treatment of IHD, especially of its acute manifestations such as heart attack, has improved survival rates and contributed to about one third of the declining IHD mortality. The volume of less invasive PCIs (percutaneous coronary interventions), one of the most common IHD interventions, has increased, at the cost of bypass operations. Recent improvements include the faster diagnosis and treatment of acute events outside the hospital, by, for example, emergency services.