Reasons for The Public Health Focus on Cardiovascular Disease

Cardiovascular disease (CVD) describes several diseases that have linked pathologies, commonly known as coronary heart disease (CHD), cerebrovascular disease, peripheral arterial disease, rheumatic and congenital heart diseases and venous thromboembolism (9,10). Often, same common risk factors lead to these conditions (9). Around seven million people in the United Kingdom (UK) are affected by cardiovascular disease (10). CVD is an ever-growing problem and cause of disability which affects individuals, families and communities (3). CVD accounts for one fourth of premature death in the UK and was responsible for 26% of all deaths in 2015 (10). It is expected that by the year 2020, CVD surpasses infectious disease as the World’s leading cause of mortality and morbidity (4). CVD presents a significant burden in terms of costs and health for the societies. National Health Service (NHS) in England spent more than £6. 8 billion on treating CVD (8). The highest expenditure was on secondary care with £4373 million spent on CVD following by primary care, the second highest setting for expenditure (8).

In primary care, most of the costs were due to prescribing (£1387. 5 million) (8). In addition to this, CVD causes productivity loses which are estimated as the earning lost because of CVD-related mortality and morbidity. In 2004, an estimated 135 988 working years were lost due to Coronary Heart Disease (CHD) deaths for a cost of £2. 96 billion (2). Furthermore, about 26 million work days were lost due to CHD‐related morbidity (2). It is claimed by the World Health Organisation that over 75% of premature CVD is preventable (6). Ameliorating risk factors can aid reduce the growing CVD burden on both individuals and healthcare providers (6). Strong agreement exists between guidelines regarding the importance of stop in smoking, having an optimum weight and importance of exercise (6, 9, 10). Whereas, there is a slight difference in guideline’s approach to hypertension and lipid profile (9). Profile of lipidIntimal disease of arteries within a range of size from the aorta down to nearly 3mm external diameter, is called atherosclerosis (7).

Animal studies suggest that regression of the proportion of the intimal surface occupied by plaques, which happens in atherosclerosis, can occur after plasma lipid concentration are decreased (7). The association of hypertension and cholesterol levels in development of CVD brings about the idea of screening and treatment thereof in otherwise healthy people, in order to cease atherosclerosis and prevent the occurrence of cardiovascular events (6). Early treatment suggestions were based on the levels of the specific risk factors, with antihypertensive treatment recommended for all the patients with a diastolic blood pressure above 105 mmHg (6,9). However, a modification then took place in preventive cardiology (6). Although hypertension guidelines remained the same, cholesterol treatment guidelines were replaced by a more sophisticated approach by moving further towards personalised treatment (6). This approach recommends pharmacological interventions based on the patient’s cardiovascular risk caused by presence of different risk factors (6).

Lifestyle and nutrients

Approximately up to 80% protection from cardiovascular disease has been confirmed with having a salutary lifestyle (5). Amongst lifestyle strategies for CVD prevention, nutrients play a considerable significant role (5). Therefore, modification in lifestyle is of supreme importance in population-based strategies for cardiovascular prevention (5,). Notably, better dietary quality is correlated with higher family income and education, thus, the public must be educated about the knowledge of cardiopretcive foods and diets (5,4).

Also, attempts should be directed to attempt to solve the issue of inequalities (5,4). Reduction in the amount of salt in foods can also contribute to CVD prevention, since salt consumption leads to hypertension which is a risk factor for CVD (10). Almost 4147 premature deaths can be prevented and £288 million can be saved to National Healthcare System in England per each gram of salt cut from average daily intake (10). In Compare to standard cardiovascular drugs and treatments, the dietary approach to CVD is more cost-effective. Because many of the prescriptions and procedures such as operations for treating CVD could be avoided by individuals if diet-focused strategies are implemented. Prevention at all levelsDue to substantial effect CVD has on social care system, investment in the most cost-effective interventions to prevent CVD from occurring is crucial (10,4,9). There are three levels of prevention (3). Primary level is to improve the overall health of the population whilst secondary and tertiary level is to improve the recovery and treatment (3). Upstream approaches tend to be inexpensive and more effective as well as involving less morbidity and mortality (3). Mortality and morbidity of the patients on waiting listImprovement in survival has led to high prevalence of people living with CVD and consequently, increase in the total number of operations carried out to treat CHD in the UK (8). This results in crisis on waiting list of patients demanding complex operations such as coronary artery bypass grafting (CABG) (1). Long waiting periods for CABG contribute to higher mortality and morbidity rates, particularly in patients with left ventricular malfunction (1).

For this reason, primary prevention of CVD events is recommended to prevent crisis on waiting lists.

Discussion

As CVD is increasing globally, it is important to understand the social and economic forces that disseminate the development of risk factors. The promotion of knowledge and the application of effective strategies, is critical to CVD prevention. It is important to analyse the effectiveness of the strategies by using the available data. This aids to recognise the practicalities of implementation. Also, to appreciate the efficacy of a strategy and the key challenges to be built on or addressed in prevention purposes.

The social determinants of health are necessary to help highlighting how social processes interact with different levels including CVD health on a global, national and individual. Importantly, intervention strategies can be tailored at an early stage, if disadvantaged groups can be identified. This can happen prior to the individual exhibiting the conventional risk factors which then can improve population health and reduces the burden placed on health care resources. It is important that scientific society and people organize, educate, advocate and convince policy makers to reduce the social and economic inequities to the minimum level. This then will decrease the social gradient of cardiovascular risk factors and consequently reducing CVD. Because of unhealthy present-day lifestyles, the burden of cardiovascular risk factors remains very high which justifies medical therapy in a considerable proportion of the population. Nevertheless, treatment with drugs comes with potential side effects and expenses (6). Therefore, regulators and policy makers should retain a healthy level of doubts regarding population-wide treatments. Current guidelines are moving further towards personalised treatment based on anticipated benefit to compensate the side-effects (6). Personalised medicine also offers saving in budget because it prevents from spending money on useless treatments that are not effective for specific groups of people. Recent eras have seen shift from risk factor-based approaches to approaches based on overall short-term and lifetime risk (6).

Conclusion

Cardiovascular diseases remain a leading cause of death and disability worldwide. Despite impressive improvement in treatment of acute cardiovascular conditions, initial manifestations of CVD are still often lethal or leads to long-time disability. Hence, priority should remain with optimal primary prevention. To deliver anticipated benefits expressed as gains in a life expectancy without CVD with specific treatment options, levels of risk factors, data on relative risk cut achieved from clinical trials and information on demographics should all involve in providing inform models. Specific treatment options also mean more informed treatment decisions by patients which can empower them to be effective advocates for their health. Similarly, anticipated harms caused by the risks associated with drug treatment can be estimated as well.

Furthermore, such data can be used by healthcare policy makers to project charges and benefits of treatment and so set acceptable treatment thresholds. Clinical practical guidelines are expecting to evolve from treatments based on risk factors to risk-based treatment and beyond that to treatment which fully consider the anticipated benefit. Yet more new strategies will emerge in that regard. Throughout this process it is important that all the care providers in both primary and secondary healthcare level and researches, continue to prioritise the time and resources to offer preventative strategies to people who are healthy and free from CVD and irrespective to the preventive measures, focus on secondary solutions and ways of improving them.