The societal challenge of the ageing population

Although the incidence of cardiovascular disease (CVD) has decreased in recent decades, CVD remains a major healthcare challenge. In Europe alone, CVD causes 3.9 million deaths annually (45% of all deaths), and due to the demographic shift toward a more elderly it will continue to increase its prevalence.1 2 In 2015, almost 49 million Europeans were living with CVD, corresponding to slightly less than 10% of the population. This fact translates into annual losses of 26 million disability-adjusted life years (QALYs) and annual costs to society of approximately €210 billion, half of which is in healthcare costs.1

Remarkably, 80% of cardiac events and strokes are preventable and 25%–75% of these are through early detection and intervention.1 3 Therefore, strategies to prevent ischaemic events offer some of the greatest potential for improving public health. The uniform natural history and prevention of manifest atherosclerosis provides the possibility for much larger benefits than seen in cancer screening programmes due to the initiation of uniform cardiovascular preventive actions, when localised lesions are detected—also protects unidentified remote lesions.4–9 Thus, the development of new proposals for screening approaches is rapidly evolving, and influential bodies such as the US Preventive Services Task Force (USPSTF) and the UK National Screening Committee (UK NSC) have evaluated a number of proposals for cardiovascular screening and, as a result, currently recommend screening for a variety of individual conditions.

Prevention of cardiovascular atherosclerotic disease