Stroke & Cardiovascular Disease JSNA

This section will focus on core epidemiological issues that take account of fixed risk factors (such as age, gender, ethnicity, family history) and modifiable risk factors (such as behaviour). The wider determinants of health (such as housing, transport and environment) are also considered.

Age

The NHS advise that CVD is most common in people over 50 and risk increases with age4.

In a study of 1,650,052 individuals newly diagnosed with at least one CVD, the mean age of the population was 70.5 years5.

Gender

• Men are more likely to develop CVD at an earlier age than women4.
• The Healthy Survey for England (2012-2017) found that men had higher rates of cardiovascular risk factors including smoking, hypertension, overweight and dyslipidaemia compared to women6.
• The gap closes as women reach menopause7. Women have a lower prevalence however are more likely to die from a heart attack than men and 50% more likely to receive an incorrect initial diagnosis after a heart attack8.
• There are female-specific conditions that elevate CVD risk including menopause, hypertensive disorders of pregnancy, premature menopause, polycystic ovary syndrome and autoimmune diseases 8, 9.

Socioeconomic status

• CVD is among the largest contributors to health inequalities and accounts for one-fifth of the life expectancy gap between the most and least deprived communities10.
• CVD incidence was significantly higher in lower socioeconomic groups after adjusting for age and sex in a study of 1,650,052 UK individuals between 2000 – 20195.
• People in the most deprived areas of England have higher rates of risk factors including smoking, obesity, physical inactivity, hypertension and diabetes. The death rate from CVD among people living in the most deprived areas under age 75 is twice the rate of those living in the least deprived 11, 8.

Qualifications

Lower educational attainment is associated with higher risk of coronary heart disease, stroke, myocardial infarction and cardiovascular disease when considered alongside BMI, systolic blood pressure and smoking behaviour12.

Mental health

The risk of cardiovascular mortality and sudden cardiac death is up to five-fold higher in patients with Severe Mental Illness (SMI) across both sexes, all ages and all ethnic groups. This is due to biological factors such as chronic inflammation, modifiable risk factors such as smoking and healthcare system factors such as stigma and discrimination13.

Ethnicity

Certain ethnic groups are more prone to specific cardiovascular conditions:

• South Asian individuals (Indian, Pakastani, Bangladeshi and Sri Lankan) have a higher risk of developing coronary heart disease and type 2 diabetes.
• African and Afro-Caribbean communities have higher incidences of hypertension8.

Comorbidities & Multimorbidity

• Around 80% of people with cardiovascular disease have at least one other health condition14.
• Individuals with pre-existing conditions such as diabetes, hypertension and high cholesterol are at higher risk as these conditions are risk factors for heart disease.
• Individuals who are overweight or obese face a higher risk due to the additional strain on the heart and an increased likelihood of associated conditions8.

Smoking & Alcohol

• Smoking increases the risk of developing heart disease as chemicals in cigarettes damage blood vessels, raise blood pressure and reduce the amount of oxygen in the blood which forces the heart to work harder 6, 8, 15.
• Excessive alcohol consumption raises blood pressure and can cause weight gain which both increase the risk of cardiovascular disease 8, 16

Family History

Family history significantly increases an individual’s risk as genetic factors can contribute to conditions such as high cholesterol and hypertension which are both major risk factors8.