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Cardiovascular Disease

Introduction

Cardiovascular disease (CVD) is a significant cause of illness and death across England and has a particularly important impact in Reading. Reading has the highest rate of premature mortality resulting from heart attack and stroke amongst the 15 local authorities with the most similar levels of socioeconomic deprivation and is ranked 72nd amongst all 150 local authorities in England (PHE, 2016).

The high rate of premature death from CVD in Reading compared to similar areas suggests that more can be done locally to support residents to reduce risks for CVD related to lifestyle.

What do we know?

Cardiovascular disease refers to diseases of the heart or blood vessels and most commonly encompasses the following conditions:

  • Coronary heart disease (CHD) - when blood flow to a person's heart is blocked or reduced by the build-up of fatty material (atheroma) in the coronary arteries. This can cause angina (chest pain) or heart attack.
  • Stroke - when blood supply to a person's brain is restricted or cut off and brain cells begin to die, sometimes causing brain damage or death.
  • Peripheral arterial disease - a blockage in the arteries to a person's limbs - usually their legs - resulting in pain when exercising (e.g. walking up stairs)
  • Aortic disease - most commonly aortic aneurysm - when the aorta (the largest blood vessel in the body) becomes weakened and bulges outward, resulting in pain in chest and abdomen.

Risk factors include:

  • High blood pressure (hypertension)
  • Smoking
  • High blood cholesterol
  • Diabetes
  • Low levels of physical exercise
  • Being overweight or obese
  • Family history of heart disease
  • Ethnic background (CVD is most common in South Asian people)

The most important risk is high blood pressure, which is itself linked to lack of exercise, being overweight, smoking and drinking alcohol and is a key cause of coronary heart disease (CHD) and heart attack (NHS Choices, 2016).

Table 1: Recorded and Estimated Prevalence of Hypertension in Reading (Local Authority area) and by CCG (2014/15)

 

Recorded

Estimated

% Hypertension detected

South Reading CCG

10.2%

19.1%

54.2%

North and West Reading CCG

13.2%

23.6%

56.1%

Reading Local Authority

11.2%

20.3%

56.3%

England

13.7%

24.7%

54.3%

Source: Healthier Lives http://healthierlives.phe.org.uk/topic/hypertension/comparisons

The actual prevalence of high blood pressure is estimated to be considerably higher than detected through contact with GPs (Table 1), with almost half of cases thought to be undetected. The rate of undetected high blood pressure is estimated to be higher in Reading than the England average.

Whilst the rate of mortality from CVD is higher than in similar areas, the good news is that the rate is declining - the annual number of deaths has fallen by half since 1961 - but is still significant. CVD causes more than a quarter of all deaths in the UK each year, mostly from CHD and heart attack (BHF, 2016a).

Figure 1: Early deaths from heart attack and stroke

image1

Source: Reading Health Profile, available from PHE (Data source: PHE based on Office for National Statistics (ONS) source data.

Mortality rates are particularly worrying in Reading. Reading has the highest rate of premature mortality resulting from heart attack and stroke amongst the 15 local authorities with the most similar levels of socioeconomic deprivation and is ranked 72nd amongst all 150 local authorities in England (PHE, 2016).

Both CVD and heart disease are more prevalent amongst more deprived groups (Health and Social Care Information Centre (HSCIC), 2011) and analysis of mortality data from the Primary Care Mortality Database suggests similar trends are evident in Reading, with mortality rates from CVD much higher in the most deprived ward areas than the least deprived (Figure 2).

Figure 2: Age-standardised mortality rates from cardiovascular disease per 100,000 population (all ages) in the most and least deprived wards in Reading.

image2

Source: Primary Care Mortality Database and Indices of Multiple Deprivation (ONS)

Reading has an ethnically diverse population, including a large population of South Asian residents - 12.9% of the total population in 2011 (Reading Borough Council and University of Reading, 2012), who are considered to be at greater risk from CVD and CHD (PHE, 2016; BHF, 2016b).

CVD is more prevalent in BME communities and it is suggested that those from BME backgrounds may have higher risk of developing conditions related to overweight and obesity, including CVD and CHD, at lower Body Mass Index (BMI) than for White European populations (NICE, 2013). This suggests that those from BME ethnic groups may be more likely to develop CVD at body weight not considered risky.

National and local strategies (current best practice)

NICE guidance on preventing CVD (NICE, 2010) recommends interventions at population and individual level. The guidance makes the case for CVD as a major public health problem and makes the following recommendations based on "extensive and consistent evidence":

Policy Recommendations

  • Reduce the amount of salt, saturated fat and trans fats in people's diets;
  • Restrict marketing and promotions aimed at children that undermine a child's right to a healthy diet
  • Reduce lobbying by food and drink industries
  • Ensure clear product labelling
  • Carry out health impact assessments on new policies, especially considering impact on CVD
  • Common Agricultural Policy to take account of CVD issues
  • Ensure local transport plans support physically active travel
  • Ensure public sector catering meet Food Standard Agency's approved dietary guidelines.
  • Restrict planning permission for take-aways and other food retail in specific areas (for example, near schools)
  • Monitor and scrutinise CVD data, including prevention activity

Practice Recommendations

  • Ensure CVD prevention programmes: comprise intense, multi-component interventions; are targeted at the whole population and complement interventions aimed at individuals who are at higher risk; and are sustainable for at least 5 years, adequately resourced and realistic to implement.
  • Ensure prevention programmes are based on an understanding of the local community and their needs, are based on theories about what will work for the population, and are monitored and evaluated.
  • Ensure those working with children and young people help them to have a healthy diet and lifestyle and ensure that food provided by the public sector is low in salt and saturated fat and is nutritionally balanced and varied.
  • Promote physical activity through the physical environment, transport system and local provision (e.g. provide cycle routes and safe pedestrian routes, do not prohibit ball games in public spaces, consider offering free swimming to parents and carers who accompany children under 5 to pools)
  • Use a variety of methods to assess the potential impact of all local and regional policies and plans on CVD and related chronic diseases.

What is this telling us?

CVD has a significant impact on health and mortality across England and is a particularly important cause of premature death in Reading. Many of the risk factors for CVD are based on lifestyle and support to enable residents to maintain a healthy weight, take part in physical exercise and stop smoking are likely to have an impact on high rates of mortality. In addition, more work is needed locally to ensure that local decision-making takes account of the impact of decisions on CVD incidence and mortality locally.

What are the key inequalities?

CVD is more prevalent amongst those in more deprived socioeconomic groups and appears to disproportionately affect those from South Asian and some other Black and minority ethnic groups. These inequalities should be taken into account when assessing local decisions and policies and when planning interventions to support healthy lifestyles.

What are the unmet needs / service gaps?

The high rate of premature death from CVD in Reading compared to similar areas suggests that more can be done locally to support residents to reduce risks for CVD related to lifestyle.

This section links to the following sections in the JSNA:

Deprivation by Ward and Lower Super Output Area

Ethnicity

Physical Activity

Obesity - adult & child

References

BHF. Your Ethnicity and Heart Disease. Available at: https://www.bhf.org.uk/heart-health/preventing-heart-disease/your-ethnicity-and-heart-disease (Accessed 16th March 2016).

British Heart Foundation (BHF), 2016a. CVD Statistics - UK Factsheet. BHF, London.

Health and Social Care Information Centre (HSCIC), 2012. Health Survey for England - 2011, Health Social Care and Lifestyles, HSCIC, London.

National Institute for Health and Clinical Excellence (NICE), 2013. NICE Guidelines [PH46]. BMI: Preventing ill health and premature death in Black, Asian and other minority ethnic groups. NICE, London.

NHS Choices. Cardiovascular Disease. Available at:  http://www.nhs.uk/conditions/Cardiovascular-disease/Pages/Introduction.aspx [Accessed 16th March 2016].

Public Health England. Longer Lives. Available at: http://healthierlives.phe.org.uk/topic/mortality (Accessed 16th March 2016)

Reading Borough Council and University of Reading (2012) Census 2011 - Detailed Factsheets. RBC, Reading 

  

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