Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

The prevalence of cardiovascular risk factors was high in Morocco and it is necessary to increase action against the cardiovascular diseases and their risk factors.

Prévalence et facteurs prédictifs de l'hypertension « de la blouse blanche » dans une importante base de données de mesure ambulatoire de la pression artérielle RÉSUMÉ Cette étude avait pour objectif de déterminer la prévalence de l'effet blouse blanche et de l'hypertension de la blouse blanche, et de recenser les variables cliniques qui sont des facteurs prédictifs de ce type d'hypertension. Au total, 2 462 sujets ont fait l'objet d'une mesure ambulatoire de la pression artérielle, en raison d'une hypertension légère (groupe 1), aux fins de l'évaluation d'un traitement antihypertenseur (groupe 2), ou en raison d'une hypotension (groupe 3). Dans la population générale, 33,0 % des sujets présentaient une hypertension de la blouse blanche, 32,8 % dans le groupe 1 et 37,0 % dans le groupe 2. Dans l'analyse multivariée, le sexe et le niveau d'hypertension étaient des facteurs prédictifs indépendants d'hypertension de la blouse blanche. ABSTRACT The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension (WCH) and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension (group 1) or for assessment of antihypertensive treatment (group 2) or for hypotension (group 3). In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2.

This study used data from the Moroccan national survey in 2000 to identify the principle risk factors for hypertension in a representative sample of the population age 20+ years. The risk of hypertension increased steadily with age and was higher among rural residents (OR = 1.42) and those with diabetes (OR = 1.72). The risk increased with increased body mass index, waist size and hypercholesterolaemia. The risk of hypertension decreased by 36% and 46% respectively for those who walked 30-60 min and > 60 min daily. Consumption of fish and fresh fruits 1+ times per week was associated with a lower risk. Among those with hypertension, only 21.9% were previously diagnosed and 8.8% were under medical treatment. Risk factors for hypertension among the adult Moroccan population

Two cases of left ventricular (LV) perforation by balloon catheter following successful balloon mitral valvuloplasty are presented. The first patient was dilated first with a single straight‐tip balloon catheter and after with a double balloon catheter. The second patient underwent a valvuloplasty with a double balloon catheter only. The subsequent tamponade was treated by immediate aspiration but without hemodynamic improvement. Both patients required emergency surgery with surgical repair of the LV apex, and both of them could be weaned. Both patients are well 18 months after the procedure. We discuss the mechanism of this serious complication and technical considerations to prevent it.