Heart disease prevention

Current situation

  • CHD remains the principal cause of death in the UK and a fifth of these deaths occur  in individuals below retirement age. 
  • The use of statins and other medications for secondary prevention of CHD has been shown to have increased since the NSF for CHD was produced (BMJ 2006; 332: 144–5). However, considerable opportunities remain for improving secondary prevention of CHD, especially in older patients.

What is the evidence?

  • Many more patients need aspirin and statin as new guidelines are produced. One study has shown that patients at high risk of cardiovascular disease are often not being treated adequately, not only with aspirin and statins, but also not being adequately treated for their hypertension (JAMA 2006; 295: 180–9).
  • A large cohort study has found that obese people had a markedly increased risk of CVD compared with people of normal weight (Eur Heart J 2006; 27: 96–106). Perhaps weight should be incorporated into the cardiovascular risk tables.
  • A Scottish study has shown that many patients may actually be having their cardiovascular risk underestimated (BJGP 2005; 55: 838–45). Risk was underestimated for people from lower socio-economic class and those living in deprived areas. This might mean therefore that even more people would benefit from aspirin and statins.
  • A recent paper echoes results from a study published several years ago showing that patients who had high to normal blood glucose levels were at a greater risk of eveloping CHD than those with low to normal levels (Am Heart J 2005; 150: 209–14).
  • A study has demonstrated that the benefits of using ACE inhibitors for elderly patients after an acute MI are a class effect rather than being unique to ramipril (Am J Cardiol 2006; 98: 6–9).
  • A European study has shown that moderate levels of physical activity can lower a person’s risk of CHD events, irrespective of other coronary risk factors (Eur Heart J 2007; 28: 492–8).

Implications for practice

  • Government initiatives favour risk factor reduction in CHD patients (secondary prevention); but population-based primary prevention (risk factor reduction in apparently healthy people) is likely to be more powerful.

Available guidelines

  • Secondary prevention of CHD is an important component of the NSF for CHD.

Useful websites

www.statistics.gov.uk — National Statistics

www.bcs.com — British Cardiovascular Society

www.pccs.org.uk — Primary Care Cardiovascular Society

www.bhsoc.org — British Hypertension Society 

Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for MRCGP and General Practitioners’ PasTest 2006

Key points

  • CHD incidence is reducing in the UK.
  • The use of statins and aspirin is increasing.
  • Obesity is a very important risk factor.
  • Exercise is beneficial.

 

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