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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 1 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). 2 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). 3 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 4 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 5