Coronary heart disease Case study A disease of affluence

Global distribution
This graph shows the CVD mortality rate per 100,000 on a global scale. It is more
common in areas Middle East and Russia where rates are between in 444- 861.
Mortality rate in areas of North America and Europe are fairly low between 120238, with higher rates in South America (239-362). This data has been taken in
2011 from World Health Organisation. The reason as to why CVD is lower in
MEDCs such as the UK is due to better research, equipment and medical help
available. This therefore allows them to be able to control it even better.
However, it is increasing in less developed countries, partly as a result of
increasing longevity, urbanisation and lifestyle changes. The World Health
Organisation (WHO) states that more than 60% of the global burden of CHD
occurs in newly developing countries

heart
when
vessels
supplying the

A
attack
occurs
the blood

heart become blocked, starving it of oxygen and

leading to the
heart muscle's failure or death.
The impact of CHD is measured both by deaths and by disability-adjusted life
years (DALYs). DALYs are an indication of the number of healthy years of life lost.
The measures indicate the total burden of the disease, as opposed to just the
number of deaths. Since 1990, more people around the world have died from
CHD than from any other cause/ Its disease burden is projected to rise from
around 47 million DALYs globally in 1990 to 82 million DALYs in 2020.
Risk factors
There are many risk factors of CHD. This is usually linked to high alcohol
consumption, smoking, high blood pressure, high cholesterol and obesity. Eating
healthier and exercising as well as better diet can reduce the risk of developing
this disease. In developing countries with low morality, such as China, the same
risk factors apply, with the additional risks of under-nutrition and communicable

diseases. In developing countries with high mortality, such as those of subSaharan Africa, low vegetable and fruit intake are also important factors.
It has been reported that there is a heart attack once every 15 minutes. It is also
known that areas of social deprivation have a higher rate of heart disease for
example, Glasgow women have the highest rates of heart attacks in the world.
Economic costs
The economic costs of CHD include the cost to the individual and to the family of
healthcare and time off work, the cost to the government of healthcare and the
cost to the country of lost productivity. In the UK alone, there are 80,500 deaths
due to CHD. Cardiac rehabilitation can cause 427 per treatment episode. Other
treatments such as ACE inhibitors are far cheaper (20 per patient per year). If
all inactive people become active, 10.5% of CHD could be prevented potentially.
However, these can be difficult to quantify, such as:
The direct costs of physical inactivity accounted for estimated US$24
billion in healthcare costs in 1996 WHO
Health problems related to obesity, such as CHD, cost the USA an
estimated US$177 billion a year WHO
Expenditure in OECD countries on CHD medications increased from 9.4%
in 1989 to 11% in 1997 WHO
Cost of healthcare to individual/the government (this will differ depending
which country the patient lives in)
Cost to the individual of having time off work
Cost to the employer
Cost of lost productivity to the country
Health Implications
Before treatment the patient can experience shortness of breath and fatigue with
only light exercise. They can also experience:
Swelling in their feet, ankles, legs and abdomen.
Pain in their chest, shoulders, arms or neck (angina).
The patient may develop a life threatening arrhythmia (irregular heartbeat
that can mean the body does not receive enough blood)
After treatment there may be side effects from the medication
There may also be psychological effects of having a heart attack/nearly
dying/the thought that it could happen again. Some people become
depressed or anxious and are referred to have professional counselling or
relaxation therapy as this can increase the patients risk of having a heart
attack
Lifestyle

In order to reduce the risk of CHD leading to a heart attack/sudden

death/damage to the heart important lifestyle changes must be made. These
include:
Regular physical activity
Taking prescribed medicines on a daily basis
Following a healthy eating plan
Watching ones weight
Not smoking
Not drinking too much alcohol
The patient should visit their doctor regularly to keep track of their blood
pressure and their blood sugar and cholesterol levels. Some patients may
also need to visit a counsellor or therapist to help with the
psychological impact of CHD
These regular appointments may restrict the persons freedom to travel or
require them to move if they live in a remote area. They will also need time off
work.
Health education - promote healthy living and eating at schools, medical
activities such as blood pressure testing, activities to engage the public in
physical activity, scientific conferences, activities to promote a heart-healthy diet
Policies and legislation- reducing tobacco smoking - increase the price,
advertising bans, smoke-free areas (UK in public places, in 2007), health
warnings on packets, taxation and outright bans in public places.