key: cord-0874035-c67lkxz2
authors: Panagiotakos, Demosthenes; Tsiampalis, Thomas
title: Excess Mortality in Greece during 2020; the role of COVID-19 and Cardiovascular disease
date: 2021-04-06
journal: Hellenic J Cardiol
DOI: 10.1016/j.hjc.2021.04.002
sha: a602c0ae350aa7cbfec19c9f73c9e04588fd1d2f
doc_id: 874035
cord_uid: c67lkxz2

nan

excess mortality was observed reaching up even the 156% in Spain during the Spring of 2020, the share of deaths from COVID-19 until September 2020 was negligible. However, in November 2020, when the number of COVID-19 specific deaths tripled compared to September 2020, the all-cause excess mortality exceeded even 30% (Figur e 2), which was approximately 116 times higher compared to Norway, where population's compliance with infection preventive measures was even higher than 98% [4] . Despite the fact that the increment of the excess mortality in Greece can largely coincide with the COVID-19 outbreak, it cannot be fully attributed to it, as similar increases have occurred in previous years, mainly due to the ageing of the population, the adoption of unhealthier lifestyles and the increased prevalence of newer risk factors [5] .

Cardiovascular diseases (CVD) are the leading cause of death in Greece since 1970s.

According to national statistics, 37% of deaths in Greece during 2019 were attributed to CVD, followed by various types of cancer (26%) and respiratory infections (12%) [3] . Based on the ATTICA epidemiological study the 10-year fatal or non-fatal incidence of CVD was 1,570 new cases per 10,000 individuals, while the causes of deaths were: 51.1% due to CVD, 30.0% due to neoplasms, 7.8% were due to infections (mainly pulmonary), and the rest 11.1% were due to various other reasons [6] . Moreover, in a systematic analysis of the Global Burden of Disease Study 2019, for Greece, ischemic heart disease had a 11.8% increase in mortality between 2009 and 2019, whereas stroke had a 20.3% increase [7] .

Even though the excess mortality for 2020 in Greece is a fact, it should be noted that it is much lower as compared to other European countries. This excess mortality is mainly attributed to the epidemic of COVID-19, was observed during the autumn outbreak and despite the restrictive measures were in force for the entire population. Nevertheless, CVD remains the main cause of death and disability in Greece, accounting for one third of deaths annually. As noted by Tousoulis D., "the residual cardiovascular risk that remains J o u r n a l P r e -p r o o f unexplained is considerable. Research on novel risk factors as a sole feature or as part of a cumulative condition may provide clues to the mechanism underlying CVD events" [5] .

Lockdown itself or changes in the organization of the health system may also have impact on the excess mortality beyond COVID-19. It has also been reported that individuals with heart symptoms may have not asked for medical care because of the fear of infection. In addition, infarct-related symptoms, such as chest pain, discomfort or dyspnea, could have been misinterpreted as being related to an acute respiratory infection. Viral infections, including COVID-19, may also play a role in increasing the burden of CVD in the future [8] [9] [10] .

Without a doubt, it is expected that cardiologists will be asked to handle much more complicated situations in clinical practice, calling for more evidence from laboratory and clinical research.

Years of life lost to COVID-19 in 81 countries

EUROSTAT 2020

Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries

Novel risk factors in coronary artery disease: are they clinically relevant?

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