If there is one thing in common among European countries that have managed to significantly reduce mortality from heart disease, it is the fact that they did not leave prevention solely to individuals. Investing in early disease detection, limiting risk factors, and public policies that encourage healthier lifestyles have proven to be just as important as medical advances. That's why the question is - what are all the systemic failures here and what should be worked on
Cardiovascular diseases are the leading cause of death in Serbia and take more lives than all malignant diseases and other chronic diseases combined. Although high blood pressure and arrhythmias are often discussed as the consequences of everyday stress, the situation is much more complex.
What do the statistics say? According to data from the Institute for Public Health "Milan Jovanović Batut", during 2024, 46.841 people died from diseases of the heart and blood vessels. This represents as much as 47,7 percent of all deaths in the country, which means that almost every other citizen who lost their life that year died from cardiovascular diseases. Out of 46.841 people, there were 25.556 women and 21.285 men. In women, diseases of the heart and blood vessels are the cause of more than half of all deaths (51,6 percent), while in men they account for 43,7 percent of the total mortality.
The largest number of deceased are elderly people (see box); the risk of heart disease, namely, increases with age. Today, Serbia has about 6,6 million inhabitants, and almost every fourth citizen is over 65 years old. As the population ages, the number of people with cardiovascular disease is expected to increase. This is confirmed by the report of the European Association of Cardiologists for 2024, according to which these diseases affect about 40 percent of people between the ages of 40 and 59, and as many as 75 percent of those over 60 years old.
WE AND OTHERSABOUT PREVENTION
As cardiologist Dr. Milan Kitanović explains for "Vreme", Western European countries have an even older population than Serbia, but their citizens live longer on average. Why? In those countries, much more is invested in prevention, so heart diseases are more often prevented or detected at an early stage.
The difference is visible here: the mortality rate in Serbia is 737 dead women and 873 dead men per 100.000 inhabitants, while in France - a country with a much older population - it is only 155 dead women and 237 dead men per 100.000 inhabitants. Similar results are recorded in Spain and Denmark.
Data from the European Association of Cardiologists show that early detection and treatment of high blood pressure, cholesterol control, smoking cessation and adoption of healthy lifestyle habits have contributed to the fact that mortality from these diseases in developed European countries has been reduced by more than 50 percent in the last thirty years. In middle-income countries, including Serbia, the decline was much smaller - around 12 percent. Numerous risk factors contribute to the development of heart disease - smoking, high blood pressure, high cholesterol, diabetes, obesity, physical inactivity and improper diet. The encouraging fact is that most of these factors can be influenced, and therefore prevention and lifestyle changes are considered the most effective way to reduce the number of premature deaths.
AT THE PRICE OF LIFE, YOURS AND OTHERS'
Among the risk factors, smoking stands out. Serbia is at the top of the list of countries with the highest percentage of smokers in Europe. According to data from the "Milan Jovanović Batut" Institute for Public Health, as many as 37,9 percent of adults in Serbia consume tobacco, and 34,1 percent do so daily.
Dr. Milan Kitanović warns that the fight against smoking in Serbia is reduced to form. "There are supposed to be smoking and non-smoking zones in restaurants and cafes, but they are not adequately separated, so we are all exposed to passive smoking, which is equally harmful," he says.
Speaking about electronic cigarettes, which are used by more and more citizens of Serbia, Dr. Kitanović points out that they may have a less harmful effect on the lungs, but that they have almost the same effect on coronary diseases as traditional cigarettes.
Data from "Batuta" also show that almost 60 percent of smokers do not think about quitting smoking at all, and Dr. Kitanović says that in practice he has met patients who survive a myocardial infarction or some other serious condition, but as soon as they feel a temporary improvement with therapy, they return to cigarettes.
INSULIN RESISTANCE, A SWORD OVER EVERYONE'S HEAD
In addition to smoking, high blood pressure and high cholesterol, one of the biggest risk factors is diabetes. In Serbia, about 450.000 people have this disease, and it is estimated that even a third of those affected do not know that they are sick. Dr. Kitanović points out that diabetes is one of the key associated diseases that can lead to serious cardiac complications and even death. However, he puts special emphasis on insulin resistance.
"With us, insulin resistance has become known mainly in the context of young women's struggle for offspring. In reality, it is a sword over the head of each of us. It is associated with fatty tissue that accumulates around the liver and internal organs, and can be recognized by an increased waist circumference," explains Dr. Kitanović. He adds that even people who actively play sports and take care of their health can have insulin resistance, regardless of gender.
Therefore, he believes that systematic screening for insulin resistance, especially in risk groups, should become part of regular health care, because this condition is a direct predisposition to the development of diabetes.
photo: tanjug / ministry of healthNON-NETWORKING OF INFORMATION SYSTEMS: If the cardiology findings of private doctors were visible in the state system, diagnosis would be drastically accelerated and the quality of treatment would increase.
THE PROBLEMS ARE SYSTEMIC
When it comes to the treatment of heart disease in Serbia, one often gets the impression that the biggest problem is the lack of doctors. However, data from the European Association of Cardiologists show that Serbia has around 109 cardiologists per million inhabitants, which is more than the European average of 95 cardiologists per million inhabitants.
Ireland has the fewest cardiologists in Europe – 25,8 per million inhabitants, while Greece is at the very top with 296,7. Serbia is in 14th place, and among the countries of the region ahead of it are Hungary with 127,8 and Romania with 127,6 cardiologists per million inhabitants.
The challenge, however, is not so much the number of doctors as the organization of the system. The report of the European Association of Cardiologists shows that emergency interventions are performed much more often in Serbia, while the wait for certain procedures, such as the installation of a pacemaker, is longer than in more developed European countries.
Dr. Milan Kitanović believes that an additional problem is the fact that the state and private health sectors in Serbia function as two separate systems, which is why patients suffer the most. "Information systems are not networked. If a patient performs a cardiology examination at a private doctor, it is not visible in the state system. This unjustified disconnection drastically slows down diagnostics and reduces the quality of treatment," explains Dr. Kitanović.
He adds that the health system is developing unevenly, so that tertiary health care centers are getting stronger, while hospitals and doctors in the interior of Serbia are often neglected.
PREVENTION IS ALSO A QUESTION OF PUBLIC POLICIES
The experiences of European countries show that prevention is not only the responsibility of the individual but also of the state. In addition to banning smoking in closed public spaces and campaigns promoting healthier lifestyles, some countries also use tax policies to influence the diet of the population.
Back in 2011, Hungary introduced a tax on products containing large amounts of sugar, salt and caffeine, France introduced a tax on sweetened soft drinks in the same year, while today Belgium, Finland, Ireland, Latvia, Norway, Portugal and Great Britain also apply various forms of tax on sweetened drinks. The goal of these measures, in addition to increasing budget revenues and encouraging producers to reduce the amount of sugar in their products, is to make citizens opt for healthier alternatives.
A similar approach has been applied to industrial trans fatty acids, which have been shown to increase the risk of coronary heart disease. Back in 2003, Denmark became the first country to legally limit their content in food, and its example was later followed by Austria, Hungary, Norway, Switzerland and other European countries. Research shows that such measures have contributed to reducing the population's exposure to cardiovascular disease risk factors and improving public health.
If there is one thing in common among European countries that have managed to significantly reduce mortality from heart disease, it is the fact that they did not leave prevention exclusively to individuals. Investing in early disease detection, limiting risk factors, and public policies that encourage healthier lifestyles have proven to be just as important as medical advances.
photo: strahinja aćimović / tanjug...
Age and mortality
Although a slight decrease in mortality from cardiovascular diseases (7,2 percent) has been recorded in the last ten years, their share in the total number of deaths remains almost unchanged. Slightly more than half of all deaths from ischemic heart disease are due to acute coronary syndrome. Within that group, heart attack is the cause of death in almost 97 percent of cases, while unstable angina pectoris accounts for the remaining three percent.
In Serbia, in 2023, according to the data of the Register of persons suffering from acute coronary syndrome, 21.626 patients with acute coronary syndrome were registered, of whom 4.255 died. More than three quarters of the deceased (77,2 percent) were over 65 years old. Nevertheless, every fifth deceased (about 22,5 percent) was between the ages of 35 and 64, while in those younger than 35 this syndrome rarely ended fatally (0,26 percent).
What is happening in the country and the world, what is in the newspapers and how to pass the time?
Every Wednesday at noon In between arrives by email. It's a pretty solid newsletter, so sign up!
How were the cases kept out of control, the investigations directed towards the citizens who sought protection, and the prosecutors were left without answers from the police? Branko Stamenković talks about the findings of the commission of the Supreme Public Prosecutor's Office, the responsibility of his colleagues and what is needed for the institutions to work according to the law again
Who now decides on the Government and the program, the plenum or the deputy? There are different views on this in the Student Movement and among the people on the list, but a middle solution is being sought, "Vreme" learns. Be that as it may, the program of over a thousand pages already exists
The outgoing government treats the state like an apartment from which it moves out after losing a dispute. And all the time she shouts loudly that her neighbors are demolishing the building
"The main priority of the new government should be the preservation of employment and the growth of the standard of the population. And this will not be easy to achieve at all, because we will have a decline in employment in clientelistic companies that cooperated with the former regime. Some will close, but the important thing is that many people will lose their jobs. In the case of large private companies that are experiencing difficulties, the government should commit to better owners taking over these companies in order to save thousands of jobs. We will already have this case with Davora Macure's companies, among which is "Idea"
How much money from the Growth Plan has been irretrievably lost for us, how much has been frozen and how much is still waiting for us? What should Serbia do in order to receive these European funds and what will the citizens get from it? Is a new chapter in Brussels-Belgrade relations beginning?
At the moment when the institutions of the Republic are destroyed, when Vučić's octopus is still alive, when people are disgusted by the injustice and the stench left behind by the Essenes regime, we have, as Machiavelli said, only civic virtue as the fuel with which we can return to the beginning
The four independent members of REM are an example of perseverance and civic responsibility. Rodoljub Šabić even, upon leaving the premises of REM, after the sentencing of the Informer, experienced that the Essenes insulted him, hit him with their hands and feet. But that too will soon be over
Vučić pardoned the batterers and Dijana Hrkalović. The election winners should abolish the sultan's power that allows one man to run afoul of the entire judicial system
The archive of the weekly Vreme includes all our digital editions, since the very beginning of our work. All issues can be downloaded in PDF format, by purchasing the digital edition, or you can read all available texts from the selected issue.
