September 15, 2008
Prevention Better Than Cure As We Try to Keep a Lid on Heart Disease
By Professor Julian Halcox
MAJOR advances have been made in the treatment and prevention of heart disease over the past few decades, resulting in a progressive fall in the number of people suffering and dying from conditions such as heart attack and stroke.
But a worrying increase in the number of overweight or obese people - particularly children and young adults - is set to reverse these trends.
If this is not dealt with effectively, we look set to see a resurgence of these largely preventable yet devastating diseases.
Heart attacks and strokes usually happen as a result of a disease called atherosclerosis, which is a condition that results in a hardening and build-up of fatty deposits (plaques) in the walls of the main arteries. These plaques will eventually cause blockages that prevent the flow of blood through the vessels.
Extensive research, including very large clinical trials carried out in thousands of patients, has led to a better understanding of the disease process and development of effective treatments.
These include medicines such as aspirin, which make blood less sticky and prone to block a diseased vessel; drugs that lower cholesterol and blood pressure, and balloon procedures or bypass surgery that restore blood flow to the heart, to name but a few.
In addition, one of the most simple and important reasons for this fall in heart disease deaths in the UK has been due to a steady reduction in the number of people who smoke.
New laws to reduce the harmful effects of passive exposure to tobacco smoke should also result in further benefits to the health of our nation's hearts.
This is highlighted by a recent Scottish study showing a 17% fall in the number of patients admitted to hospital with heart attacks and acute angina since the introduction of legislation banning smoking in public places.
But all is not rosy. Recent population studies from the UK and United States have worryingly shown that despite all this medical progress, the death rate from coronary heart disease in middle-aged men and women is no longer falling.
In fact, the situation is worsening for American women in their 30s and 40s, who are more likely to die of a heart attack now than they were 10 years ago. The UK is also heading this way.
The big question is why? The answer is almost certainly the obesity epidemic.
The unprecedented increase in the numbers of overweight and obese people in the UK is certainly no secret.
Welsh children are among the most overweight in Europe, and numbers of overweight and obese children appear to be doubling every 10 years or so.
Wales was recently named and shamed as the fattest nation in the UK.
This is likely to have a huge impact on the long-term risk of heart disease. People who are overweight and obese tend to have higher blood pressure, higher cholesterol levels, stickier blood and a strong tendency to develop diabetes.
All of these factors promote the changes in the arteries that eventually lead to heart attack and stroke and the earlier these risk factors emerge the earlier this progressive damage begins.
We know that prevention is better than cure, and the best way to try to tackle this big problem is to try stopping people becoming overweight in the first place.
The greatest opportunity is to begin in childhood where lifelong behaviour patterns are learned but also potentially most open to influence.
Recent research has shown that school and family-based programmes aimed at increasing physical activity and healthy eating are more likely to be successful at promoting weight loss and healthy weight maintenance than simply focusing on individual children.
We need to do more as a society to make the healthy choice the easy and enjoyable choice by promoting initiatives such as increased physical activity in schools and the workplace, town planning to increase walking and safe cycling and developing food and nutrition policy to improve education, labelling and availability of affordable, healthy food.
These are all issues at the forefront of the Welsh Assembly Government's health agenda, which has supported several programmes including Health Challenge Wales, healthy local food co-operatives, the school cooking bus and support for the Big Lottery Fund's Way of Life initiative.
These are all excellent signs of progress but we still have a long way to go.
It is vital that we measure and compare how well future initiatives influence levels of obesity and risk factors for heart disease to ensure that we make the wisest investments in our young people's future health.
The medical profession will need to continue to increase its efforts to tackle obesity and its complications, but is really only in a position to deal with those with the worst problems.
Far greater progress is likely to be made by us tackling the problem effectively as a society.
To an increasing extent, we will all need to become heart disease specialists in the future, most importantly those in a position to influence positively children's behaviour, including not just their parents but also teachers, town planners, supermarket executives and of course our politicians.
If you are interested in supporting heart disease research in Wales or finding out more about heart disease, you can do so through the Heart Research Fund for Wales - www.heartwales.org.uk - and the British Heart Foundation at www.bhf.org.uk Professor Julian Halcox is a consultant cardiologist at Cardiff University and the University Hospital of Wales
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