Download Cardiovascular Disease (CVD)

Cardiovascular Disease (CVD)
Cardiovascular disease (CVD) also known as “heart and circulatory disease,” includes all the diseases of
the heart and circulation, such as, coronary heart disease (which can result in angina and heart attack,
caused by poor supply of blood to the muscles of the heart), heart failure, congenital heart disease, stroke,
heart valve disease and cardiomyopathy (a disease of the heart muscles) (British Heart Foundation, BHF).
The most common cause of CVD is reduced blood flow to the heart, brain or body resulting from the
build-up of plaques of fatty atheroma (a process called “atherosclerosis”), causing narrowing of the
arteries, or the formation of blood clots (thrombosis) which completely block the flow of blood.
There are a range of risk factors associated with CVD. Some are modifiable (which can be addressed
through lifestyle, environment and other changes), including smoking, air pollution, high alcohol
consumption, high cholesterol levels in the bloodstream, high blood pressure, being overweight or obese,
having diabetes, being physically inactive and mental stress; whilst others are fixed such as, age, gender,
ethnicity and family history (BHF). However, the World Health Organisation (WHO factsheet no. 317)
points out that behavioural risk factors (that can be changed) are responsible for about 80% of coronary
heart disease and cerebrovascular disease. For further information on CVD and its risk factors, refer to
the British Heart Foundation and World Health Organisation websites.
In 2011, almost 160,000 people in the UK died from CVD, including 74,000 deaths caused by coronary
heart disease, the UK's single biggest killer. During 2012, there were 131,659 deaths in England alone from
all circulatory diseases, which equated to a directly age standardized rate (DSR) of 277.94 per 100,000
population. This compares with rates of 268.3 per 100,000 for London and 299.6 per 100,000 for Enfield
(Health and Social Care Information Centre, HSCIC).
CVD Prevalence
Modelled Prevalence of CVD amongst those aged 16 and over, by London borough: 2011
Source: ERPHO Disease prevalence models, now part of the Public Health England (PHE) website
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Disease prevalence modelling from the Eastern Region Public Health Observatory (ERPHO), now part of
Public Health England (PHE), estimated that 23,837 people aged 16 and over had CVD in Enfield, equating
to 10.45% of the population aged 16 and over, in 2011. Enfield had the 8th highest modelled prevalence rate
of CVD across London, above the London average of 9.71%, but below the England rate of 11.76%.
Recorded prevalence for CVD is not available locally.
CVD mortality
Directly age and sex standardised mortality rate (DSR) per 100,000 registered patients, persons aged
under 75 years, London CCGs, 2013
Source: Health and Social Care Information Centre (HSCIC), Indicator Portal, National Statistics
During 2013, there were 140 premature deaths (aged under 75 years) due to all cardiovascular diseases in
Enfield, equating to a DSR of 61.5 per 100,000 population. This rate of premature mortality for CVD was
the 12th lowest amongst the London CCGs and lower than both the London (64.7 per 100,000) and
England (64.9 per 100,000) averages, although not statistically significantly lower.
CVD mortality is greater amongst men than women. During 2013, males in Enfield, London and England
had significantly higher premature mortality from CVD than their female counterparts. For example, CVD
mortality amongst men (aged under 75 years) in Enfield was 81.9 per 100,000, which was significantly
higher than for females (41.1per 100,000). However, the premature mortality rate from CVD was lower in
Enfield males, compared to males in London (88.4 per 100,000) and England (88.0 per 100,000), although
the differences were not statistically significant. In contrast, females in Enfield had a premature mortality
rate from CVD which was similar to the London rate (41.0 per 100,000) and only slightly lower than the
rate for England (41.8 per 100,000) (Health and Social Care Information Centre Indicator Portal, National
Statistics, 2014).
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Trend in the Directly Standardised Rate of mortality caused by cardiovascular disease, per 100,000 persons
under 75 years, in Enfield, London and England: 2009-2013
Source: Health and Social Care Information Centre Indicator Portal (Indicator Portal), CCG indicator 1.2 (NHS OF 1.1)
Between 2010 and 2011, under 75 mortality from cardiovascular disease (CVD) declined in Enfield, as well
as in London and England. However, in Enfield, premature mortality from CVD has increased since 2011, in
contrast to London and England, where figures showed a plateauing between 2012 and 2013. In 2013,
Enfield’s rate of under 75 mortality from CVD was 61.5 per 100,000, which was below the London average
(64.7 per 100,000) and the England rate of 64.9 per 100,000. It should be noted that these DSR figures
have been calculated using a new methodology and therefore may be different from the figures published
previously.
Deprivation is associated with CVD mortality. The all age mortality rate in 2009-11 for persons who live in
the most deprived areas of Enfield was 199.2 per 100,000. This is 1.3 times greater than the overall
mortality rate for Enfield and 1.7 times greater than the mortality rate for persons who live in the least
deprived areas of Enfield (Cardiovascular disease Local Authority health profile for Enfield).
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Directly standardised all-age mortality rate from CVD in Enfield by deprivation quintile, per 100,000
persons: 2009-2011
Source: Cardiovascular disease Local Authority health profile for Enfield, South East Public Health Observatory (SEPHO), now Public Health England (PHE)
Prevention and treatment of CVD
The National Institute for Health and Care Excellence (NICE) have produced a number of guidance
documents relating to the prevention, management and treatment of cardiovascular diseases. This guidance
covers a wide range of topics from hypertension through to stroke and can be accessed through the NICE
website.
Since April 2013, the NHS Health Check programme has been the responsibility of local authorities and
aims to help prevent: heart disease, stroke, diabetes, kidney disease and certain types of dementia.
All of the conditions covered by the NHS health checks fall within the cardiovascular disease family of
diseases. The programme aims to invite everyone aged between 40 and 74 (once every five years), who has
not already been diagnosed with one of the above conditions, to have a check to assess their risk for them
and to receive support and advice to reduce / manage that risk. This is a preventative programme designed
to help people stay healthier for longer and as such has considerable scope for preventing CVD through
earlier identification and management of its risk factors and/or early identification of the disease itself (see
NHS Health Checks website).
Further information
Cardiovascular Disease Outcomes Strategy
Cardiovascular Disease Profiles
NHS Atlases of Variation
British Heart Foundation
World Health Organisation factsheet no 317 on cardiovascular diseases
NICE guidance on cardiovascular conditions
NHS Health Check
Enfield Joint Strategic Needs Assessment – 2014
Reference
British Heart Foundation (BHF) website: Cardiovascular disease
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Cardiovascular disease Local Authority health profile for Enfield, South East Public Health Observatory
(SEPHO), now Public Health England (PHE)
Health and Social Care Information Centre (HSCIC) Indicator Portal, National Statistics, 2014
World Health Organisation (WHO): WHO factsheet no. 317 on Cardiovascular diseases (CVD), 2013
Page Updated: January 2015
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