Lifestyle and Risk - Cardio Vascular Disease (CVD) or Coronary Heart Disease (CHD)

Alcohol | Diet | Physical Activity | Weight | Psychosocial | Blood Pressure |  Cholesterol | Diabetes

Smoking
It is estimated that smoking causes over 30,000 deaths a year from CVD in the UK. Secondhand smoke is also harmful to cardiovascular health. Regular exposure to secondhand smoke increases the risk of CHD by around 25%.

Until recently the proportion of adult cigarette smokers had been decreasing rapidly but the decline has now levelled off with the rate remaining relatively stable since the early 1990s. About 26% of men and 23% of women in Britain still smoke cigarettes. In both men and women the proportion of adults who smoke is highest in those aged 20-34 years, with rates declining steadily with age.

Cigarette smoking is more prevalent among manual social groups than nonmanual groups – 31% of men and 28% of women in manual households smoke compared with 22% of men and 19% of women in non-manual households. Smoking rates vary considerably between ethnic groups in the UK and are particularly high (40%) in Bangladeshi men. Over the last 25 years in the UK, adults smoking rates have been consistently highest in Scotland.

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Diet
One reason why CHD rates are high in the UK is because the average diet is so unhealthy. In particular fat intake - especially of saturated fat - in the UK is too high, and fruit and vegetable consumption is too low. Salt intake is also well above recommended levels.

In adults, the percentage of total energy derived from fat in the UK diet is falling, but only gradually, from about 40% in the mid 1970s to around 37% now. The type of fat eaten has changed with the percentage of total energy derived from saturated fat falling from around 19% to around 15%. However, around six out of seven adults (88% men and 83% women) consume more than the recommended levels of saturated fat. The consumption of fresh fruit has risen four fold since the 1940s but vegetable consumption has declined.Overall, only 13% of men and 15% of women in Great Britain currently eat the recommended number of portions of fruit and vegetables.

In recent years the consumption of salt has increased and average daily consumption is currently around 11g in men and 8g in women,well above the recommended maximum of 6g per day. UK dietary statistics also show marked social class differences in the consumption of fresh fruit and vegetables with adults on lower incomes and on benefits consuming less than those on higher incomes or in non-benefit households.

Eating habits in children are also poor. Only 13% of children consume the recommended daily intake of five servings of fruit and vegetables and average salt intakes are well above recommended levels.The National Fruit Scheme aims to increase fruit consumption in children. Since 2004, all children aged 4-6 in school in England, are given a free piece of fruit daily. Amongst minority ethnic groups, Chinese, Indian and Pakistani men and women have the highest levels of consumption of fresh fruit and vegetables.

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Physical Activity
Being physically active lowers the risk of CHD. The activity needs to be regular, of moderate intensity and rhythmic such as brisk walking, dancing or cycling. It is recommended that adults should aim for at least 30 minutes of moderate activity on five or more days of the week.

The Health Survey for England shows that only 37% of men and 24% of women in England are active at this level. Activity declines rapidly with age with only 17% of men and 13% of women aged 65-74 meeting the recommended levels. Over the last 25 years, levels of physical activity have declined in the UK. In England the average number of miles per capita travelled each year by foot have fallen by around a quarter, and by cycle by around a third since the mid 1970s.Over the same period the annual number of miles per capita travelled by car has increased by 70%.

Evidence on more recent trends in physical activity levels comes from Health Survey for England data.These suggest that between 1997 and 2004 there have been small increases in physical activity levels for men and women at all ages. Children are recommended to participate in moderate intensity activity for at least an hour a day. In England 70% of boys aged 2-15 and 61% of girls are active at this level. Rates decline steeply in girls after the age of 10 years, with only 50% active at the recommended level by the age of 15.

In 2005, Choosing Health: a physical activity action plan,was published, outlining the key commitments relating to physical activity contained within the White Paper Choosing Health, as well as further activity across government, which aims to increase levels of physical activity in adults and children in England. An ambitious target for physical activity in England has been proposed by the Government’s Strategy Unit: to more than double the current proportion of adults participating in 30 minutes of moderate activity on five or more days a week to 70% by 2020.

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Overweight and Obesity 
Overweight is associated with raised blood pressure, raised blood cholesterol, noninsulin dependent diabetes and low levels
of physical activity.Overweight individuals therefore have an increased risk of CHD. About 44% of men and 35% of women are overweight (have a body mass index of 25- 30kg/m2) in England and a further 23% of men and 24% of women are obese (a BMI of more than 30 kg/m2).

Overweight and obesity are also common in children.Over a fifth of boys and more than a quarter of girls aged 2-15 years in England are overweight or obese. Overweight and obesity increase with age. In England over three-quarters of men and two-thirds of women age 65-74 years have a BMI above 25kg/m2.Obesity is also more common in adults employed in
lower supervisory, semi-routine and routine occupations, particularly in women. The adverse effect of excess weight ismore pronounced when fat is concentrated mainly in the abdomen (known as central obesity). Around a third of men and women in England have central obesity. This is more common in adults employed in semi- routine and routine occupations, especially women, and in Bangladeshi women.

The percentage of people who are overweight or obese is increasing rapidly. In England, the percentage of adults aged 16-64 years who are obese has increased by 50% in the past decade. This increase in obesity is particularly marked in men, among whom rates have tripled since the mid 1980s,with men now as likely to be obese as women.There has also been a steady increase in the prevalence of obesity in children,with rates in England doubling in boys and increasing by 30% in girls between 1995 and 2002.

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Alcohol
Moderate alcohol consumption (one or two drinks per day) is associated with a reduced risk of CHD. At high levels of intake – particularly in "binges"- the risk of CHD is increased.The government recommends daily sensible drinking benchmarks of no more than 4 units of alcohol in men and 3 units in women. In addition men should not drink more than 21 units a week and women no more than 14 units a week.Overall 39% of men and
22% of women in Great Britain consume more alcohol than the daily recommended limits.

Slightly lower proportions, 27% of men and 17% of women, drink more than the weekly recommended levels. In the last 10 years the proportions rose by over 50% in women but remained stable in men. Alcohol consumption is higher in younger age groups. Binge drinking is highest in the 16-24 year age group with 32% of young men and 24% of young women binge drinking at least once a week. In both men and women, the highest rates of binge drinking are found in the North West and Yorkshire and the Humber. Adults from all ethnic minority groups, with the exception of the Irish, are less likely to drink alcohol, and much less likely to drink more than the recommended levels than the general population.

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Psychosocial Well-being
A number of psychosocial factors are associated with an increased risk of CHD. These include inadequate social support or lack of social networks,work stress (especially employment which combines high demands with low control), depression (including anxiety) and personality (particularly hostility). In England, 17% of men and 10% women report a severe lack of social support. Men and women in semi-routine and routine jobs are more than twice as likely to report this lack of social support
compared to those in managerial or professional employment. Adults from the South Asian and Chinese communities are around twice as likely to report a severe lack of social support. In England, 15% of women and 11% of men have high levels of psychological distress as measured by the General Health
Questionnaire (GHQ12).

People on low incomes, those aged over 75 years, and adults from the Pakistani and Bangladeshi communities are more likely to report high GHQ12 scores.

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Blood Pressure 
Risk of CHD is directly related to both systolic and diastolic blood pressure levels. In adults aged 40-69 years, each 20mmHg increase in usual systolic blood pressure or 10mmHg increase in diastolic blood pressure, doubles the risk of death from CHD.

The 2004 British Hypertension Society guidelines recommend that drug treatment should be considered for individuals with blood pressures of 140/90mmHg or over, and that optimal blood pressure treatment targets are a systolic blood pressure of less than 140mmHg and a diastolic blood pressure of less than 85mmHg (and lower still in people with CVD or diabetes).
The significance of raised blood pressure as a leading risk factor for CVD was highlighted in the recent WHO World Health Report 2002. Raised blood pressure was identified as the second most
important cause of death and disability in developed countries, exceeded only by tobacco.

Blood pressure levels are high in the UK. In England, 34% of men and 30% of women have raised blood pressure (more than 140/90mmHg) or are being treated for raised blood pressure.The prevalence of high blood pressure increases with age in both men and women. Around fourfifths (78%) of men and two-thirds (67%) of women with raised blood pressure are not
receiving treatment.Of those that are treated, just under 60% remain hypertensive.

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Blood Cholesterol 
Risk of CHD is directly related to blood cholesterol levels. Blood cholesterol levels can be reduced by drugs, physical activity and by changes in the diet, in particular a reduction in saturated fat consumption. The average blood cholesterol level for men is about 5.5 mmol/l and for women 5.6 mmol/l. About 66% of men and women have blood cholesterol levels above 5.0 mmol/l. These percentages increase with age in both men and women. Blood cholesterol levels in England are high by international
standards, especially in women.

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Diabetes
Diabetes substantially increases the risk of CVD and CHD. Men with Type 2 diabetes have a two to fourfold greater annual risk of CHD, with an even higher (three to fivefold) risk in women with Type 2 diabetes. Over 4% of men and 3% of women in the UK (around 1.9 million people) have diagnosed diabetes. However not all diabetes is diagnosed.

The Health Survey for England estimates that in addition, 3% of men and 1% of women aged 35 and over (around 600,000 people) have undiagnosed diabetes. Prevalence increases with age: those aged 65-74 are at least 10 times as likely as those aged 25-34 to have the disease.The prevalence of diagnosed diabetes in Black Caribbean men and women, Indian men and Pakistani women is more than double that found in the general population. As in many countries worldwide, diabetes is increasing in England. Since 1991, the prevalence of diagnosed diabetes has more than doubled in men and increased by 80% in women. It is estimated there will be about 3 million people with diagnosed diabetes in the UK by the year 2010.

^{Courtesy of 'The British Heart Foundation'}

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