This blog is part of a wider project on cardiovascular disease. The work for this project has been sponsored by Daiichi Sankyo and Edwards Lifesciences. The associated report, which will be published in November 2022, has been independently developed, researched and written by The King’s Fund. The sponsors have not been involved in its development, research or creation and all views are the author’s own.
Between the 1970s and early 2000s, there were dramatic falls in the number of people dying from cardiovascular diseases (CVDs)1 globally, a result of lifestyle changes and medical advances. This has driven unprecedented improvements in life expectancy. The number of people dying of CVDs in the UK fell by almost 70 per cent between 1980 and 2013. Given these spectacular declines, some consider the subsequent slowdown in the rate of improvement as inevitable. But does this mean the job of tackling CVDs is done? The evidence suggests not by a long margin and The NHS Long Term Plan identifies CVDs as ‘the single biggest area where the NHS can save lives over the next 10 years’.
Much of the ill health and many of the deaths associated with CVDs are potentially preventable – by modifying risk factors and the use of readily available evidence-based, cost-effective interventions and treatments. Moreover, the risk factors for CVDs, for example, smoking, obesity, inadequate physical exercise, excess alcohol consumption, are also risk factors for cancer, diabetes, dementia and Alzheimer’s disease, liver disease and other long-term conditions. So, tackling CVDs gives many ‘bangs for your buck’ in terms of improving population health, and reducing health inequalities, NHS and social care workloads and costs. Reducing risk factors for CVDs should be a priority for national and local leaders.
In the years leading up to the Covid-19 pandemic, CVDs were among the leading causes of death in England, accounting for one in four of all deaths and premature deaths (in people aged under 75), but in 2020 and 2021, Covid-19 took over as the leading cause of death (see Figure 1). In 2022, Covid-19 deaths have fallen – in part due to the vaccination programme and higher levels of population immunity – and CVDs, including heart disease and stroke, have once again become some of the leading causes of death.
*Ischaemic (or coronary) heart disease and cerebrovascular diseases (a leading cause of stroke) are major components of CVDs.
Far from the job being over, the pandemic has added further urgency to the case for tackling CVDs. People with a CVD or associated risk factors (eg obesity, diabetes, hypertension) have a four-fold higher risk of severe Covid-19 and three-fold higher risk of dying from Covid-19. Moreover, these conditions contributed to the deaths of about 75 per cent of people who died of Covid-19 in 2020 and 2021 in England and Wales. The need for health systems in high-income countries to tackle CVD in the post-Covid era is widely recognised.
Clearly, CVDs have a very significant effect on the number of people that die each year – both as a direct result of having a CVD and, in recent years, because having a CVD significantly increases the risk of dying from Covid-19. Reducing the prevalence of CVDs and co-morbidities could, therefore, mitigate the adverse health impacts of ‘living with Covid’ and is also vital because the virulence and deadliness of further mutations of the virus are unpredictable.
It’s also important to continue to tackle CVDs because they are a major contributor to health inequalities. CVDs account for about one-fifth of the nine-year gap in life expectancy between most- and least-deprived areas in England, and, compared with the white population, mortality rates from CVD and diabetes are significantly higher in South Asian and Black groups. Moreover, Covid-19 has significantly exacerbated the large pre-existing socio-economic and ethnic health inequalities.
CVD adds significantly to NHS and social care workloads and costs, and wider economic costs to society and loss of productivity. For example, social care for stroke survivors costs the UK economy £5.2 billion annually, and the overall health care costs of CVDs in England are estimated at £7.4 billion annually, with an annual cost to the wider economy of £15.8 billion. Reducing the prevalence and impact of CVDs can therefore significantly reduce health and care workloads and costs, and wider societal costs – locally and nationally.
The pandemic has caused significant disruption to the prevention, diagnosis and treatment of CVDs, leading to a sharp increase in the number of people with unmet cardiovascular care needs. For example, GP consultations, referrals, elective procedures and emergency admissions for CVD fell by 40–50 per cent in 2020, and NHS health checks by more than 90 per cent. The backlog in cardiovascular care means, for example, large numbers of people with high blood pressure or raised cholesterol levels going undiagnosed because routine checks and tests were missed. It’s estimated that almost half a million fewer people across England, Scotland, and Wales began treatment for high blood pressure from March 2020 to May 2021 compared to 2019. An estimated 320,000 people in England were waiting for heart tests and treatment, including surgery, in April 2022. Added to which, about two-thirds of adults are overweight or obese and some behavioural changes during the pandemic could increase the risk of CVDs, eg, the rise in excess alcohol consumption.
The international context reinforces the case for tackling CVD. Life expectancy in the UK compares unfavourably with comparator countries, especially for women. Moreover, although improvements in life expectancy in many high-income countries slowed markedly in the pre-pandemic decade, the slowdown was most marked in the UK. The slowdown in CVD mortality improvements was a significant contributor to these trends. The pandemic caused life expectancy in 2020 to fall across most OECD countries, but the fall in life expectancy in the UK was larger than in most comparator countries, worsening the UK’s position relative to other countries. Reducing mortality from CVDs therefore has the potential to improve the UK’s international standing on life expectancy.
As integrated care systems (ICSs) and their place-based partnerships with a range of local organisations develop, there are new opportunities for improving population health and reducing health inequalities. Their agendas and priorities will be informed and shaped by the health needs of their local populations. Given the significant potential for improving overall population health and life expectancy, reducing health inequalities, and decreasing workloads and costs for health and social care services, reducing the prevalence and impact of CVD should be among the urgent priorities for consideration.
The King’s Fund is working on a project aimed at government, national bodies and ICSs including local government that will make the case for prioritising the prevention and management of CVDs, provide information to inform strategic decision-making, and outline how progress on reducing CVD morbidity and mortality can be accelerated within the new system structures – positioning this as a critical part of Covid-19 recovery plans. Our report will be published in November 2022.