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Vol. 66. Issue 7.
Pages 591-593 (July 2013)
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Vol. 66. Issue 7.
Pages 591-593 (July 2013)
Scientific letter
DOI: 10.1016/j.rec.2013.01.012
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Disease Burden Attributable to Major Risk Factors in Western European Countries: The Challenge of Controlling Cardiovascular Risk Factors
La carga de enfermedad atribuible a los principales factores de riesgo en los países de Europa occidental: el reto de controlar los factores de riesgo cardiovascular
Ferrán Catalá-Lópeza,b,??
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Corresponding author:
, Ricard Gènova-Malerasc
a División de Farmacoepidemiología y Farmacovigilancia, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
b Centro Superior de Investigación en Salud Pública (CSISP), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
c Servicio de Informes de Salud y Estudios, Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
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To the Editor,

The description and detailed evaluation of the magnitude and distribution of diseases and risk factors, acknowledging their specific characteristics, are important for establishing strategies that make it possible to improve the health of the general population. Although in recent decades enormous advances have been made in the analysis of the effects of risks on our health, mortality assessments have historically been the indicators used to evaluate the health of populations, and even to define their degree of social and human development.

During the 20th century, there was a considerable decrease in mortality in every country of the world, and especially in the most highly developed nations. Consequently, the measurements of mortality have decreased sensitivity to detect changes in the health of populations, and the need to use alternative indicators is becoming increasing evident. The burden of disease, the major indicator of which is the number of disability-adjusted life-years, measures the health losses in the population that represent both the fatal and nonfatal consequences of diseases and the risk factors associated with them. The advantage of using disability-adjusted life-years with respect to other measurements is that it offers the possibility of condensing the entire set of epidemiological data on each disease or risk factor (mortality, prevalence, disability, severity) into a single indicator. It can be used to measure and compare the health of different populations or social groups, study the changes in the health of a population or the magnitude of a health problem over the course of time, enable the utilization of these findings as a tool in the definition of health priorities, or even to evaluate the impact of certain health interventions.1,2

Specifically, the Global Burden of Disease study was the first to establish a systematic evaluation of the changes in population health resulting from the modification of a group of risk factors. More recently, new epidemiological estimates of the health losses attributable to 67 risk factors have been published for several regions, in what constitutes the largest collaborative effort of its kind to date.3 Despite the uncertainties inherent in quantifying disease burden, the new estimates show that the loss of health in Western European countries is strongly affected by cardiovascular risk factors (smoking, hypertension, overweight and obesity, and alcohol consumption, among others) that continue to be widespread and have a great impact on health.

Using the information provided in the databases of the Institute for Health Metrics and Evaluation4 ( and applying meta-analysis techniques that weight the measurements using inverse variance, we quantified the health losses (on average) attributable to the major risk factors in Western European countries. The cross-sectional comparison of the population impact in 1990 and 2010 (Figure) shows that, while the prevalence of risk factors like hypertension, smoking, alcohol consumption, and hypercholesterolemia appears to have decreased in absolute terms, they continue to be the major contributors to the burden of mortality and disability in the European region. However, it seems that these potential improvements have been eclipsed by the increases in the disease burden attributable to overweight, obesity, and physical inactivity.


Disease burden attributable to the 10 major risk factors in Western European countries, 1990 and 2010. 95%CI, 95% confidence interval; DALY, disability-adjusted life-years.

Source of information: Institute for Health Metrics and Evaluation, 2012.4


After decades of efforts to call attention to the disease burden attributable to cardiovascular risk factors,5,6 these findings represent an important step toward their complete and critical description. This epidemiological evidence should be expected to direct the debates on the new challenges for maintaining and promoting cardiovascular health in the coming years, as well as specific actions that enable the application of multidisciplinary approaches to the prevention and management of the risk factors and their associated comorbidities. Given the complexity of this issue and the fact that the interactions among the determinants of health vary from one context to another, progress in the attempts to control cardiovascular risk factors will require sustained efforts on a regional, national, and international scale.


The authors received research grants from the Spanish Health Research Fund (Fondo de Investigación Sanitaria), Instituto de Salud Carlos III (project no. PS09/086).

Conflicts Of Interest

The opinions expressed in this letter are the responsibility of the authors and, thus, do not necessarily reflect the point of view of the organizations in which they work. The authors declare that they have no conflicts of interest.

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Copyright © 2013. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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