Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood vessels. This group of diseases incudes coronary heart disease, heart failure, stroke as well as peripheral artery disease and aortic disease. Aortic aneurysms are discussed in greater detail in the chapter ‘non-cancer screening’. Chronic kidney disease and diabetes are related conditions as they share risk factors with CVD and are associated with a greater risk of CVD.
Cardiovascular disease causes more than a quarter of all deaths in the UK, or around 155,000 deaths each year - an average of 425 people each day or one every three minutes. Around 41,000 people under the age of 75 in the UK die from CVD each year and there are an estimated 7 million people living with cardiovascular disease in the UK.
The cost to the UK of premature death, lost productivity, hospital treatment and prescriptions relating to CVD is estimated at £19 billion each year. Healthcare costs alone total an estimated £8 billion.
Risk factors for cardiovascular disease include those that cannot be modified for example age, gender, family history and ethnicity as well as factors that can be modified for example lifestylefactors.
Lifestyle risk factors for cardiovascular disease overlap with risk factors for many other non-communicable diseases such as diabetes, cancer and chronic lung disease. They include poor diet, physical inactivity, smoking and excess alcohol. These risk factors are also known to cluster and are associated with socioeconomic status.
Despite still being the leading cause of death, deaths from cardiovascular disease in England have in fact almost halved since 1990 (Source: Global Burden of Disease Study). This reduction in deaths is not due to a reduction in disease prevalence, but rather because treatment of CVD has improved significantly. This is particularly true for coronary heart disease. In fact, the number of operations to treat coronary heart disease have increased tenfold over the last three decades (Source: Townsend et al 2014).
Using modelled estimates from the Health Survey for England, it is estimated that 25.7% of the adult population in Slough are obese compared with 23% in England and 21.1% in South East. (NOO, PHE, 2015). New data on physical inactivity in adults shows that Slough is now ranked 95th with 53.5% not meeting the national guidelines.
In Slough the prevalence of obesity among children entering school in reception is now in line with the national average at 9.8% (2014/15) and at age 10 – 11 years remains statistically above national rates at 24.2%.These figures relate to children with Slough postcodes rather than schools with Slough postcodes (Source: National Child Measurement Programme 2014/15).
It is estimated that 19.9% of the population in Slough smoke (Integrated Household Survey IHS). This is lower than the estimated proportion in England (20.7%) and higher than Thames Valley (18.0%). The rate of smoking related deaths is 298 per 100,000. This represents 136 deaths per year. Estimated levels of adult smoking are worse than the England average but have fallen from 22% to 19% (Health Profile, 2015).
It is estimated that 18.9% of the population in Slough have increasing or high risk drinking behaviour (General Household Survey). This is lower than England (22.3%) and lower than Thames Valley (23.3%).
Hypertension is both a risk factor for further cardiovascular disease as well as being classified as a condition in itself. Over 10% of patients registered with GPs in Slough have been classified as having high blood pressure (hypertension) . This is approximately half the number of people in Slough estimated to be living with high blood pressure.
Figure 1 illustrates the prevalence of recorded cardiovascular diseases in Slough compared with the National figures. It is important to note that looking at the numbers of people currently being treated for a disease does not show the true prevalence of the disease or impact on a population’s health. There will also be many people who have a disease or condition that are not aware of it and have not been diagnosed.
In fact, while 10% of the population of Slough are recorded by their GP as having high blood pressure (hypertension), it is estimated that the true prevalence in Slough 19.5%. This suggests that half the people with hypertension in Slough have not been identified.
Following national trends, deaths due to cardiovascular disease in Slough are also falling. Figure 2 illustrates the change in CVD deaths over the last 10 years.
Although falling, the death rate in Slough remains higher than the national average as well as similarly deprived local authorities. In fact, Slough is ranked 32nd out of 326 district and unitary authorities in England for rates of premature (under 75) cardiovascular deaths
The Cardiovascular Disease Outcomes Strategy (2013) identifies for commissioners and providers of health (including public health) and care services the ten key actions that will make a difference in improving outcomes for CVD patients, in line with the NHS, Public Health and Adult Social Care Outcomes Frameworks. These include:
These actions build on continuing implementation of the National Service Frameworks for coronary heart disease, diabetes and renal services and the Stroke Strategy. The Strategy also outlines evidence-based interventions and their potential costs for each activity area. Additional useful analyses can be found through NHS Englands Commissioning for Value packs.
The NICE Guidance PH25: Cardiovascular disease prevention provides both recommendations for national policy as well as recommendations for local practice. Practice recommendations include actions on providing a sustainable regional CVD prevention programme.
Despite significant improvements in the treatment of cardiovascular disease, and resulting reductions in mortality; the number of people in Slough at risk of or currently being treated for cardiovascular diseases continues to rise. Prevention, therefore, is a priority.
There is scope to review the current provision of various preventative programmes to align services and prevent duplication of efforts. Work is already underway on this, as well as the design of an integrated community cardiac rehabilitation programme.