Britain at top of heart disease league

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Britons are ignoring advice on the prevention of heart disease which has pushed the country to the top of the heart deaths league, a group of experts said yesterday.

The United Kingdom and Ireland have the worst heart disease death rates in the Western world, having overtaken the United States, Australia and Scandinavia.

One in four men and one in five women die of the disease, which is the single commonest cause of death. Only the emerging countries of Eastern Europe and Russia have a higher toll. The Mediterranean region and Japan - all countries with diets which have been associated with good health - have the lowest rates.

There has been a worldwide fall in heart deaths since the 1970s (with the exception, again, of Eastern Europe) attributed to the fall in smoking and changes in diet. However, the decline in the UK - at 30 per cent - has been slower than in other countries and the burden of disability caused by the disease is rising.

Professor Desmond Julian, chairman of the National Heart Forum, an alliance of medical organisations that is calling for a new strategy to combat heart disease, said countries such as Australia and the US had tackled the problem with greater vigour and commitment and reaped greater success.

"Our world is changing - the population is ageing, work patterns are changing and although the disease is still the leading cause of death among the whole adult population, heart disease inequalities are becoming more marked. In this context it is clear that prevention strategies must be re-fashioned," he said.

Professor Gerry Shaper, vice-chairman of the forum, said that the main causes of heart disease - diet, smoking and lack of exercise - had been known for more than 20 years and there was no new research likely to alter that view. Infection, nutrition in the womb, genes and stress might all have a role, but were not significant compared with the main factors.

"We have no mystery on our hands. There is no holy grail waiting to be discovered. I gravely doubt there is any new evidence to emerge which will challenge the existing model on which we work. Even those who are researching these new areas do not expect it."

Professor Shaper said claims that the traditional risk factors could explain only half of heart disease were rubbish. "That bald statement based on inadequate research has been repeated ad nauseam for 20 years. It drives me mad. Heart attacks do not come out of the blue. More than 90 per cent of them have at least one factor - raised blood pressure, raised cholesterol or smoking - which at least doubles the risk."

Scientists needed to sign up to the basic thesis, rather than squabbling over the finer points, to persuade the population to take advice on diet, smoking and exercise seriously. "The average diet is a disaster and the average level of physical activity is totally inadequate. We need to make dramatic changes, not just fiddle around at the edges," he said.

Professor Sir Michael Peckham, the Government's former head of medical research, said the threefold difference in heart death rates between the top and bottom socioeconomic groups, which had emerged only in the past 25 years, was "quite unacceptable." As chairman of a select committee of the forum set up to consider prevention policies, he said heart disease could be used as a Trojan horse to test the effectiveness of government policies to tackle health inequalities.

He called for a public health agency to monitor the impact of government policies in housing, transport and welfare on health.