Diet and Cardiovascular

Disease
Diet
Fats- fatty acids- trans fats Outcomes/ confounders
Fruits and veg fat Lipid profile- HDL2 LDL 3
Red meat - iron Atherogenic lipid profile
Salt and nitrates Insulin sensitivity/ resistance
Alcohol Blood pressure
Fibre Inflammatory markers
Potassium Heart attacks/ stroke/ death
Vitamins – vit c antioxidant vit E beta carotene Blood flow/ atherosclerosis/ angina
Selenium zinc ---------------------------------------------------------------------------------
polyphenols
Body composition- fat mass/ weight loss
Sugar digestible carbohydrate – glycaemic index
Family history
fructose
Smoking
Nuts – fatty acids
Age
Oily fish 0mega 3 ratio with n-6
Gender
Olive oil/ rape seed oil
Physical activity/ lifestyle
Water??
Other diseases- risk factors- metabolic syndrome
Dietary patterns
Stable angina

Unstable angina

Acute myocardial infarction

Sudden death (with or without history of MI or chest pain)

 WHO 2017

CVD is the name for a group of disorders of the heart

& blood vessels including:

Hypertension

Coronary heart disease

Cerebro-vascular disease

Peripheral vascular disease

Heart failure

Rheumatic heart disease

Congenital heart disease

• Atheroma of the coronary arteries

• Narrowing (stenosis)

• Thrombosis / occlusion
Baker heart & diabetes institute
cardiosecur.com
WHO 2017
Roth, Gregory A., et al. "Global and regional patterns in cardiovascular mortality from 1990 to 2013." Circulation132.17 (2015): 1667-1678.
Men; age group 45–74 ears Women; age group 45–74 ears
Medicographia. 2009;31:343-348
 Age-standardised death rate per 100,000 from
cardiovascular disease (CVD), by gender, United Kingdom,
1,400 1969 to 2016 Age-standardised death rate per 100,000 from cardiovascular
disease (CVD), by gender, Scotland, 1969 to 2016
1,200 1,600

1,000
Men 1,400
Death rate per 100,000

Women
800 Both

Death rate per 100,000

1,200
Men
600 Women
1,000 Both

400
800

200
600

0
400
1969

1973

1977

1981

1985

1989

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

200

1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
 BHF
2019

Deaths from and numbers living with heart and circulatory diseases (CVD) 2017

Deaths BHF/University of Birmingham analysis from latest official statistics (ONS/NISRA/NRS);

UK total includes non-residents (ONS data) Living with heart and circulatory disease (CVD) estimates based on latest health surveys with CVD fieldwork and GP patient data

Top five UK premature heart & circulatory disease (CVD) Scotland premature (under 75) heart and circulatory diseases
death rates 2015-17 (CVD) death rates 2015-17
Steady downward trend in deaths from CHD in Scotland and the rest of the UK over the last 10 years. In Scotland, the mortality rate fell by 39.6%
between 2007 and 2016.

Second most common cause of death in Scotland after cancer, accounting for 26% of deaths in 2017 (compared with 29% for cancer). 12% of
deaths which caused by IHD, a further 7% caused by cerebrovascular disease (e.g. stroke).

CHD still a leading cause of death and a national clinical priority for NHS Scotland.

Incidence rates for CHD remain consistently higher in males than females.

For an individual admitted to hospital as an emergency with their first heart attack, chances of surviving at least 30 days improved over the last ten
years from 84.9% to 92.9%.

The number of prescriptions for drugs to treat diseases of the circulation increased by 6.6% in the last ten years. Despite this, the cost of
prescriptions dispensed for these drugs has fallen by 44.6% over the last ten years to £116.8 million in 2015/16, reflecting falls in drug prices for
these conditions
 Prescriptions used in the treatment and prevention of
CVD
England 1981 - 2015 Scotland 2001- 2015

Must keep in mind the differences in population

Risk factors
 abdominal obesity

Ethnicity

Stress
Homocysteine

Thrombotic risk
factors

Amit V. Khera & Sekar Kathiresan. Nature Reviews Genetics volume18, pages331–344 (2017)
 WHO
2017

Global risk factors

High blood pressure Major risk for heart attack & most important risk  Low socioeconomic status (SES) Consistent inverse relationship with
factor for stroke. risk of CHD and stroke.

High total cholesterol, LDL, TAG & low HDL increase risk of CHD &  Mental ill-health - depression is associated with an increased risk of
ischaemic stroke. CHD

Tobacco use Increases risks of CVD, especially when started young &  Psychosocial stress Chronic life stress, social isolation and anxiety
heavy smokers. Passive smoking an additional risk. increase risk CHD and stroke.

Physical inactivity Increases risk of heart disease & stroke by 50%.  Alcohol use 1-2 drinks/day may lead to 30% reduction in CHD; heavy
drinking damages the heart muscle.

Obesity Major risk for CHD & diabetes.

 Some oral contraceptives & HRT increase risk of CHD.

Low fruit & veg intake estimated to cause ≈ 31% of CHD & 11% of stroke  Left ventricular hypertrophy (LVH) A powerful marker of cardiovascular
worldwide; high sat fat intake increases risk of CHD & stroke through death.
effect on blood lipids and thrombosis.

Diabetes mellitus Major risk for CHD & stroke.

•Advancing age: most powerful independent risk factor for CVD; risk of stroke  Excess homocysteine in blood High levels may be
doubles every decade after age 55. associated with an increase in cardiovascular risk.

Heredity or family history: Increased risk if a first-degree blood relative has had  Inflammation Several inflammatory markers are associated
CHD or stroke before the age of 55 years (for a male relative) or 65 years (for a with increased cardiovascular risk, e.g. elevated C-reactive
female relative).
protein (CRP).

Gender: Higher rates of CHD among men compared with women

(premenopausal age); risk of stroke is similar for men and women.  Abnormal blood coagulation Elevated blood levels of
fibrinogen and other markers of blood clotting increase the
risk of cardiovascular complications.
Ethnicity or race: Increased stroke noted for Blacks, some Hispanic Americans,
Chinese, and Japanese populations. Increased CVD deaths noted for South
Asians and American Blacks in comparison with Whites.
 Deaths by cause in men, UK 2016 Deaths by cause in women, UK 2016

Chronic Hypertensive
Hypertensive Chronic rheumatic diseases
rheumatic heart diseases… heart diseases 2%
diseases
0.2%
0.1%
Coronary heart
Coronary heart disease
disease 9% Other heart diseases
14% Other heart 5%
All other causes All other causes
diseases Diseases of
20% 19%
4% arteries,arterioles and
Stroke capillaries
7% 2%
Stroke
Dementia and 5%
Alzheimer's
8%
Dementia and
Alzheimer's Diseases of veins,
Diabetes 15% Cancer lymphatic vessels
1% 26% 0.6%
Respiratory Cancer
disease 31% Diseases of
14%
arteries,arteriol
es and Diabetes Respiratory disease
capillaries 1% 14%
2%
Diseases of
veins, lymphatic
vessels
0.5%
24.4% All 17.0% All cardiovascular
24.7% All cardiovascular 26.7% All
cardiovascular disease
disease cardiovascular
disease in women under 75 years
In men under 75 years disease
The reduction in all-age mortality rates for CHD was seen in both the most and least deprived
communities. The percentage reduction in deaths in the most deprived category (31.3%) over the
last ten years was smaller than that in the least deprived category (38.5%).

Early mortality from heart disease and stroke have both improved in recent years, but concern
remains about continuing inequalities in relation to morbidity and mortality linked to these
conditions.
Scottish Executive, 2017
Proportion of total deaths attributable to diabetes mellitus, chronic respiratory diseases,
CVD, and cancer by age in 2013

Roth, Gregory A., et al. "Global and regional

patterns in cardiovascular mortality from
1990 to 2013."
Circulation132.17 (2015): 1667-1678.
West Midlands Key Health Data 2009/10
 Non South Asians South Asians

Female Rate (Admissions/1000 No of cases Census population ** Rate (Admissions/1000 population / year) No of cases Census population **
population/year)

25 to 34 0.03 29 320,018 0.00 0 3,519

35 to 44 0.20 199 366,337 0.28 2 2,647
45 to 54 0.68 584 322,103 1.36 6 1,653
55 to 64 2.00 1408 264,030 3.49 8 860
65 to 74 5.05 3043 225,973 8.39 10 447
75 to 84 11.33 4605 152,421 24.19 8 124
85 and over 21.92 3406 58,266 42.86 4 35
Crude rate, all ages 2.91 13276 1,709,148 1.53 38 9,285

Standardised rate (95% CI), all ages 2.56 (2.51, 2.60) 4.86 (3.05, 6.67)

Male

25 to 34 0.12 86 278,236 0.00 0 3,328

35 to 44 0.69 609 332,767 1.58 11 2,612
45 to 54 2.36 1948 308,996 2.56 12 1,756
55 to 64 5.43 3525 243,602 6.36 20 1,179
65 to 74 10.28 5091 185,773 15.29 27 662
75 to 84 18.77 4726 94,429 42.55 16 141
85 and over 31.05 1710 20,655 26.79 2 28
Crude rate, all ages 4.53 17696 1,464,458 3.40 88 9,706

Standardised rate (95% CI), all ages 5.00 (4.93, 5.08) 7.71 (5.68, 9.75)
* acute MI defined as ICD10 code I21 in the principal diagnostic position
** restricted to those successfully linked to a Community Health Index record CM Fischbacher et al.,2007
7 Country study.
Verschuren et al., 2004
Holmes, M.V. et al. J Am Coll Cardiol. 2018;71(6):620–32.
Holmes, M.V. et al. J Am Coll Cardiol. 2018;71(6):620–32.