Introduction

The Growing Burden of Heart Disease and Stroke in Canada 2003 is the sixth edition of our biennial publication on the status of cardiovascular diseases in Canada.  It serves as a natural sequel to the previous edition, The Changing Face of Heart Disease and Stroke in Canada 2000, which focused on the unfavourable profile of determinants of cardiovascular disease with an aging population and the adoption of unhealthy lifestyles by young Canadians, immigrants and native peoples.  In this edition, we highlight the ongoing high cost that these diseases impose on our society, both in financial terms and in quality of life.  With a predicted increase in the numbers of cases of cardiovascular diseases over the next 20 years, the resulting burden is expected to continue to increase.

In large part, the growing burden will result from the “greying of Canada”.  Between 1991 and 2001, the population aged 80 years and over rose 41% to 932,000 and is expected to increase an additional 43% between 2001 and 2011.  By then, it will have surpassed an estimated 1.3 million.  The population between 45 and 64 years of age increased 36% between 1991 and 2001, witnessing the entry of the baby boomers into this group.  According to the 2001 Census, seniors aged 65 and over constituted 13% of the Canadian population in 2001, up from nearly 12% in 1991.  This proportion is projected to reach 15% by 2011 and just over 20% by 2025.

Deferred adverse outcomes will add to the growing burden.  Cardiovascular diseases are rarely cured; medical and surgical treatments for the most part provide temporary relief.  As the underlying disease progresses, events occur and the ensuing burden accumulates.

The growing burden of cardiovascular diseases remains a consequence of lifestyle choices that include smoking, overeating and physical inactivity.  In particular, individuals who are socio-economically disadvantaged show higher prevalence rates of the major risk factors.  Reaching these and other high-risk populations remains an unmet challenge, even as data show some narrowing of the risk factor gap between the high and low socio-economic strata.

In spite of some gains, much remains to be done in terms of prevention.  Eighty percent of the Canadian population has at least 1 modifiable risk factor for cardiovascular disease; nearly one-third has 2 risk factors; and another 11% have 3 or more. The prevalence of some risk factors, such as overweight among men, diabetes and high blood pressure, is increasing.  Witness the epidemic rise in obesity among adolescents, accompanied by the decline in physical activity.  Even the decreased levels of activity among seniors should not be accepted as a normal consequence of aging.  Billions of dollars are spent treating cardiovascular diseases.  The proportion and amount of the cardiovascular health care dollar that is allocated to prevention needs to be increased.  Realigning the focus on prevention presents an enormous challenge.  Those involved in providing care, as well as those who need care, may feel threatened by the need to go after limited resources in order to meet this challenge.  Their needs must be secure even as the preventive agenda is addressed.

Focusing on cardiovascular diseases in isolation misses an opportunity to recognize the consequences of cardiac related lifestyle factors on other major non-communicable diseases. The following table (Table I-1) indicates the contribution of modifiable risk factors for cardiovascular disease to 3 other leading non-communicable diseases, including diabetes, cancer and chronic obstructive pulmonary disease. Pooling resources and coordinating strategies locally, provincially, nationally and globally can provide a common preventive pathway for relieving the burden of a variety of non-communicable diseases.  In addition, reliable and timely data can provide the basis for appropriate policy interventions in order to further aid both primary and secondary prevention.

Table I - 1

Table I-1         The 8 Major Modifiable Risk Factors for Cardiovascular Diseases and Other Leading Non-communicable Diseases
Condition Risk factor	Cardiovascular Diseases*	Diabetes	Cancer	Chronic-obstructive Pulmonary Disease
Smoking	ü	ü	ü	ü
Alcohol	ü		ü
Physical Inactivity	ü	ü	ü
Nutrition	ü	ü	ü
Obesity	ü	ü	ü	ü
Raised Blood pressure	ü	ü
Dietary fat/Blood lipids	ü	ü	ü
Blood glucose	ü	ü	ü
* This includes heart disease, stroke and hypertension. Source: World Health Organization

While we emphasize prevention in this document, we also acknowledge the importance of medical and surgical treatment for cardiovascular diseases.  The investment in research into new pharmacological agents and innovative surgical approaches is paying off with improved survivorship and a better quality of life for those with disease.  Understanding the role played by specific genes can help us plan targeted interventions, bringing a new hope that we can treat and prevent cardiovascular diseases more effectively.  Likewise, the testing of new strategies to motivate lifestyle changes, such as smoking cessation or the adoption of increased physical activity, should lead to more widespread primary and secondary prevention.  Hope for the future does not dismiss the failures of yesterday, however, and their consequences today.  Both in-hospital and out-of-hospital medical and surgical treatments, rehabilitation and home care are expensive and, as a result, will cause the economic burden of disease to increase.

Once again, The Growing Burden of Heart Disease and Stroke in Canada 2003 is the collaborative effort of the Heart and Stroke Foundation of Canada, the Centre for Chronic Disease Prevention and Control (Health Canada), and the Canadian Cardiovascular Society.  We gratefully acknowledge the key partnership role played by Statistics Canada and the Canadian Institute for Health Information in the provision of the data and data analysis for this publication.  Please note that the “Implications for Action” sections appearing at the end of each of the chapters in this publication do not represent the opinion of Statistics Canada or of the Canadian Institute for Health Information.  We also welcome the participation of the Institute for Clinical Evaluative Sciences.  All the information contained in this publication, including all tables and graphs, are accessible in English and in French on the internet at  www.heartandstroke.ca/growingburden

We welcome feedback on this, our latest report on the status of cardiovascular diseases in Canada.  We have attempted to respond to the suggestions offered in the survey request after the previous edition.  As in the past, this publication aims to not only present the best data available but also suggest key policy implications.  As Canadians put their health care system under intense review amidst the throes of determining its very future, the demand for health-related information increases.  Indeed, this process serves to underscore the importance of surveillance.  The public, health professionals and policy-makers all see the need for timely, accurate and relevant data.  By exploring the data contained in this edition we show the gaps in our knowledge and raise new questions.  Forecasting and tracking changes as well as monitoring progress are integral parts of achieving heart health for all.  We challenge ourselves and major stakeholders to invest in a coordinated surveillance system that will address the information needs related not only to cardiovascular diseases, but to all non-communicable diseases as well.

Andreas Wielgosz, Scientific Editor