Rome wasn’t built in a day. Neither is improvement for global cardiac health. Europe’s cardiovascular disease (CVD) and stroke mortality rates have improved, but not unilaterally, according to a report published Aug. 19 in the European Heart Journal.

The report, written by a team from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention at the University of Oxford, explored five-to-10 year trends across Europe in countries where data could be obtained. They found that while rates have dramatically improved in some countries, in others, the CVD burden has increased.

First author Melanie Nichols, PhD, and colleagues compiled data from a number of sources including those provided by the World Health Organization, updating previous work from 2013.

According to their findings, CVD is responsible for over 4 million deaths per year in Europe, and is the leading cause of death. Coronary heart disease is, on its own, responsible for one-fifth of deaths in Europe each year. Nichols et al found that three out of 10 deaths of people under the age of 65 in Europe were attributable to CVD.

Taken as a whole, these numbers seem grim. However, the research team noted, that this is in fact a reduction from prior mortality numbers and that the burden for CVD over the last decade has not been the same in all countries.

Denmark and Norway, for example, had among the lowest rates of age-adjusted mortality for CVD, while the highest rates of CVD mortality were largely seen in many eastern European countries, including the Russian Federation, Belarus, Uzbekistan and Kyrgyzstan. Denmark, France, Portugal, the Netherlands and Spain were among the countries with the lowest rates of coronary heart disease in Europe.

Deaths before age 75 from CVD ranged by magnitudes between countries such as San Marino, France, Israel and Switzerland, which saw fewer than 65 deaths per 100,000 persons, to countries like the Russian Federation and Belarus, which had 560 deaths per 100,000 persons.

The country with the lowest CVD mortality rates among 75-79 year olds for both sexes was France. When compared to this group, Nichols et al found that there were five countries where there were higher death rates among 55-59 year olds; five countries with mortality rates higher among 60-64 year olds; and 10 countries where mortality rates were equal to the French rates – except for being 10 years younger.

Acute MI and both hemorrhagic and ischemic stroke fatality rates have dropped in most counties with available data over five years of data, with a few exceptions. Latvia saw an increase in acute MI by 2.8 percent and in hemorrhagic stroke by 4.8 percent. Hungary had a 0.4 percent increase in hemorrhagic stroke fatalities. Luxembourg and Belgium both increased in ischemic stroke fatalities, by 0.6 percent and 0.2 percent respectively.

Nichols et al noted that while the World Health Assembly made noncommunicable diseases a worldwide target for reducing mortality, little commitment has been seen at national or regional levels toward monitoring and reporting cardiovascular risks and outcomes.

They wrote that while some countries have made great strides, there was much further to go in others. More data, particularly more recent data, was needed in order to see whether these rates will continue to decline, and decline more successfully in all countries.