Heart diseaseHeart disease

Some facts:Some facts: Heart and circulatory disease is the Heart and circulatory disease is the

UK's biggest killer.  In 2001, UK's biggest killer.  In 2001, cardiovascular disease caused 40% cardiovascular disease caused 40% of deaths in the UK, and killed over of deaths in the UK, and killed over 245,000 people.245,000 people.

Death rates for heart disease have Death rates for heart disease have

been falling rapidly in the UK since been falling rapidly in the UK since the late 1970s. Despite this, death the late 1970s. Despite this, death rates from CHD in the UK are still rates from CHD in the UK are still amongst the highest in the world.  amongst the highest in the world. 

Office of National Statistics (2002)General Register Office (2002) www.heartstats.org

Deaths by cause, men under 75, 2001, United Kingdom

Other cancer 20%

Colo-rectal cancer 4%

Respiratory disease8%

Injuries and poisoning8%

All other causes16%

Coronary heart disease22%Stroke

6%

Other CVD7%

Lung cancer 9%

Lung cancer 8%

Breast cancer8%

Colo-rectal cancer 3%

Coronary heart disease14%

Stroke7%

Other CVD7%

Injuries and poisoning4%

All other causes17%

Other cancer23% Respiratory disease

9%

Office of National Statistics (2002)General Register Office (2002) www.heartstats.org

Deaths by cause, women under 75, 2001, United Kingdom

Death rates from CHD for people aged under 65, 1970-2000, England

0

10

20

30

40

50

60

70

80

90

100

70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

Dea

ths

/100

,000

(ag

e-st

and

ard

ised

)

Office of National Statistics (2002)

www.heartstats.org

Coronary Heart Disease Statistics (2003)

www.heartstats.org

Age-standardised death rates per 100,000 population from CHD

for men under 65, by local authority, 1998/2000, United Kingdom

Age-standardiseddeath rates per100,000 by quintile

20.6 – 41.141.2 – 50.750.8 – 57.757.8 – 68.969.0 – 136.7

Shetland

Islands

London boroughs

Death rates from CHD by social class, men and women aged 35-64, 1976/81-1986/92, England and Wales

0

50

100

150

200

250

300

350

400

1978 1983 1988

Manual men

Non-manual men

Dea

ths/

100,

000

(ag

e-st

and

ard

ised

)

Manual women

Non-manual women

Office of National Statistics (1997)

www.heartstats.org

Wild S, McKeigue P (1997)

Standardised mortality ratios for CHD by sex and country of birth, 1989/92, England and Wales

0 50 100 150 200 250 300

Scotland

All Ireland

East Africa

West Africa

Caribbean

South Asia

Men

Women

www.heartstats.org

SMR

Cost of CHD to the National Health Service and social care system, 1999, UK

Liu JLY et al (2002) Heart 88: 597-603 www.heartstats.org

£ £ millionmillion % of total cost% of total cost

           

Primary preventionPrimary prevention 12.612.6 0.70.7

Primary carePrimary care 48.848.8 2.82.8

Accident and emergency careAccident and emergency care 16.5416.54 1.01.0

Outpatient careOutpatient care 33.3233.32 1.91.9

Inpatient careInpatient care 917.25917.25 53.053.0

Day casesDay cases 1616 0.90.9

MedicationMedication 582.37582.37 33.733.7

RehabilitationRehabilitation 28.428.4 1.61.6

Community health/social Community health/social servicesservices 74.874.8 4.34.3

TotalTotal 1,730.081,730.08 100100

           

What is coronary heart disease?What is coronary heart disease?

The process of coronary heart disease begins when The process of coronary heart disease begins when the coronary arteries become narrowed by a gradual the coronary arteries become narrowed by a gradual build-up of fatty material within their walls.build-up of fatty material within their walls.

This condition is called atherosclerosis and the fatty This condition is called atherosclerosis and the fatty material is called atheroma. In time the artery may material is called atheroma. In time the artery may become so narrow that it cannot deliver enough become so narrow that it cannot deliver enough oxygen-containing blood to the heart muscle when it oxygen-containing blood to the heart muscle when it needs it, such as when you are doing exercise. This needs it, such as when you are doing exercise. This is angina. The pain of angina is due to the heart is angina. The pain of angina is due to the heart muscle becoming short of oxygen.muscle becoming short of oxygen.

The coronary arteries supply blood to the The coronary arteries supply blood to the heart muscle. The right coronary artery heart muscle. The right coronary artery supplies both the left and the right heart; supplies both the left and the right heart; the left coronary artery supplies the left the left coronary artery supplies the left heart.heart.

Cholesterol is a waxy, fat-like material Cholesterol is a waxy, fat-like material that is found in all parts of the body. It that is found in all parts of the body. It comes from two sources: our liver comes from two sources: our liver produces it, and we consume it in meat produces it, and we consume it in meat and dairy products. and dairy products.

A heart attack occurs A heart attack occurs when one of the when one of the arteries that supplies arteries that supplies the heart muscle the heart muscle becomes blocked. becomes blocked.

Blockage may be Blockage may be caused by spasm of caused by spasm of the artery or by the artery or by ateriosclerosis with ateriosclerosis with clot formation. clot formation.

The blockage results The blockage results in damaged tissue and in damaged tissue and a permanent loss of a permanent loss of contraction of this contraction of this portion of the heart portion of the heart muscle. muscle.

ArteriosclerosisArteriosclerosis

Furred up arteries!Furred up arteries!

Coronary heart disease can become more serious Coronary heart disease can become more serious if a narrowed coronary artery becomes blocked by if a narrowed coronary artery becomes blocked by a blood clot. This causes a heart attack. High a blood clot. This causes a heart attack. High blood pressure puts an added strain on the heart blood pressure puts an added strain on the heart and can make coronary heart disease worse.and can make coronary heart disease worse.

Human Red Human Red Blood Cells, Blood Cells, Platelets and T-Platelets and T-lymphocyte lymphocyte (erythocytes = (erythocytes = red; platelets = red; platelets = yellow; T-yellow; T-lymphocyte = lymphocyte = light green) light green) (SEM x 9,900). (SEM x 9,900).

Human Red Blood Human Red Blood Cells, Platelets and Cells, Platelets and T-lymphocyte T-lymphocyte (erythocytes = red; (erythocytes = red; platelets = yellow; T-platelets = yellow; T-lymphocyte = light lymphocyte = light green) (SEM x green) (SEM x 9,900). 9,900).

Heart disease most Heart disease most often occurs when often occurs when cholesterol cholesterol accumulates and accumulates and forms "plaque" in a forms "plaque" in a coronary artery. With coronary artery. With blood flow impeded, blood flow impeded, the heart becomes the heart becomes starved for oxygen, starved for oxygen, causing chest pain causing chest pain (angina). If a blood (angina). If a blood clot forms and clot forms and completely obstructs completely obstructs the artery, a heart the artery, a heart attack (myocardial attack (myocardial infarction) can occur.infarction) can occur.

How to help prevent heart diseaseHow to help prevent heart disease

The major risk factors for coronary heart The major risk factors for coronary heart disease that you can do something about are:disease that you can do something about are:

smoking smoking high blood pressure high blood pressure high blood cholesterol, and high blood cholesterol, and physical inactivity.physical inactivity. Obesity (being very overweight), drinking too Obesity (being very overweight), drinking too

much alcohol, and having too much salt can much alcohol, and having too much salt can also increase the risk of coronary heart also increase the risk of coronary heart disease. disease.

Eating well can help Eating well can help improve your general improve your general health. If you have health. If you have coronary heart coronary heart disease.disease.

It is important to eat less Fats and It is important to eat less Fats and CholesterolCholesterol Cholesterol is a fatty Cholesterol is a fatty

substance which is mainly substance which is mainly made in the body. The liver made in the body. The liver makes it from the saturated makes it from the saturated fats in food. fats in food.

The cholesterol enters the The cholesterol enters the blood and is carried around blood and is carried around by proteins. These by proteins. These combinations of cholesterol combinations of cholesterol and proteins are called and proteins are called 'lipoproteins'. 'lipoproteins'.

There are two main types of There are two main types of lipoproteins - low density lipoproteins - low density lipoprotein (LDL) which are lipoprotein (LDL) which are bad!bad!

and high density lipoprotein and high density lipoprotein (HDL) – not so bad!(HDL) – not so bad!

How to reduce cholesterol intakeHow to reduce cholesterol intake

You need to: You need to:

Reduce the total amount of fat you eat and eat Reduce the total amount of fat you eat and eat starchy foods instead (bread, pasta, rice, cereals starchy foods instead (bread, pasta, rice, cereals and potatoes). and potatoes).

Cut right down on saturated fats and substitute Cut right down on saturated fats and substitute them with small amounts of polyunsaturated fats them with small amounts of polyunsaturated fats and monounsaturated fats.and monounsaturated fats.

Keeping a healthy Keeping a healthy weightweight

Remember that Remember that losing weight losing weight involves both eating involves both eating healthily and healthily and increasing physical increasing physical activity. activity.

Professor Sir Charles George, Medical Director at the British Heart FoundationProfessor Sir Charles George, Medical Director at the British Heart Foundation,,

"The fact that deaths from coronary heart disease are continuing to fall "The fact that deaths from coronary heart disease are continuing to fall is good news and is in part a testament to the resources and skill is good news and is in part a testament to the resources and skill committed to CHD in the UK today.committed to CHD in the UK today.

"However, the fact that we have one of the highest death rates in the "However, the fact that we have one of the highest death rates in the western world is shocking - and a reality that we cannot ignore. While western world is shocking - and a reality that we cannot ignore. While we can expect more people to survive the condition in the future, we we can expect more people to survive the condition in the future, we need to consider the growing burden on the NHS to provide treatment need to consider the growing burden on the NHS to provide treatment and care for those living with CHD.and care for those living with CHD.

"We need to tackle the underlying causes of CHD in the UK - in "We need to tackle the underlying causes of CHD in the UK - in particular lifestyle factors such as physical inactivity - if we are to particular lifestyle factors such as physical inactivity - if we are to improve the heart health of the nation."improve the heart health of the nation."

The message that CHD is largely preventable is clearly not getting through:The message that CHD is largely preventable is clearly not getting through: Smoking Smoking levels remain static in the UK - levels remain static in the UK - 29% of men 29% of men and and 25% of 25% of

women women still smoke. still smoke. Around Around 40% 40% of men and women have of men and women have raised blood pressure raised blood pressure - -

despite recent evidence from the World Health Organisation (WHO) despite recent evidence from the World Health Organisation (WHO) that it is the second most important cause of death and disability in that it is the second most important cause of death and disability in developed countries - exceeded only by tobacco. developed countries - exceeded only by tobacco.

Only Only 13% of men 13% of men and and 15% of women 15% of women eat the recommended eat the recommended 5 5 portions portions of fruit and veg a day. While the consumption of fruit has of fruit and veg a day. While the consumption of fruit has risen four fold since the 1940s, vegetable consumption has declined. risen four fold since the 1940s, vegetable consumption has declined.

Physical inactivity Physical inactivity is still a major problem - only just over a third is still a major problem - only just over a third ((37%37%) of men and a quarter of women () of men and a quarter of women (25%25%) take the recommended ) take the recommended 30 minutes 30 minutes of exercise five times a week. of exercise five times a week.

The proportion of adults who are The proportion of adults who are overweight overweight continues to rise - continues to rise - particularly in men. Obesity rates in men have particularly in men. Obesity rates in men have tripled tripled in the since the in the since the mid 1980s - with men now as likely to be obese as women. mid 1980s - with men now as likely to be obese as women.

In the last ten years, the number of women In the last ten years, the number of women drinking drinking more than the more than the weekly recommended levels of alcohol has risen by over weekly recommended levels of alcohol has risen by over 50% 50% but but remained stable in men.remained stable in men.

Unusual Unusual breathlessnessbreathlessness when doing light activity or at rest, or when doing light activity or at rest, or breathlessness that comes on suddenly. breathlessness that comes on suddenly.

AnginaAngina - chest pain, heaviness or tightness in the chest that - chest pain, heaviness or tightness in the chest that comes on during exertion, emotional stress and may spread to comes on during exertion, emotional stress and may spread to arms, neck, jaw, face, back or stomach. arms, neck, jaw, face, back or stomach.

PalpitationsPalpitations - awareness of your heart beat or a feeling of - awareness of your heart beat or a feeling of having a rapid and unusually forceful heart beat, especially if having a rapid and unusually forceful heart beat, especially if they last for several hours or recur over several days and/or they last for several hours or recur over several days and/or cause chest pain, breathlessness or dizziness. cause chest pain, breathlessness or dizziness.

FaintingFainting - although not always a serious symptom, fainting is - although not always a serious symptom, fainting is due to insufficient oxygen reaching the brain which may be due due to insufficient oxygen reaching the brain which may be due to many reasons, so you should report it to your doctor. to many reasons, so you should report it to your doctor.

Fluid retention or puffinessFluid retention or puffiness - (oedema to use the medical - (oedema to use the medical term) is abnormal accumulation of fluid in tissues such as term) is abnormal accumulation of fluid in tissues such as ankles, legs, lungs and abdomen. Although usually perfectly ankles, legs, lungs and abdomen. Although usually perfectly normal e.g. on a hot day, it can be a sign that the heart is not normal e.g. on a hot day, it can be a sign that the heart is not pumping as well as it should (heart failure). pumping as well as it should (heart failure).

Bluish tinged fingernails or around lipsBluish tinged fingernails or around lips - known - known medically as cyanosis - it can be a result of too little-oxygen medically as cyanosis - it can be a result of too little-oxygen in the blood. in the blood.

FatigueFatigue - fatigue is a very common symptom with - fatigue is a very common symptom with numerous causes including depression. It is always worth numerous causes including depression. It is always worth seeing the doctor if you feel unusually tired, especially if it seeing the doctor if you feel unusually tired, especially if it is combined with symptoms that can not be explained. is combined with symptoms that can not be explained.

Severe crushing chest painSevere crushing chest pain that may come on at rest and that may come on at rest and is accompanied by sweating, light-headedness, nausea or is accompanied by sweating, light-headedness, nausea or shortness of breath and lasts more than 15 minutes may shortness of breath and lasts more than 15 minutes may be a heart attack. Seek medical help immediately by be a heart attack. Seek medical help immediately by phoning 999 and asking for an ambulance. This will ensure phoning 999 and asking for an ambulance. This will ensure prompt treatment and less damage to heart muscle may prompt treatment and less damage to heart muscle may occur.occur.