With plausible estimates of 730,000 patients with CHD, of 120,000 persons with heart failure, and of 260,000 men and women with AF, the total count of Dutch individuals with some manifestation of heart disease could be as high as one million. In addition, a substantial number of women and men have other forms of atherosclerotic disease, either of the cerebral and/or the peripheral arterial system. However, since atherosclerosis is usually not limited to one organ system and many cardiac and vascular diseases co-exist, the simple summation of the various disease manifestations will likely overestimate the number of individuals with cardiovascular and/or heart disease.
In view of the high CVD prevalence, it is striking that actual mortality from CVD has declined so much. Currently, 27 % of all deaths result from CVD, and cancer has overtaken CVD as the main cause of death in the Netherlands in both women and men (source: Statistics Netherlands (CBS)). Despite substantial risk factor burden [24, 25], cardiovascular mortality in the Netherlands is low in international comparisons. The current Dutch age-standardised mortality from circulatory disease is 147 per 100,000, and only Spain and France have lower cardiovascular mortality rates (143 and 126 per 100,000, respectively). In all other European countries, including for instance Switzerland and Greece, cardiovascular mortality is higher .
The number of cardiac procedures in the Netherlands, in particular that of PCI and CABG, is below the Organisation for Economic Cooperation and Development (OECD) average. As in most other European countries, the rate of PCI versus CABG is in the order of 2.5. Both the numbers of percutaneous and surgical cardiac procedures in the Netherlands are 50 % lower than in our affluent neighbouring countries, Belgium and Germany . Patients with an acute MI are the main PCI target population with about 13,000 procedures in 30,000 patients hospitalised for MI. The 15,000 PCIs performed for stable angina constitute a relatively large proportion of PCI procedures, although the large number of patients with angina in the population must be taken into account.
Throughout our review we have cited various sources from which we obtained data on CVD in the Netherlands. However, data from different sources can be conflicting due to differential participation of hospitals in registries or due to the outcome definitions used. As an example, cardiovascular mortality is defined differently in the statistical updates from the Dutch Heart Foundation  compared to Statistics Netherlands (CBS). This results in minor discrepancies in the annual number of deaths attributable to CVD, in this case related to the inclusion or exclusion of congenital and perinatal heart disease and vascular autoimmune disorders (e.g. Table 1 and 2).
Future projections are always fraught with uncertainty, but demographic trends undeniably suggest an increase in the number of patients with heart disease and other forms of CVD in the not too distant future. Still, these trends are not dissimilar to the circumstances observed in the last decades, during which time cardiovascular mortality decreased so markedly. Most likely, these developments will continue, and high morbidity (and high prevalence) but relatively low mortality from CVD remains the most plausible scenario for the foreseeable future.