Britain: The sick heart of Europe

Heart disease, the most preventable health threat facing Britain today, is costing the economy £29bn a year.

Rising rates of obesity, an ageing population and the soaring prescription bills for heart drugs such as statins mean that the bill is likely to rise in the future.

In the first study of its kind to calculate the financial burden of cardiovascular disease (CVD), analysts found that the UK is spending more healthcare money on the condition than any other European country. They said that more effort and money should go into preventing CVD through diet and exercise rather than current policies which have focused on improving access to drugs. In Britain, more people die of coronary heart disease and strokes than cancer.

Peter Weissberg, medical director of the British Heart Foundation, said: "This study should stimulate policy-makers to reconsider public health measures to reduce the massive burden of cardiovascular disease in the UK.

"The unfortunate thing is that we know much of this disease burden could be reduced or even abolished with appropriate public health measures such as reducing smoking, increasing opportunities for exercise and improving the nation's diet.

"Although it might be expensive to provide facilities such as playing fields and gyms, today's research shows that it is much more expensive not to."

Britain has one of the world's highest rates of CVD, which covers a range of illnesses including coronary heart disease, strokes, angina and hypertension. Researchers from the Health Economics Research Centre at Oxford University calculated that the NHS spent £15.7bn on treating CVD in 2004 - 21 per cent of the entire health service budget. Germany spends 15 per cent of its health budget on CVD while France spends just 8 per cent.

Almost 70 million working days were lost due to the diseases and, with other costs to productivity, this added up to £7bn.

When the economic burden of informal care for people with CVD by their relatives was included, along with other factors such as private healthcare bills, the total cost to the UK was £29.11bn a year. The study, published in the medical journal Heart, concluded: "Our study highlights the public health problem CVD poses in the UK in terms of economic burden."

The Government has pledged to reduce deaths from coronary heart disease by 40 per cent by 2010. Heart deaths fell by 7 per cent in 2004 and experts say progress is being made on treating the diseases but not enough is being done to prevent them.

In an accompanying editorial to the Heart study, Dr Georgias of the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority warned that the costs of CVD were likely to rise, despite the falling death rate.

He said that rising rates of obesity and the associated increase in adult-onset diabetes will both impede the progress being made on heart disease and strokes.

Only a third of men and a quarter of women take the recommended level of exercise and more than half of adults are overweight or obese.

The fall in deaths has been achieved mainly through a massive rise in the prescribing of the cholesterol-lowering drugs, statins. Thirty million prescriptions for the drugs were written in 2004 - double the number in 2001. Medicines for CVD account for £2.77bn of the £15.7bn spent by the NHS and are second only to in-patient hospital stays in terms of healthcare costs.

Statins cuts the risk of a heart attack by up to 30 per cent, but health experts are worried that many people are simply popping pills to manage heart disease rather than changing their unhealthy lifestyles.

Keith Jackson, chairman of the British Cardiac Patients Association, said: "People could do more to manage heart conditions and prevent heart disease through having a better diet and more exercise. Statins are a poor alternative and should not be seen as a fallback. We need a greater emphasis on preventative measures when tackling cardiovascular disease, and need to get the message across that this improves quality of life."

But Dr Shyam Kolvekar, cardiac surgeon at University College Hospital, London, believes that younger people are more aware of protecting their health.

"People in their twenties and thirties are more image conscious and spend more time exercising, while the people we are treating now are older," he said. "We are on track to deal with heart disease but the effects of the changing patient population and the use of statins will not be seen for another 10 years.

"We are getting more proactive so all patients who come in for surgery, even if they do not have high levels of cholesterol, will be given statins.

"If a patient with heart disease is treated well, they will be able to play a functioning part in society - they can continue to work and lead a full life."

A spokeswoman for the Department of Health said that reducing heart disease was a "top priority" for the Government and death rates had fallen by 31 per cent between 1997 and 2004.

Roy Banks: 'It started with a crushing sensation in my chest'

By Geneviève Roberts

Roy Banks, 56, is retied and lives in Solihull with his wife Carol. He has two children, Ann-Marie, 26, and Christopher, 27. He was diagnosed with heart disease eight years ago after he collapsed. Two years ago he was diagnosed with an abdominal aortic aneurysm.

"It started with a crushing sensation at the centre of my chest and the pain radiated across my neck and down my arms as I struggled for breath,' he said. "I would collapse regularly - in the middle of a meeting in our open -plan office at work, as I was queueing for a cashier at the bank, while waiting at the airport to go on holiday."

As the attacks became more regular, Mr Banks was given an angiogram, which revealed that his arteries had narrowed. This led to a coronary angioplasty - surgery where stents are inserted into the arteries to widen them - at Heartlands Hospital in Birmingham.

His lifestyle has changed drastically. "I was a project leader for a power company, earning £50,000 a year, but I had to retire because of the amount of time I was taking off," he said. "Now I receive less than £20,000 in pension, disability and incapacity benefits. The only work I do is voluntary, for the Commission for Patient and Public Involvement in Health, and I miss the buzz of worklife.

"I eat less fatty food. I have cut down on sugar and eat more fruit and vegetables. Walking the dog used to be my wife's job, but is now shared, and I walk around town rather than taking the bus."

The disease has affected his family's lives too. "My wife had to give up her job as a retail assistant to look after her mother and me. I have been in and out of hospital so much that my son and daughter always have a second of worry when they receive a family phone call."

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