Hot topic - Heart disease deaths in England
26 March 2004 - written by Bupa's Health Information Team
On 25 March 2004, every UK newspaper ran the story that heart disease deaths in people under the age of 65 years will be eradicated in the UK. The stories were based on the Department of Health report: Winning the war on heart disease.
This statement was based on projections of how quickly heart disease death rates in men and women under 65 years have been falling - and if they continue to fall at the same rate, they should reach zero by 2013. This fall in death rate has been attributed to positive lifestyle changes in the UK population and increasingly sophisticated and successful medical treatment.
However, the situation is not clear cut, because other factors (for example the rise in inactivity and obesity in the UK population, and the attendant rise in type 2 diabetes) could halt this fall and may even reverse it.
Below we look at the issue in more depth:
How many people are affected by heart disease in the UK?
Coronary heart disease is a preventable disease. Approximately 275,000 people in the UK have a heart attack every year. It that kills more than 110,000 people in England every year.
How have the current rates of heart disease deaths in men and women under the age of 65 years in England changed when compared with 10 years before?
| Year | Men in England under the age of 65 years who died from heart disease |
|---|---|
| 1990 | 90 deaths in every 100,000 |
| 2000 | 50 deaths per 100,000 |
This represents a decline in death rate of 45% for men under the age of 65 years in England.
| Year | Women under the age of 65 years who died from heart disease |
|---|---|
| 1990 | 25 deaths in every 100,000 |
| 2000 | 10 deaths per 100,000 |
This represents a decline in death rate of 60% for women under the age of 65 years in England.
The decline in heart disease death rates was not just confined to people aged younger than 65 years. Secretary of State for Health, John Reid, said: "Deaths from cardiovascular disease fell by more than 23% between 1995/97 and 2000/02."
How was the prediction of no coronary heart disease deaths in people in England aged under 65 years by 2013 arrived at?
By plotting the decline in death rates from coronary heart disease in men and women aged under 65 years over time, it is possible to extrapolate the lines to the point where no deaths should occur. For men the time for reaching a zero death rate is predicted for the year 2013. For women the time for reaching a zero death rate is predicted for 2011.
However, these are only predictions and are based on the assumption that the death rates will continue to decline at the same rate. Unfortunately there are many reasons why this may not occur, please see: Why is there concern that this fall in rates may not continue, and could even rise?
Why have England's heart disease death rates in under 65-year-olds been falling?
There are two main reasons why heart disease death rates in people in England under the age 65 years have declined:
- improvement in lifestyles
- improvements in the treatment of heart disease
Improvement in people's lifestyles
Smoking is an important risk factor for the development of coronary heart disease. In fact, about 20% of all coronary heart disease related deaths in men and 17% of coronary heart disease related deaths in women can be attributed to smoking. The rates of adult smoking are declining, in 1998 28 percent of men and women smoked, but by 2002 this had fallen to 26 percent. However, roughly 10 million people in England continue to smoke (more than one in four people) which means that there is still plenty of room for improvement.
Another area of improvement is in people's diets. Diet is a key factor in the development of coronary heart disease, yet this risk can be reduced by healthy eating. For example, eating at least five portions of a variety of fruit and vegetables a day could lead to an estimated reduction of up to 20 per cent in overall deaths from chronic diseases, such as heart disease, strokes and cancer. For this reason, the Government and health charities have been encouraging the population to eat more fruit and vegetables.
Improvements in the prevention and treatment of heart disease
Treatment of high cholesterol
People who have high levels of cholesterol are at greater risk of developing coronary heart disease and often benefit from receiving drugs known as statins. These drugs reduce the level of cholesterol in a person's blood. By reducing their cholesterol level the risk of having a heart attack is significantly reduced and this, in turn, reduces the risk of dying prematurely.
More than 1.8 million people are now receiving statins and it is estimated that this saves 6-7000 lives a year.
Treatment of heart attacks with clot-busting drugs
Between a third and two-thirds of all heart attack deaths take place outside hospital, many within the first few minutes of the onset of symptoms. For this reason, clot-busting drugs and anti-clotting drugs should be given as soon as possible after a heart attack to reduce the possibility of death and disability. In the past, the use of clot-busting drugs was patchy, but now their use is much more widespread. Treatment with clot-busting drugs can be given up to 12 hours after the onset of the symptoms of a heart attack but it is most effective when given within the first two hours.
Use of clot-busting drugs (known as thombolytics)
Percentage of people with a heart attack given thrombolytic treatment within 30 minutes of arrival at hospital:
- In 2000 - 38% of people with a heart attack
- December 2003 - 81% of people with a heart attack
Percentage receiving thrombolytic treatment within 60 minutes of first calling for professional help in 2004 - 47%
Professor Sir Charles George, Medical Director of the British Heart Foundation, said: "The improvement in thrombolytic therapy for heart attack patients witnessed since 2000 is a fantastic achievement. Speedy application of these clot-busting drugs can mean the difference between life and death."
Why is there concern that this fall in deaths may not continue, and could even rise?
Although the decline in death rates from coronary heart disease in people aged under 65 years is good news, there are a number of issues with modern lifestyles that mean that the rates may not continue to fall. The main problems are:
- increasing levels of inactivity
- rise in obesity
- increase in cholesterol levels
- rise of type 2 diabetes (also known as adult-onset diabetes).
Increasing levels of inactivity
Regular physical activity reduces the risk of death from cardiovascular disease in general and of coronary heart disease mortality in particular. Physically inactive people have roughly double the risk of coronary heart disease when compared with active people.
Rise in obesity
The incidence of coronary heart disease is highest amongst people who are obese. Overall 22% of men and 23% of women in England are now obese.
Type 2 diabetes (also known as adult-onset diabetes)
It has been found that diabetes raises the risk of developing coronary heart disease, although the reasons why are unclear. It is possible that the increased levels of glucose in the blood affect the lining of the walls of the arteries and this increases their risk of furring up (a process known as atherosclerosis).
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: "We are delighted that death rates from coronary heart disease in the UK continue to fall, aided by British Heart Foundation funded advances in prevention, diagnosis and treatment. Projecting this rate of decline into the future is difficult, as growing trends of obesity, inactivity and high cholesterol levels will have a negative impact on any decline in coronary heart disease."
What can I do to lower my risk of developing coronary heart disease
The best actions that you can take to reduce your risk of developing coronary heart disease are:
- take regular exercise
- eat a healthy balanced diet (including eating five portions of fruit and vegetables a day)
- stop smoking
- drink alcohol only in moderation
- have your blood pressure checked
- have your blood cholesterol level checked
Further information
Bupa resources:
- Bupa factsheet: Blood pressure
- Bupa factsheet: Healthy eating
- Bupa factsheet: Healthy weight for adults
- Bupa factsheet: Heart attack
- Bupa factsheet: High cholesterol
- Bupa factsheet: Looking after your heart
- Bupa factsheet: Physical activity
- Bupa factsheet: Problem drinking
- Bupa factsheet: Type 2 diabetes
- Alcohol section
- Exercise section
- Stop smoking section
- Bupa 5-a-day article
