Cardiovascular disease: primary care intelligence packs

Data and analysis of cardiovascular disease (CVD) prevalence, variation, treatment and outcomes in clinical commissioning groups (CCG) areas | Public Health England

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Image source: PHE

Healthcare professionals can use this resource to check the prevalence, variation and treatment of cardiovascular conditions in the local area. This can help with planning, commissioning and improving local services.

The pack uses GP practice data on prevention, detection and management across a range of cardiovascular conditions:

  • high cardiovascular risk and hypertension
  • stroke and atrial fibrillation
  • diabetes
  • kidney disease
  • coronary heart disease and heart failure

The pack has a chapter for each of these conditions with:

  • a narrative that explains the case for prevention and suggestions actions
  • data that show the variation between local practices and between demographically similar clinical commissioning group (CCG) areas

The data also identifies the number of undiagnosed and inadequately treated people in the local area.

Read the Rotherham intelligence pack here

Behaviour change interventions for primary prevention of cardiovascular disease

It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care | BMJ Open

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Background: A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness.

Conclusions: MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions’ rationale, content and delivery is essential to understanding their effectiveness.

Full reference: Alageel, S. et al. (2017) Multiple health behaviour change interventions for primary prevention of cardiovascular disease in primary care: systematic review and meta-analysis. BMJ Open. 7:e015375. 

Physical Inactivity

Report from The British Heart Foundation (BHF) suggests that large numbers of people in the UK are still failing to meet recommendations for physical activity, putting them at greater risk of heart and circulatory disease.

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The British Heart Foundation has published Physical Inactivity Report 2017. This report provides an overview of the levels of physical inactivity and sedentary behaviour in adults across the UK.

The Government recommends that adults undertake at least 150 minutes of moderate intensity physical activity a week and strength activities on at least two days a week . It is also recommended that adults minimise their levels of sedentary behaviour.
The data in this report suggests that large numbers of people in the UK are failing to meet these recommendations for physical activity.

The statistics also show that levels of sedentary behaviour in the UK remain high. This is of particular concern as evidence is growing which shows that sedentary behaviour  – time in which energy expenditure is very low – is an independent risk factor to physical inactivity.

The impact of physical inactivity and sedentary lifestyles also weighs heavily on UK healthcare, estimated to cost as much as £1.2 billion a year.

The report suggests that making physical activity easier and more accessible for all is of paramount importance if we are to reduce the burden of inactivity-related ill health and improve the future cardiovascular health of our population.

Read the full report: Physical Inactivity and Sedentary Behaviour Report 2017

Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular diseases

The Cochrane Database of Systematic Reviews has published ‘Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular diseases’.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability worldwide, yet ASCVD risk factor control and secondary prevention rates remain low. A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill, or polypill, has been proposed as one strategy to reduce the global burden of ASCVD.

This study aims to determine the effect of fixed-dose combination therapy on all-cause mortality, fatal and non-fatal ASCVD events, and adverse events. The researchers also sought to determine the effect of fixed-dose combination therapy on blood pressure, lipids, adherence, discontinuation rates, health-related quality of life, and costs.

The authors concluded that the effects of fixed-dose combination therapy on all-cause mortality or ASCVD events are uncertain. A limited number of trials reported these outcomes, and the included trials were primarily designed to observe changes in ASCVD risk factor levels rather than clinical events, which may partially explain the observed differences in risk factors that were not translated into differences in clinical outcomes among the included trials. Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo, active comparator, or usual care but may be associated with improved adherence to a multidrug regimen. Ongoing, longer-term trials of fixed-dose combination therapy will help demonstrate whether short-term changes in risk factors might be maintained and lead to expected differences in clinical events based on these changes.

Read more here

Disadvantaged women at greater risk of heart disease than men

Women from low socioeconomic backgrounds are 25% more likely to suffer a heart attack than disadvantaged men. | OnMedica | Journal of Epidemiology and Community Health.

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In a review of 116 studies, researchers from The George Institute for Global Health examined data from 22 million people from North America, Europe, Asia and Australasia and found, as expected, that markers of a lower socioeconomic status (education, occupation, income or area of residence), compared to a higher, are associated with a higher risk of cardiovascular disease for both sexes.  However, the results also showed women from more disadvantaged backgrounds were relatively more likely to suffer from coronary heart disease than men from similar backgrounds.

Read more at OnMedica

Full reference: Backholer K, Peters SAE, Bots SH, et al. Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis. Journal of Epidemiology and  Community Health, published online first 14 December 2016

Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease

Khera, A.V. et al. NEJM. Published online: 13 November 2016

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Image source: Bill McConkey – Wellcome Images // CC BY-NC-ND 4.0

Background: Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.

Methods: Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts — 7814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women’s Genome Health Study (WGHS), and 22,389 in the Malmö Diet and Cancer Study (MDCS) — and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

Conclusions: Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle.

Read the full article here

Cardiovascular disease: getting serious about prevention

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This series of slides highlights the work done by PHE and partners, and makes the case for the steps to be taken around prevention in the future.

This publication brings together Public Health England’s (PHE’s) broad-ranging work in addressing cardiovascular disease, the second leading cause of premature death and ill health. It sets out the main programmes already underway and the next steps in tackling cardiovascular disease going forward.

The publication is intended for those involved in the commissioning and provision of services for cardiovascular disease and its prevention, including:

  • clinicians
  • local authorities
  • service commissioners
  • public health specialists
  • the third sector
  • PHE staff

Access the full document:  Action on Cardiovascular disease: getting serious about prevention