4
strokes occur as a result of atherosclerosis (narrowing of the arteries) and thrombo-
sis (blood clotting). The narrowing of the arteries in atherosclerosis is an inflamma-
tory process characterised by the accumulation of low-density lipoprotein cholesterol
(LDL-C) in the artery wall and the formation of atherosclerotic plaques. Angina
(pain in the chest) can occur when an atherosclerotic plaque become large enough
to compromise blood flow in a coronary artery. However, many heart attacks occur
without warning when a plaque ruptures, its thrombotic content is exposed to blood,
and a large clot is formed [ 2 ]. In fact, autopsy data suggest that around 90% of heart
attacks occur when a blood clot is superimposed on an already narrow artery. While
gender, age and genetics play roles in CVD, it is now well established that environ-
mental factors such as smoking and lack of physical activity are the major determi-
nants of disease risk in most individuals in developed nations. In this chapter we
describe the human and economic burdens of CVD in the EU and we outline the
major risk factors for this group of diseases. The evidence on the role of physical
activity in the primary prevention of CVD will be reviewed with a view to making
a case that exercise is medicine.
2 The Burden of Cardiovascular Disease
2.1 Human Costs
Cardiovascular disease is responsible for four million deaths across Europe.
Coronary heart disease is the single most common cause of death, accounting for
approximately 20% of all deaths, while stroke and other CVD are responsible for
11% and 14% of all deaths, respectively [ 1 ]. The human costs of caring for individu-
als with cardiovascular disease has also been calculated. It is estimated that over half
a million people in the UK alone provide over 500 million hours of informal care for
family and friends with CVD [ 3 ]. In addition to being a major cause of death, CVD
significantly reduces quality of life for many individuals in the UK. Disability
Adjusted Life Years is a measure of the years of life lost due to premature death and
the years of healthy life lost through disability. It is estimated that more than 80 mil-
lion fully healthy life years are lost to CVD every year in the European Region [ 4 ].
The human costs of physical inactivity are described in Sect. 3.2.
2.2 Economic Costs
Cardiovascular disease is estimated to cost the EU economy almost €196 billion a
year. Some 54% of the total cost is due to direct health care costs, 24% to productiv-
ity losses, and 22% to the informal care of people with CVD. The cost to the health
care systems of over €106 billion represents a cost per capita of €212 per annum [ 5 ].
The economic costs of physical inactivity are described in Sect. 3.2.
M. Hamer et al.