Can more CVD prevention increase life expectancy in Germany? Analysis with European data 2000-2019

Abstract Background Life expectancy (LE) in Europe is increasing since long - while mortality from cardiovascular diseases (CVD) declines, attributed to advances in therapy and prevention. Whether this is still applies the last 20 years is unclear. Recently, Germany’s low LE compared to other Western European countries (2019: 81.3 yrs; Spain: 84, Italy 83.6) was seen as result of high CVD mortality due to insufficient prevention. This led to the establishment of the German Federal Institute for Prevention and Education in Medicine, aimed at reducing CVD and -in the long term - narrowing the gap in LE. We explore whether data on CVD mortality and morbidity support this idea. Methods With data from OECD, WHO and IHME (GBD 2021), we calculated the mean annual change in LE and in age-standardised mortality (ASM) for CVD for 2000-2019 for European countries by sex. We estimated the linear association (adj R²) between the mean annual change in LE and ASM for CVD for West- and East-Europe, and -country-specific- between incidence and ASM from CVD. Results For 2000-2019, mean annual change in LE was lower in West- than in East-Europe: 0.25 yrs vs. 0.30 in men and 0.17 vs 0.22 in women; for ASM in CVD, it was about half as large: -6.6/100.000 vs. -11.1 for men and -4.1 vs. -8.0 for women. Similarly, the adj R² for the association between mean annual change in LE and in ASM for CVD was lower in West- compared to East-Europe: 0.43 vs. 0.24 in men and 0.21 vs. no association (adj R² -0.01) in women. Courses of CVD incidence were heterogeneous (linearly or wave-shaped in- or decreasing, stable or u-shaped). In Germany, it decreased wave-shaped, with an adj R² for linear association with ASM for CVD of 0.79 in women and 0.63 in men. The association between LE and ASM for CVD is low in West-European countries. Even if amplified prevention lowers CVD mortality, a positive effect on LE is questionable. Differences in LE are stable since long. Non-morbidity related factors might decisively effect LE. Key messages • Life expectancy in Europe-and it’s mean annual change since 2000 is not associated with age-standardised CVD mortality in women, and only moderate in men in West-Europe, in contrast to East-Europe. • Course of CVD incidence is country-specific and very heterogeneous and reveals no overall association with CVD mortality rates.