Last year (the data is provisional, the INE will publish the final ones at the end of the year) 433,163 people died. Of them, 115,013 were due to cancer (26.6%) and 114,865 were due to diseases of the circulatory system (26.5%).
Although the difference is minimal, it symbolizes the different evolution of these two large groups of pathologies in the last decade: While cancer deaths have remained stable, cardiovascular deaths have been significantly reduced.
In 2015, the cardiovascular mortality rate stood at 267.6 per 100,000 inhabitants. In 2023 it was 237.5, falling no less than 11.2% since then and 5.3% in the last year.
The decrease occurs in the four most important cardiovascular pathologies. Ischemic and heart diseases decreased by 6.4%, cerebrovascular diseases decreased by 6.1%, heart failure decreased by 7.2% and hypertensive disease decreased by 2.7%.
“There was a clear trend in the last nine or ten years of decrease in both absolute numbers and incidence rates,” he explains. Manuel Anguitaspokesperson for the Spanish Society of Cardiology.
“Between 2020 and 2022, there was an increase in deaths due to delays in diagnosis and treatment caused by the Covid-19 pandemic, we have documented this, but since then we have continued with the previous trend.”
The spike in deaths during the pandemic may have influenced that drastic drop in 2023 —those who they had to died last year before – but Anguita believes that in the coming years deaths from cardiovascular disease will continue to be lower than those from cancer.
“This is what was being seen before the pandemic, it was interrupted by it, and we hope it will continue to decline further.”
Cardiovascular diseases have been gaining in importance since the epidemiological transition that occurred in our country starting in the 1950s. Someone born at the beginning of the 20th century is likely to have died from an infectious disease.
Sociodemographic changes and the advancement of medicine (it is no coincidence that vaccines such as poliomyelitis appeared in the middle of the last century) modified the panorama and in recent decades the Leviathan has been diseases of the circulatory system, although this has begun to diminish. change in recent years.
“It’s not that there is less cardiovascular disease, on the contrary,” he explains. Irene Mendezcardiologist at the Gregorio Marañón University Hospital (Madrid).
“These pathologies are more prevalent with age and the population is aging, so deaths from them should increase, but there have been enough advances in recent decades that explain this decrease,” he continues, but not before warning that there is no than to underestimate them: one in every four deaths in Spain continues to be due to this cause.
Heart attack code and stroke code
Méndez emphasizes that one of the great causes of the reduction in cardiovascular mortality has been the management of acute patients, mainly those with myocardial infarction and stroke.
The implementation of the ‘heart attack code’ throughout the country has been fundamental. It is a system to transfer the patient in the shortest possible time to the nearest hospital to perform an urgent catheterization and open the artery.
The ‘stroke code’ acts in a similar way: the urgent transfer of a patient to a referral hospital to treat them with a powerful medication that breaks up the clot or perform revascularization.
In both cases, “the time until the intervention is essential for the prognosis,” explains Méndez. “Right now, at both the cardiology and neurology levels we are very organized to provide early care to these acute patients with a serious condition, where the time of action is very important to avoid sequelae.”
The head of the Cardiology service at the Puerta de Hierro University Hospital (Madrid), Javier Segovia, affects the success of these strategies. The heart attack code began to be implemented in the early 2000s but “the last communities have been incorporated four or five years ago.”
The stroke code is more recent and it is likely that we will only now begin to see the results of this strategy. “In addition, the ‘aorta code’ and the ‘PE code’ for pulmonary thromboembolism are being developed.”
Something similar, but with a different type of intervention, is the organization of care shock cardiogenic, “a situation of acute failure in the function of the heart, which has a mortality rate of almost 100% in hours or days and which requires the urgent implantation of ventricular assist devices that replace the function of the heart.”
The arrival of devices such as ECMO (extracorporeal membrane oxygenation system) has been essential, which maintains respiratory and cardiovascular functions in critical situations.
It’s not just about organization. Surgery has given way to less invasive interventions that are faster and easier to perform. “In the past we could say that there was only the famous bypassbut today we have drugs and catheters that solve circulatory problems with remarkable effectiveness.”
If a work day only allows time for one or two surgical interventions, it nevertheless allows for performing up to eight minimally invasive coronary interventions. “In addition, they began to be performed only in those centers trained for cardiac surgery and now they can be performed in centers of medium complexity,” highlights Segovia.
Cholesterol and diabetes
These have not been the only advances in recent years. Cardiologist Irene Méndez points out the importance of secondary prevention. When someone has already experienced a cardiovascular event, they have a high risk of suffering another one in the following two years.
“Drugs have appeared that manage to control dyslipidemia (cholesterol) and diabetes,” he points out. “More and more patients are attending cardiac rehabilitation, a specific program to control cardiovascular risk factors and make lifestyle changes in patients.”
The arrival of new antidiabetics such as GLP-1 analogues—yes, the drugs that have been a revolution in weight loss—promise to continue improving the cardiovascular health of the population.
There are some margins for improvement. Javier Segovia highlights the prevention of sudden death. “Almost 80% of sudden deaths have cardiovascular events as the main cause.”
The problem here is that this no longer involves only health professionals but the entire society. “If action is not taken within minutes it is irreversible. and health education is needed in volunteers, schools or in certain professions such as firefighters or police so that they can perform resuscitation and keep the patient alive before the emergency services arrive.”
Segovia recalls that in Spain there are “about 30,000 sudden deaths a year, of which less than 10% can be reversed without leaving serious neurological consequences. This percentage can clearly be improved.”
Manuel Anguita, spokesperson for the Spanish Society of Cardiology, recalls that just a couple of years ago the Cardiovascular Health Strategy of the National Health System was launched, just as it already existed for cancer or neurodegenerative diseases.
“There was already a plan for ischemic heart disease, which is the most prevalent heart disease, but it has been expanded and improved to include all the most prevalent cardiovascular pathologies and focus on prevention.”
Well, if there are some factors that are inevitable for heart disease, there are others that are not at all. You may be familiar with: smoking, sedentary lifestyle and obesity.