Cardiovascular disease

Cardiovascular Disease

Cardiovascular disease, which includes heart disease, stroke and high blood pressure, affects an individuals circulatory system. In England, 3.3% of people have coronary heart disease, and 13.8% have high blood pressure (hypertension). However, the prevalence is considered to be higher than this, as these conditions maybe undiagnosed particularly in the early stages. Premature deaths, which is when a person under the age of 75 dies, due to CVD accounted for 99,240 deaths between 2012 and 2014. This is a rate of 75 per 100000. CVD deaths rates are higher in males than females.


The National recommendations are comprehensive, and will involve buy-in from a range of Government agencies, and stakeholders including food and drink manufacturers and caterers.

As a large proportion of CVD can be modified through lifestyle changes, the recommendations are quite specific, and are included below. For full information, please refer to Cardiovascular disease prevention | recommendations | Guidance and guidelines | NICE

Recommendations:

  • Salt

High intake of salt from food, particularly from the high levels within processed foods is linked with high blood pressure, which can lead to stroke and impact on coronary heart disease. Although there has been progress, through working with the Food Standards Agency, on reducing salt in processed foods, the rate of consumption in children continues to be a cause for concern. Policy within the UK is more stringent than in the EU, and strengthening of EU policy is considered to be a priority. Additionally promotion of low salt products through competitive pricing , and a recognition of low salt intake levels for children is proposed.

  •  Saturated Fats

Through joint work with the Food Standards Agency, industry and consumers, the population intake of saturated fats is being reduced, with the aim of attaining intake of saturated fats at below 11% of food energy, with the current rate being 13.3%. A cautious note is that if the consumption was still more dramatically reduced, to approximately 6-7% of total energy consumption, it might prevent not only 30,000CVD deaths annually, but would also prevent the same number of new cases developing each year. 


This is a potential enormous health benefit. National initiatives to reduce consumption target food manufacturers, and promoting semi-skimmed milk for children over 2 years.

  • Trans fats

Industrially-produced trans fatty acids (IPTFAs) which are found mainly in fried fast foods constitute a significant health hazard. Although some countries have banned IPTFAs, an EU ban has not yet been established. Through more accurate recording of who within the population is most impacted, more targeted interventions may be feasible. At a local level, it may be possible for Local Authorities to monitor their use in food outlets, and continue to encourage the use of vegetable oils high in poly and monounsaturated fatty acids to replace IPTFAs.

  • Marketing and promotions aimed at children and young people

There are currently restrictions on advertisements for food products which are high in fats, sugars and salt being shown when under 16year olds are watching television. Information from other countries where the ban on such advertising is until 9pm have demonstrated considerable reduction in advertising exposure. Additionally, moves to restrict advertising aimed at young people particularly using other technologies may need to be considered.

  • Product labelling

Informed choice by consumers, including parents, is supported by clarity of labelling, which is understandable, clear and easy to interpret. There is evidence that a simple visual system, based on the traffic light system, and including information on the product’s percentage contribution to daily guideline amounts for salt, sugar and fat is effective.

  • Physically active travel

Any initiative which encourages physical activity as a regular inclusion in everyday a life is positive. However, the promotion of walking and cycling as active transport modes is patchy, and inclusion of this in overall strategy for CVD reduction, including weight management and children’s obesity and inactivity issues is positive.

  • Public sector catering guidelines

It is estimated that, overall, public service organisations provide around one in three meals eaten outside of the home. Therefore, ensuring good nutritional quality contributes to a well-balanced and healthy diet assists with prevention of CVD. All publically funded catering should comply with Foods Standards Agency approved guidelines. 

  • Take-away and other food outlets

Fast food outlets can be controlled through local planning authorities, and thereby  assist in both prevention and reduction of CVD. This is particularly pertinent to location of outlets near schools.

  • Monitoring

As CVD accounts for about a third of the observed gap in life expectancy for those living in the areas of deprivation, when compared with other areas, it is important that data and interventions are both monitored and directed towards those with the largest health inequalities. This monitoring could include using population surveys (including the 'National diet and nutrition survey' [NDNS] and the 'Low income diet and nutrition survey' [LIDNS]) and data from all relevant sources to monitor intake of nutrients for all population groups. (Sources include: the Food Standards Agency, Department of Health, Department for Environment, Food and Rural Affairs, Office for National Statistics, the Public Health Observatories, academic and other researchers.) 


Importantly, we know that much cardiovascular disease is preventable, and that lifestyle factors can greatly influence incidence of and effects of CVD.

Programmes, which ideally should be of a minimum of 5 years duration (which are constantly evaluated), which support the above issues in a local context are ideal, as are those which are inclusive of a wide range of people.

 

One potential route into these lifestyle programmes can be through the NHS Health Checks programme. This is a national programme targeted at people aged 40-74 years without a pre-existing cardiovascular condition.  It checks your circulatory and vascular health and provides the individual with the information of their risk of developing a disabling vascular disease. This check can help people to modify lifestyle factors, make positive health conscious decisions, and can signpost people into local CVD programmes.     

Wokingham Borough overall has lower rates of CVD than the South East of England, and England generally. The rates of CVD related deaths in under 75s   are declining since 2001-3, although it is apparent that the gap is narrowing, see figure 1.

 

Figure 1: 

Under 75 mortality persons

These rates are lower for both males and females, although the information clearly shows that the rates are much higher in males than females See figures 2 and 3 below

    

Figure 2:     

Under 75 mortality males

Figure 3:

Under 75 mortality females

For Wokingham this means that we have lower rates in comparison with the South East and England, but the fact that the gaps are narrowing means that we must not become complacent and must still continue to encourage people to be self-empowered to maintain their own healthy, and therefore protective lifestyle, and also concentrate efforts in those least likely to be aware or empowered to modify the factors which can contribute to the development of CVD.

 

  • Accessibility to  locally produced healthy foods    
  • Accessibility and use of physical activity activities
  • Health literacy influencing informed choices in parents and others
  • Promotion of physical activity which is locality based.  

 

An overarching forward looking strategy which addresses childhood obesity and nutrition, adult obesity and physical activity which is locality based and inclusive.

     

Due to the huge impact of CVD, and the fact that there is a considerable amount that can be done to prevent its impact, joint working with partners to increase the profile of self-management would be beneficial to the Borough’s CVD health status.