CARDIOVASCULAR DISEASE STATISTICS 2015 British Heart Foundation Centre on Population Approaches for Non‑Communicable Disease Prevention. Nuffield Department of Population Health, University of Oxford CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 1 CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CENTRE ON POPULATION APPROACHES FOR NON‑COMMUNICABLE DISEASE PREVENTION Nick Townsend, Prachi Bhatnagar, Elizabeth Wilkins, Kremlin Wickramasinghe and Mike Rayner. Nuffield Department of Population Health, University of Oxford © British Heart Foundation, December 2015 ISBN 978-1-899088-32-4 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, electronic, photocopying or otherwise without prior permission of the publishers. NHS workers and teachers may make photocopies for education purposes only, provided that no charge or profit is made for any course or event for which they are used. Published by the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW bhf.org.uk Registered charity in England and Wales (225971) and in Scotland (SC039426) Edited by Ed Dicks, British Heart Foundation Compiled by Nick Townsend, Prachi Bhatnagar, Elizabeth Wilkins, Kremlin Wickramasinghe and Mike Rayner, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF www.ndph.ox.ac.uk/bhfcpnp Suggested citation: Townsend N, Bhatnagar P, Wilkins E, Wickramasinghe K, Rayner M (2015). Cardiovascular disease statistics, 2015. British Heart Foundation: London. CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 2 3 CONTENTS FOREWORD 6 INTRODUCTION 7 SUMMARY 8 GLOSSARY 10 Chapter 1 MORTALITY 12 Deaths by cause, by gender and age, United Kingdom 2014 Table 1.1 14 Deaths by cause in men, United Kingdom 2014 Figure 1.1a 16 Deaths by cause in women, United Kingdom 2014 Figure 1.1b 16 Deaths by cause, by gender and age, England, Wales, Scotland and Northern Ireland 2014 Table 1.2 18 Deaths by cause in men under 75, United Kingdom 2014 Figure 1.2a 20 Deaths by cause in women under 75, United Kingdom 2014 Figure 1.2b 20 Age-standardised death rates from cardiovascular disease (CVD), all ages, England, Wales, Scotland, Northern Ireland and United Kingdom 1969 to 2013 Table 1.3 22 Age-standardised death rate per 100,000 from CVD, by gender, United Kingdom 1968 to 2013 Figure 1.3 23 Age-standardised death rates from CVD, under 75, England, Wales, Scotland, Northern Ireland and United Kingdom 1969 to 2013 Table 1.4 24 Age-standardised death rate per 100,000 from CVD, by gender, aged under 75, United Kingdom 1968 to 2013 Figure 1.4 25 Age-standardised death rates from coronary heart disease (CHD), all ages, England, Wales, Scotland, Northern Ireland and United Kingdom 1971 to 2013 Table 1.5 26 Age-standardised death rate per 100,000 from CHD, by gender, United Kingdom 1974 to 2013 Figure 1.5 27 Age-standardised death rates from CHD, under 75, England, Wales, Scotland, Northern Ireland and United Kingdom 1969 to 2013 Table 1.6 28 Age-standardised death rate per 100,000 from CHD, by gender, aged under 75, United Kingdom 1974 to 2013 Figure 1.6 29 Age-standardised death rates from stroke, all ages, England, Wales, Scotland, Northern Ireland and United Kingdom 1969 to 2013 Table 1.7 30 Age-standardised death rate per 100,000 from stroke, by gender, United Kingdom 1968 to 2013 Figure 1.7 31 Age-standardised death rates from stroke, under 75, England, Wales, Scotland, Northern Ireland and United Kingdom 1969 to 2013 Table 1.8 32 Age-standardised death rate per 100,000 from stroke, by gender, aged under 75, United Kingdom 1968 to 2013 Figure 1.8 33 Excess winter mortality for CVD and CHD by gender and age, England 2010/11 to 2012/13 Table 1.9 35 Excess winter mortality for CVD and CHD by gender and age, Wales 2010/11 to 2012/13 Table 1.10 36 Excess winter mortality for CVD and CHD by gender and age, Northern Ireland 2011/12 to 2013/14 Table 1.11 37 Excess winter mortality for CVD, England and Wales, 2007/08 to 2012/13 Table 1.12 38 Numbers of deaths and age-standardised death rates from cardiovascular disease (CVD) in men and women, all ages and under 75, by region and country, United Kingdom 2011/13 Table 1.13 41 Numbers of deaths and age-standardised death rates from coronary heart disease (CHD) in men and women, all ages and under 75, by region and country, United Kingdom 2011/13 Table 1.14 43 Numbers of deaths and age-standardised death rates from stroke in men and women, all ages and under 75, by region and country, United Kingdom 2011/13 Table 1.15 45 Rankings for ten local authorities with highest and lowest cardiovascular disease (CVD) mortality rates, United Kingdom 2011/13 Table 1.16 47 Age-standardised death rates from CVD in men and women all ages, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.16a 48 Age-standardised death rates from CVD in men and women under 75, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.16b 50 Rankings for ten local authorities with highest and lowest coronary heart disease (CHD) mortality rates, United Kingdom 2011/13 Table 1.17 51 Age-standardised death rates from CHD in men and women all ages, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.17a 52 Age-standardised death rates from CHD in men and women under 75, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.17b 54 Rankings for ten local authorities with highest and lowest stroke mortality rates, United Kingdom 2011/13 Table 1.18 55 Age-standardised death rates from stroke in men and women all ages, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.18a 56 Age-standardised death rates from stroke in men and women under 75, per 100,000, by local authority, United Kingdom 2011/13 Figure 1.18b 58 Chapter 2 MORBIDITY 60 Inpatient episodes by main diagnosis in NHS hospitals by gender, England, Scotland, Wales, Northern Ireland and United Kingdom 2013/14 Table 2.1 62 Inpatient episodes by main diagnosis in men for NHS hospitals, United Kingdom, 2013/14 Figure 2.1a 64 Inpatient episodes by main diagnosis in women for NHS hospitals, United Kingdom 2013/14 Figure 2.1b 64 Inpatient episodes by main diagnosis in men for NHS hospitals, England 2013/14 Figure 2.1c 65 Inpatient episodes by main diagnosis in women for NHS hospitals, England 2013/14 Figure 2.1d 65 Inpatient episodes by main diagnosis in men for NHS hospitals, Scotland 2013/14 Figure 2.1e 66 Inpatient episodes by main diagnosis in women for NHS hospitals, Scotland 2013/14 Figure 2.1f 66 Inpatient episodes by main diagnosis in men for NHS hospitals, Wales 2013/14 Figure 2.1g 67 Inpatient episodes by main diagnosis in women for NHS hospitals, Wales 2013/14 Figure 2.1h 67 Inpatient episodes by main diagnosis in men for NHS hospitals, Northern Ireland 2013/14 Figure 2.1i 68 Inpatient episodes by main diagnosis in women for NHS hospitals, Northern Ireland 2013/14 Figure 2.1j 68 Inpatient episodes by main diagnosis in NHS hospitals in men, England, Scotland, Wales, Northern Ireland and United Kingdom, 2005/06 to 2013/14 Table 2.2a 69 Inpatient episodes by main diagnosis in NHS hospitals in women, England, Scotland, Wales, Northern Ireland and United Kingdom, 2005/06 to 2013/14 Table 2.2b 70 CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 4 5 Inpatient episodes by main diagnosis in NHS hospitals, England, Scotland, Wales, Northern Ireland and United Kingdom, 2005/06 to 2013/14 Table 2.2c 71 Trends in inpatient episodes of specific cardiovascular conditions in England, 2006/07 to 2013/14 Figure 2.2a 72 Trends in inpatient episodes of specific cardiovascular conditions in Scotland, 2009/10 to 2013/14 Figure 2.2b 73 Trends in inpatient episodes of specific cardiovascular conditions in Wales, 2005/06 to 2013/14 Figure 2.2c 75 Trends in inpatient episodes of specific cardiovascular conditions in Northern Ireland, 2010/11 to 2013/14 Figure 2.2d 76 Prevalence of selected cardiovascular conditions by region and country, United Kingdom 2013/14 Table 2.3 78 Prevalence of selected cardiovascular conditions, England 2004/05 to 2013/14 Table 2.4 80 Prevalence of selected cardiovascular conditions, England 2004/05 to 2013/14 Figure 2.4 80 Prevalence of selected cardiovascular conditions, Scotland 2008/09 to 2013/14 Table 2.5 81 Prevalence of selected cardiovascular conditions, Scotland 2008/09 to 2013/14 Figure 2.5 81 Prevalence of selected cardiovascular conditions, Wales 2006/07 to 2013/14 Table 2.6 82 Prevalence of selected cardiovascular conditions, Wales 2006/07 to 2013/14 Figure 2.6 82 Prevalence of selected cardiovascular conditions, Northern Ireland 2004/05 to 2013/14 Table 2.7 83 Prevalence of selected cardiovascular conditions, Northern Ireland 2004/05 to 2013/14 Figure 2.7 83 Prevalence of selected cardiovascular conditions in men by age, Great Britain 1988 to 2011 Table 2.8a 85 Prevalence of selected cardiovascular conditions in women by age, Great Britain 1988 to 2011 Table 2.8b 86 Prevalence of selected cardiovascular conditions by gender, Great Britain 1988 to 2011 Figure 2.8 87 Prevalence of selected cardiovascular conditions by gender, England 2003 to 2011 Table 2.9 88 Prevalence of selected cardiovascular conditions by gender, England 2003 to 2011 Figure 2.9 89 Prevalence of selected cardiovascular conditions by gender, Scotland 2003 to 2014 Table 2.10 90 Prevalence of selected cardiovascular conditions by gender, Scotland 2003 to 2014 Figure 2.10 91 Prevalence of selected heart conditions by gender, Wales 2003/04 to 2014 Table 2.11 92 Prevalence of selected heart conditions by gender, Wales 2003/04 to 2014 Figure 2.11 93 Chapter 3 TREATMENT 94 Prescriptions used in the prevention and treatment of cardiovascular disease, England 1981 to 2014 Table 3.1 96 Prescriptions used in the prevention and treatment of CVD, England 1995 to 2014 Figure 3.1 97 Prescriptions used in the prevention and treatment of cardiovascular disease, Wales 2005 to 2014 Table 3.2 98 Prescriptions used in the prevention and treatment of CVD, Wales 2005 to 2014 Figure 3.2 99 Prescriptions used in the prevention and treatment of cardiovascular disease, Scotland 2001/02 to 2014/15 Table 3.3 100 Prescriptions used in the prevention and treatment of CVD, Scotland 2001/02 to 2014/15 Figure 3.3 101 Prescriptions used in the prevention and treatment of cardiovascular disease, Northern Ireland 2000 to 2014 Table 3.4 102 Prescriptions used in the prevention and treatment of CVD, Northern Ireland 2000 to 2014 Figure 3.4 103 Prescriptions used in the prevention and treatment of cardiovascular disease, United Kingdom latest available year Table 3.5 104 Number of CABGs and PCIs, United Kingdom 1977 to 2013 Table 3.6 106 Number of coronary artery bypass operations and percutaneous coronary interventions per year, United Kingdom 1980 to 2013 Figure 3.6 107 Number of valve replacements and repairs, United Kingdom 2003 to 2012 Table 3.7 108 Cardiothoracic transplant list, United Kingdom 2014/15 Table 3.8 109 Cardiothoracic transplants and rate per million population, by country, United Kingdom 2010/11 to 2014/15 Table 3.9 110 Out-of-hospital cardiac arrest survival rates, England, 2011 to 2014 Table 3.10 110 Chapter 4 HEALTHCARE COSTS 112 Percentage of NHS expenditure on CVD by care setting, England 2013/14 Figure 4.1 113 NHS expenditure on CVD by care setting and CVD type, England 2013/14 Table 4.1 115 NHS expenditure on CVD by CCG cluster, England 2013/14 Figure 4.2 117 NHS expenditure on CVD by CCG cluster, England 2013/14 Table 4.2 118 NHS expenditure on CVD by Commissioning Region, England 2013/14 Table 4.3 120 NHS expenditure on CVD by Health Board, Wales 2013/14 Table 4.4 121 NHS expenditure on CVD by Health and Social Care Trust, Northern Ireland 2013/14 Table 4.5 122 NHS expenditure on CVD by care setting and condition, Scotland 2011/12 Table 4.6 124 Chapter 5 MEDICAL RISK FACTORS 126 Obesity 128 High blood pressure 129 Diabetes 129 Cholesterol 130 Chapter 6 BEHAVIOURAL RISK FACTORS 132 Smoking 134 Poor diet 135 Physical inactivity 136 Alcohol consumption 138 CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 6 7 INTRODUCTION In this, the twentieth edition of statistics related to heart disease published by the British Heart Foundation, we present trends in Cardiovascular disease statistics in the UK spanning the last thirty years or more. This builds on our Trends in Coronary Heart Disease, 1961–2011 report published in 2011 that presented statistics back to the inception of the BHF. The compendium is divided into six chapters. Chapter one describes mortality from cardiovascular disease (CVD), including total CVD, coronary heart disease (CHD) and stroke. Data are presented for all ages and for those under 75 years (premature mortality), by gender and region. This includes trends in age-standardised death rates for CVD, CHD and stroke covering the last thirty years. This is the first time these have been calculated using the 2013 European Standard Population. Chapter two describes the current morbidity burden of cardiovascular disease in the UK along with trends in incidence and prevalence. Hospital episode statistics are used as a proxy for incidence whilst prevalence data come from health surveys from UK countries and for Great Britain, along with Quality and Outcomes Framework data for the whole of the UK. Chapter three includes statistics on the treatment of CVDs, presenting trends in the prescribing of drugs for treating CVD for all UK nations. Trends and current statistics on surgical interventions for CVD such as the use of percutaneous coronary interventions (PCIs) and coronary artery bypass grafts (CABGs) are also presented, along with transplant rates and out-of-hospital cardiac arrest survival data. For the first time costs of treating CVD are included for all UK countries in chapter four, with these broken down by region where possible. Chapter five presents summary statistics on the main medical risk factors of CVD: obesity, blood pressure, diabetes and cholesterol. Chapter six presents summary statistics for key behavioural risk factors: smoking, diet, physical inactivity and alcohol consumption. Chapters one to four contain a set of tables and figures to illustrate key points and a brief review of the data presented. These include graphs of the most recent statistics along with those for trends over previous years, sometimes decades. Chapters five and six present summary statistics and links to health surveys where more information can be found. More statistics around risk factors, along with all the tables and figures included in this publication, are available from the British Heart Foundation’s website at bhf.org.uk/statistics The website aims to be the most comprehensive source of statistics on cardiovascular disease in the UK; it is updated on a regular basis and contains a wider range of tables and figures than is available in the Cardiovascular disease statistics series of publications. Copies of this publication can be downloaded or ordered from the website, along with supplements to the Cardiovascular disease statistics series and other titles, including: − Physical Activity Statistics (2015) − Children and Young People Statistics (2013) − European Cardiovascular Disease Statistics (2012) − Trends in Coronary Heart Disease, 1961–2011 (2011) FOREWORD This year, in addition to presenting our usual snapshot of the latest UK heart health statistics, this edition of Cardiovascular disease statistics also presents trend data relating to cardiovascular disease (CVD) in the UK over recent years. The British Heart Foundation (BHF) was founded 54 years ago to fund CVD research by doctors who were concerned about the seemingly unstoppable epidemic of coronary heart disease that was afflicting the UK at the time. The statistics presented here are a testament to the impressive progress that has been made since then. Particularly satisfying are the continuing decreases in CVD death rates for all of the UK. Since 1980 age-standardised death rates from CVD have decreased by over two thirds for people of all ages and by more than three quarters for those under the age of 75 years. A number of factors have contributed to this success, including lifestyle changes such as smoking cessation and improved diet, as well as the increased use of drugs to treat risk factors such as high blood pressure and cholesterol and improved treatment of acute heart attacks and strokes in our hospitals. All of these changes have come about to a greater or lesser extent as a consequence of the BHF’s research and activities. But despite this success, or even as a consequence of it, the number of hospital admissions for cardiovascular disease across the UK continues to grow as more and more people are living with the consequences of having survived a damaging heart attack or stroke, placing a heavy burden on our already stretched health and social services. GP patient data show a stubbornly high prevalence for many cardiovascular conditions. Each week in the UK thousands of patients suffer a heart attack or stroke. And whilst average mortality rates are falling, there are substantial regional and gender variations in the incidence of cardiovascular events that reflect inequalities in prevention and treatment. There is still an awful lot more to do to improve the cardiovascular health of our population. Only by collecting accurate data on risk factors and unhealthy behaviours in the populations most at risk of cardiovascular disease can we hope, through research, to devise ways of reducing this continuing burden of disease so that people can live, not just longer, but healthy lives. Professor Peter Weissberg Medical Director, British Heart Foundation CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 8 9 Chapter 3 TREATMENT This chapter reports on different methods of treatment for cardiovascular disease (CVD), with a focus on treatments for coronary heart disease (CHD). The chapter includes tables and figures on the number of prescriptions, operations and cardiac arrest survival in the UK. − In 2014, more than 313 million prescriptions were dispensed for CVD in England, more than six times as many as issued in 1981. − In 2014, around 23 million prescriptions were dispensed for CVD in Wales, more than 24 million in Scotland and close to 9 million in Northern Ireland. − Over 92,000 percutaneous coronary interventions (PCI) were carried out in the UK in 2013, more than two times higher than a decade ago. − Aortic valve replacement has increased since 2003. In 2012 there were 4,561 isolated aortic valve replacements and a further 3,263 aortic valve replacements with coronary artery bypass graft surgery (CABGs) in the UK. − Although the number of mitral valve repairs in the UK has increased since 2003 the number of mitral replacements has decreased. In 2012 there were 1,456 isolated mitral valve repairs and 638 isolated mitral valve replacements. There were a further 820 mitral valve surgeries with CABG in the UK. − In 2014/15, there were 180 heart transplants, plus a further three heart/lung transplants. The overall heart transplant rate was 2.8 per million population, this was higher than found in 2010/11 when 126 heart transplants were performed (2.0 per million). − In 2014, there were nearly 30,000 resuscitation attempts for out-of-hospital cardiac arrests (OHCA) in England and 8.8% of patients were discharged alive from hospital. Chapter 4 HEALTHCARE COSTS This chapter describes the burden of cardiovascular disease (CVD) within the UK. It presents total costs and costs per person to the NHS of treating CVD broken down by subtype, by NHS care setting and region for England. Costs by region and CVD subtype are also presented for Wales and Northern Ireland, and for the first time costs by care setting and condition are presented for Scotland. − Data from Clinical Commissioning Groups (CCGs) do not cover as great a range of healthcare costs as previous data, with £4.3 billion spent on treating CVD through CCGs within the NHS in England in 2013/14. − At 40% unscheduled care was the largest component of CCG CVD-related spending, with 23% within primary prescribing and 22% in scheduled care. − Smaller CCGs with older populations and more rural areas demonstrated the highest expenditure per head (£87) and those in mixed communities in Inner London the lowest (£56). − London had the lowest costs for CVD per head (£68) and the highest costs in England were in the North region. − Expenditure data from the programme budget returns in Wales reported that in 2013/14 expenditure on CVD by the NHS within Wales came to more than £430 million. − 2013/14 Welsh data showed that Powys Teaching LHB has the highest costs per head of population (£179) and Cardiff & Vale UHB the lowest (£106). − Costs for inpatient episodes and day case attendances in acute hospital settings in Northern Ireland show the total expenditure on CVD in Northern Ireland in 2013/14 to be £393 million. − Expenditure per head of population was greatest in Belfast (£448), more than twice that found for Northern Ireland as a whole (£215). The lowest expenditure by population is found in the Northern Trust with £128 spent on CVD per person. − Programme budgeting data for Scotland show that in 2011/12 close to £800 million was spent on treating CVD, equating to more than £150 per person in the country. SUMMARY Chapter 1 MORTALITY This section reports on cardiovascular disease (CVD) mortality in the United Kingdom, in the context of mortality from other chronic conditions; along with regional and seasonal differences and trends in CVD, coronary heart disease (CHD) and stroke. − Diseases of the heart and circulatory system (or CVD) were the second most common cause of death in the United Kingdom in 2014, with a total of around 155,000 deaths. In 2014, CVD caused 27% of all deaths and cancers caused 29%. − One quarter of premature deaths in men and 17% of premature deaths in women were from CVD in 2014. In total there were almost 41,000 premature deaths from CVD in the UK. − CHD by itself is the biggest single cause of death in the UK. In 2014, 15% of male deaths and 10% of female deaths were from CHD, a total of around 69,000 deaths. − Around 39,000 deaths were from stroke in 2014, with 6% and 8% of deaths from stroke in men and women respectively. − Between 1980 and 2013, age-standardised CVD death rates declined by 69% in England, 67% in Wales and Scotland, and 74% in Northern Ireland. − Between 1974 and 2013, UK age-standardised CHD death rates declined by 73% in those dying at any age and 81% for those dying before age 75. − There is a pattern of excess winter cardiovascular mortality in the UK. In 2012/13, over 7,000 more people died of CVD in the winter months in England, Scotland and Wales. Between 2010/11 and 2012/13, excess winter mortality from CVD increased for those aged over 65. − Age-standardised death rates in people aged below 75, for CVD, CHD and stroke, were highest in Scotland and the North of England; the lowest rates were found in the South of England. Chapter 2 MORBIDITY This section presents UK statistics for the incidence and prevalence of cardiovascular disease (CVD) and conditions including coronary heart disease (CHD), myocardial infarction (heart attack), heart failure and stroke. − In the United Kingdom, there were almost 1.7 million episodes related to cardiovascular disease (CVD) in NHS hospitals, accounting for 10% of all inpatient episodes among men and 6.2% among women. − The proportion of inpatient episodes attributed to CHD was more than twice as high among men as among women, accounting for 3.4% of all inpatient episodes in men and 1.4% in women in the United Kingdom. − The number of hospital episodes attributed to CVD has been increasing in all UK nations in recent years. − The incidence of other cardiovascular disease (not CHD or stroke) showed the greatest rises, increasing by 30% between 2005/06 and 2013/14 in England. − Comparing between UK nations the prevalence of CVD is lowest in England. Within England prevalence rates are highest in the north. − Using Quality and Outcomes Framework (QOF) data, the prevalence of CHD has decreased in all UK nations in recent years, whilst the prevalence of other conditions (including atrial fibrillation and stroke) has either increased or remained stable. CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 10 11 Heart failure – a clinical syndrome which occurs when the heart muscle is unable to pump blood as efficiently around the body. It occurs because the heart is damaged or overworked. Some people with minor heart failure may have few or no symptoms. People with moderate or severe heart failure often suffer from a number of problems, including shortness of breath, general tiredness and swelling of the feet and ankles. Hospital Inpatient Episodes – periods of continuous admitted patient care under the same consultant. Hypertension – a clinical condition of having a high blood pressure. Mostly it is considered blood pressures of 140/90 mmHg and greater to be high although this is influenced by other factors. Incidence – a measure of morbidity based on the number of new episodes of an illness arising in a population over a defined time period. International Classification of Disease (ICD) – a coding system published by the World Health Organization that provides an internationally recognised method of coding diseases in order to categorise mortality and morbidity statistics. The ICD is revised approximately every ten years. The tenth and most recent revision (ICD-10) was introduced in 2000. Change between revisions can result in discontinuities in mortality and morbidity trends, such as the move from ICD-9 to ICD-10 which resulted in an artificial increase in the number of reported stroke incidents and mortalities. LDL (Low-density Lipoprotein) cholesterol – the more harmful fraction of cholesterol which carries cholesterol from the liver to the cells of the body and causes atherosclerosis. Mitral valve – also called the bicuspid valve, the mitral valve separates the upper left heart chamber (left atrium) from the lower left heart chamber (left ventricle), and helps control blood flow through the heart. Myocardial infarction (MI) – see heart attack. Percutaneous Coronary Intervention (PCI) – a minimally invasive approach to open narrowed coronary arteries (see angioplasty) by accessing them through small needle-size punctures in the skin. Peripheral Arterial Disease (PAD) – a condition in which a build-up of fatty deposits in the arteries restricts blood supply to parts of the body, most commonly the legs. It is also known as peripheral vascular disease (PVD). Prevalence – a measure of morbidity based on the current level of a disease in the population at any particular time. Primary prevention – interventions aimed at reducing the risk of disease before the disease has presented. Primary prevention interventions are usually aimed at populations, such as regulation of tobacco advertising. Secondary prevention – interventions aimed at reducing the risk of disease recurrence after the disease has initially presented. Secondary prevention interventions are therefore targeted at individuals who have already experienced symptoms of or have been diagnosed with a disease. Stent – a short tube of expandable mesh which is inserted at the part of the artery that is to be widened by coronary angioplasty. It helps to keep the artery open and prevent re-narrowing. Stroke – the consequence of an interruption to the flow of blood to the brain. A stroke can vary in severity from a passing weakness or tingling of a limb to a profound paralysis, coma and/or death. Systolic blood pressure – a common blood pressure reading might be 120/80 mmHg. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries. This pressure is called systolic pressure. Transient Ischaemic Attacks (TIA) – a temporary disruption in the blood supply to part of the brain. Sometimes called a mini-stroke, a TIA does not last as long as a stroke. The effects are usually fully resolved within 24 hours. Waist Circumference (WC) – a measure of central obesity, where fat is concentrated in the abdomen. For men, central obesity is defined as a waist circumference greater than 102cm. For women, central obesity is defined as a waist circumference of greater than 88cm. GLOSSARY This section provides a definition for some of the terms used throughout Cardiovascular disease statistics 2015 edition. Age-standardised rate – a measure of the rate that a population would experience if it had a standard age structure. It is useful to present rates as age-standardised, as it allows for comparisons between populations with very different age structures. Angina – the most common form of coronary heart disease. It is characterised by a heaviness or tightness in the centre of the chest which may spread to the arms, neck, jaw, face, back and/or stomach. Angina occurs when the arteries of the heart become narrow and not enough oxygen-rich blood can reach the heart muscle, especially when its demands are high, such as during exercise. Angioplasty – a technique to widen a narrowed or obstructed blood vessel by inflating tightly folded balloons that have been passed into the narrowed location via a catheter. This technique squashes the fatty tissue that has caused the narrowing, hence widening the artery. Atherosclerosis – a disease characterised by chronic inflammation in the artery walls. The disease is commonly referred to as ‘hardening’ or ‘furring’ of the arteries. Atrial fibrillation – a heart condition that causes an irregular and often abnormally fast heart rate. Blood pressure – the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre. These values are quoted in units known as millimetres of mercury (mmHg). See systolic pressure and diastolic pressure. Body Mass Index (BMI) – a formula relating body weight to height to assess whether a person is overweight. BMI is calculated by dividing a person’s weight (in kilograms) by their height (in metres) squared. Adults with a BMI of 25-30 are considered to be overweight. Those with a BMI of over 30 are considered obese. British National Formulary (BNF) – a publication that provides key information on the selection, prescribing, dispensing and administration of all medicines that are generally prescribed in the UK. Cardiovascular disease (CVD) – the collective term for all diseases affecting the heart and blood vessels. Cerebrovascular disease – the collective term for all diseases affecting blood vessels that supply the brain. Technically, stroke (and the many subtypes of stroke) is a subset of cerebrovascular disease, but the two terms are often used interchangeably. Coronary Artery Bypass Graft (CABG) – an operation to bypass a narrowed section of a coronary artery and improve the blood supply to the heart muscle. Coronary Heart Disease (CHD) – the collective term for diseases that occur when the walls of the coronary arteries become narrowed by a gradual build-up of fatty material called atheroma. The two main forms of CHD are heart attack (also known as myocardial infarction) and angina. Diabetes – a disease caused by a lack of insulin (type 1) or an increased resistance of the body to insulin (type 2). Diabetes is characterised by high blood glucose levels. The resulting chronic high blood glucose levels (hyperglycaemia) are associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Diastolic blood pressure – A common blood pressure reading might be 120/80 mmHg. The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats. This pressure is called diastolic pressure. The European Standard Population (ESP) – an artificial population structure, which is used in the weighting of mortality or incidence data to produce age-standardised rates. The ESP was updated in 2013 to better reflect the age distribution of Europe. HDL (High-density Lipoprotein) cholesterol – the fraction of cholesterol that removes cholesterol (via the liver) from the blood. Low levels of HDL-cholesterol are associated with an increased risk of atherosclerosis. Heart attack – a condition where the heart muscle is starved of oxygen, most commonly caused by a blockage of one of the coronary arteries. A heart attack usually causes severe pain in the centre of the chest. The pain usually feels like a heaviness or tightness which may also spread to the arms, neck, jaw, face, back or stomach. There may also be sweating, light-headedness, nausea and/or shortness of breath. Sometimes a heart attack can be ‘silent’ and produce little or no discomfort. CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 12 13 CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 12 We age-standardise all rates in this chapter to the 2013 European Standard Population (ESP). Mortality rates are standardised to the ESP in order to account for different age structures between populations in different regions and across time. Mortality is related strongly to age; therefore, by accounting for the age structure of a population, we are able to compare mortality rates between populations and time periods with very different age structures. The ESP is a theoretical population that has been designed to reflect the average age structure of all European populations. By standardising rates to this population, we are comparing mortality rates as if all deaths had occurred in populations with the age structures of the European Standard population.1 The 2013 ESP is an update from 1976 and reflects the older age structure of the present population of Europe. As CVD affects older age groups more than younger age groups, the larger number of older people in the 2013 ESP means that any age-standardised rates for CVD mortality calculated will be higher than if they were calculated using the old 1976 ESP. This means that the trends in ESP 2013 age-standardised mortality rates presented in this publication are not comparable to the trends that have been presented in older publications. Within this chapter we present a selection of key tables and maps on mortality in the UK. A full selection of maps and tables related to mortality from CVD, CHD and stroke in men and women, for all ages and under-75s can be found on the BHF website at bhf.org.uk/statistics TOTAL MORTALITY In 2014, cardiovascular disease (CVD) was the second biggest cause of death in the United Kingdom, causing 27 per cent of all deaths while cancer caused 29 per cent. CVD is no longer the biggest cause of death for women, causing 26 per cent of all female deaths; cancer was responsible for 27 per cent in 2014. In men, 28 per cent of deaths were from CVD and 32 per cent were from cancer (Table 1.1, Figures 1.1a and 1.1b). The main forms of CVD are coronary heart disease (CHD) and stroke; just under half (45 per cent) of CVD deaths were from CHD and a quarter were from stroke (25 per cent). CHD by itself is the biggest single cause of death in the UK. In 2014, 15 per cent of male deaths and 10 per cent of female deaths were from CHD, a total of just over 69,000 deaths. The third biggest single cause of death is cerebrovascular disease (stroke). Around 39,000 deaths were from stroke, responsible for 6 per cent of all deaths in men and 8 per cent of all deaths in women (Table 1.1, Figures 1.1a and 1.1b). Other heart diseases caused 17 per cent of all CVD deaths, and were mainly due to pulmonary heart diseases, heart failure and atrial fibrillation. About 19 per cent of CVD deaths in women were from other heart diseases, compared to 14 per cent in men. Of people dying from CVD under the age of 35, almost half (49 per cent) of these deaths were from these other heart diseases (Table 1.1, Figures 1.1a and 1.1b). Chapter 1 MORTALITY This chapter reports on cardiovascular disease (CVD) mortality in the United Kingdom. It presents CVD mortality in the context of mortality from other chronic conditions; local, regional and seasonal differences and trends over time in CVD, coronary heart disease (CHD) and stroke. Where possible, the latest data along with historical trend data from routinely collected, national datasets have been used. CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 14 15 All ages Under 35 35-44 45-54 55-64 65-74 75-84 85+ All cancer (C00-D48) Men 88,666 683 1,020 4,034 11,601 24,448 29,372 17,508 Women 78,916 727 1,474 4,627 10,019 18,909 24,092 19,068 Total 167,582 1,410 2,494 8,661 21,620 43,357 53,464 36,576 Colo-rectal cancer (C18-C21) Men 8,727 44 106 406 1,153 2,298 2,933 1,787 Women 7,563 50 107 326 751 1,452 2,473 2,404 Total 16,290 94 213 732 1,904 3,750 5,406 4,191 Lung cancer (C33,C34) Men 19,602 15 132 781 2,877 6,454 6,567 2,776 Women 16,361 12 78 695 2,459 5,052 5,202 2,863 Total 35,963 27 210 1,476 5,336 11,506 11,769 5,639 Breast cancer (C50) Women 11,384 94 468 1,334 1,765 2,353 2,685 2,685 Prostate cancer (C61) Men 11,301 1 3 73 583 2,302 4,309 4,030 Respiratory disease (J00-J99) Men 36,344 193 195 671 2,163 6,503 12,541 14,078 Women 38,938 172 164 504 1,756 5,092 11,336 19,914 Total 75,282 365 359 1,175 3,919 11,595 23,877 33,992 Diabetes (E10-E14) Men 3,018 68 84 151 293 575 1,009 838 Women 3,295 32 39 85 170 428 970 1,571 Total 6,313 100 123 236 463 1,003 1,979 2,409 Dementia and Alzheimer’s (F01-03, G30) Men 19,187 – – 9 140 1,213 6,557 11,268 Women 38,724 – – 10 142 1,205 9,129 28,238 Total 57,911 – – 19 282 2,418 15,686 39,506 Notes ICD-10 codes in parentheses. ¶ *Not classified elsewhere ¶ This table compiles data from the four countries of the UK. In Northern Ireland and Scotland, the data for lung cancer only includes ICD-10 code C34. Source England and Wales, Office for National Statistics (2015) Deaths registered by cause, gender and age. www.statistics.gov.uk (accessed July 2015). ¶ Scotland, National Records of Scotland (2015) Deaths, by gender, age and cause. http://www.nrscotland.gov.uk/ (accessed September 2015). ¶ Northern Ireland, Statistics and Research Agency (2015) Deaths by sex, age and cause http://www.nisra.gov.uk/ (accessed July 2015) Table 1.1 Deaths by cause, by gender and age, United Kingdom 2014 All ages Under 35 35-44 45-54 55-64 65-74 75-84 85+ All causes Men 278,455 7,232 6,244 14,139 27,734 55,484 86,823 80,799 Women 291,886 4,315 3,839 9,495 18,871 39,532 79,610 136,224 Total 570,341 11,547 10,083 23,634 46,605 95,016 166,433 217,023 All diseases of the circulatory system (cardiovascular disease) (I00-I99) Men 78,240 433 1,153 3,722 7,605 15,034 25,667 24,626 Women 76,399 239 509 1,423 3,049 7,845 21,568 41,766 Total 154,639 672 1,662 5,145 10,654 22,879 47,235 66,392 Chronic rheumatic heart diseases (I05-I09) Men 319 3 10 8 31 61 124 82 Women 611 3 7 22 31 81 237 230 Total 930 6 17 30 62 142 361 312 Hypertensive diseases (I10-I15) Men 2,743 6 42 153 272 504 779 987 Women 3,975 2 12 52 143 346 962 2,458 Total 6,718 8 54 205 415 850 1,741 3,445 Coronary heart disease (I20-I25) Men 41,364 98 544 2,285 4,911 8,997 13,421 11,108 Women 27,799 33 133 540 1,385 3,392 8,331 13,985 Total 69,163 131 677 2,825 6,296 12,389 21,752 25,093 Other heart diseases (I26-I52) Men 11,090 206 246 516 831 1,637 3,273 4,381 Women 14,737 120 122 244 461 1,150 3,565 9,075 Total 25,827 326 368 760 1,292 2,787 6,838 13,456 Stroke (I60-I69) Men 16,222 74 204 480 984 2,419 5,724 6,337 Women 23,060 53 148 401 720 2,007 6,374 13,357 Total 39,282 127 352 881 1,704 4,426 12,098 19,694 Diseases of arteries, arterioles and capillaries (I70-I79) Men 4,629 17 39 115 308 963 1,791 1,396 Women 3,891 6 28 47 106 472 1,353 1,879 Total 8,520 23 67 162 414 1,435 3,144 3,275 Diseases of veins, lymphatic vessels and lymph nodes* (I80-I89) Men 1,251 22 54 140 208 307 328 192 Women 1,656 19 50 93 158 301 526 509 Total 2,907 41 104 233 366 608 854 701 Cardiovascular disease causes more than 1 in 4 deaths in the UK CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 16 17 PREMATURE MORTALITY In the UK death before the age of 75 years is routinely considered to be premature. One quarter of premature deaths in men and around 17 per cent of premature deaths in women were from cardiovascular disease (CVD) in 2014. In total that year, there were over 41,000 premature deaths from CVD in the UK. Coronary heart disease (CHD) by itself is the most common cause of premature death in the UK in men. About 15 per cent of male premature deaths in 2014 were from CHD, equating to around 16,800 deaths under the age of 75. In women, CHD by itself caused just under 7 per cent of premature deaths, equating to almost 5,500 deaths. Stroke accounted for about 7,500 premature deaths while other heart diseases totalled 5,500 (Table 1.2, Figures 1.2a and 1.2b). Figure 1.1a Deaths by cause in men, United Kingdom 2014 Hypertensive diseases 1% Coronary heart disease 15% Other heart diseases 4% Stroke 6% Diseases of arteries, arterioles and capillaries 2% Cancer 32% Respiratory disease 13% Diabetes 1% Dementia and Alzheimer’s disease 7% All other causes 19% 28% CARDIOVASCULAR DISEASE Figure 1.1b Deaths by cause in women, United Kingdom 2014 Hypertensive diseases 1% Coronary heart disease 10% Other heart diseases 5% Stroke 8% Diseases of arteries, arterioles and capillaries 1% Diseases of veins, lymphatic vessels and lymph nodes 1% Cancer 27% Respiratory disease 14% Diabetes 1% Dementia and Alzheimer’s disease 13% All other causes 19% 26% CARDIOVASCULAR DISEASE 41,000 In 2014, there were around 41,000 premature deaths from CVD in the UK CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 18 19 All ages Under 75 England Wales Scotland Northern Ireland England Wales Scotland Northern Ireland All cancer (C00-D48) Men 73,062 4,867 8,311 2,248 33,933 2,350 4,210 1,166 Women 64,434 4,323 7,856 2,167 28,923 2,020 3,665 1,040 Total 137,496 9,190 16,167 4,415 62,856 4,370 7,875 2,206 Colo-rectal cancer (C18-C21) Men 7,165 538 802 207 3,247 264 371 115 Women 6,153 408 773 221 2,157 141 303 82 Total 13,318 946 1,575 428 5,404 405 674 197 Lung cancer (C33,C34) Men 15,856 1,070 2,119 524 8,195 566 1,175 300 Women 12,993 899 1,998 454 6,502 492 1,048 243 Total 28,849 1,969 4,117 978 14,697 1,058 2,223 543 Breast cancer (C50) Women 9,497 577 966 321 4,956 312 534 191 Prostate cancer (C61) Men 9,529 613 906 242 2,456 150 286 66 Respiratory disease (J00-J99) Men 30,086 2,145 3,143 931 7,916 559 974 254 Women 31,971 2,299 3,563 1,073 6,157 450 877 188 Total 62,057 4,444 6,706 2,004 14,073 1,009 1,851 442 Diabetes (E10-E14) Men 2,362 176 376 99 870 76 176 46 Women 2,602 166 424 100 565 29 133 24 Total 4,964 342 800 199 1,435 105 309 70 Dementia and Alzheimer’s (F01-03, G30) Men 16,175 994 1,575 435 1,118 86 122 36 Women 32,286 2,022 3,340 1,063 1,106 62 137 52 Total 48,461 3,016 4,915 1,498 2,224 148 259 88 Notes ICD-10 codes in parentheses. ¶ *Not classified elsewhere. ¶ This table compiles data from the four countries of the UK. ¶ The data shown here do not add up to the United Kingdom totals in Table 1.1, as the separate England and Wales figures are only for people who were residing in the country at the time of death; therefore the mortality figures for England and Wales separately are different to the published mortality figures for England & Wales together. Source England and Wales, Office for National Statistics (2015) Personal communication. ¶ Scotland, National Records of Scotland (2015) Deaths, by gender, age and cause. http://www.nrscotland.gov.uk/ (accessed September 2015). ¶ Northern Ireland, Statistics and Research Agency (2015) Deaths by sex, age and cause http://www.nisra.gov.uk/ (accessed July 2015) Table 1.2 Deaths by cause, by gender and age, England, Wales, Scotland and Northern Ireland 2014 All ages Under 75 England Wales Scotland Northern Ireland England Wales Scotland Northern Ireland All causes Men 229,116 15,341 26,289 7,024 89,335 6,100 11,749 3,131 Women 239,759 16,098 27,950 7,654 61,155 4,204 8,212 2,190 Total 468,875 31,439 54,239 14,678 150,490 10,304 19,961 5,321 All diseases of the circulatory system (cardiovascular disease) (I00-I99) Men 64,181 4,460 7,464 1,859 22,506 1,599 2,936 706 Women 62,501 4,348 7,552 1,860 10,392 770 1,475 347 Total 126,682 8,808 15,016 3,719 32,898 2,369 4,411 1,053 Chronic rheumatic heart diseases (I05-I09) Men 263 27 24 5 94 12 6 1 Women 491 42 54 22 111 11 17 3 Total 754 69 78 27 205 23 23 4 Hypertensive diseases (I10-I15) Men 2,314 140 240 37 796 69 92 12 Women 3,446 200 260 67 477 29 40 8 Total 5,760 340 500 104 1,273 98 132 20 Coronary heart disease (I20-I25) Men 33,802 2,348 3,989 1,056 13,529 923 1,806 447 Women 22,562 1,575 2,883 726 4,298 328 666 160 Total 56,364 3,923 6,872 1,782 17,827 1,251 2,472 607 Other heart diseases (I26-I52) Men 9,114 611 1,091 243 2,752 178 405 82 Women 12,202 854 1,286 368 1,667 124 228 64 Total 21,316 1,465 2,377 611 4,419 302 633 146 Stroke (I60-I69) Men 13,208 963 1,605 423 3,345 260 427 115 Women 18,579 1,353 2,518 579 2,661 189 380 82 Total 31,787 2,316 4,123 1,002 6,006 449 807 197 Diseases of arteries, arterioles and capillaries (I70-I79) Men 4,307 287 431 75 1,306 112 134 30 Women 3,655 224 457 75 599 54 88 15 Total 7,962 511 888 150 1,905 166 222 45 Diseases of veins, lymphatic vessels and lymph nodes* (I80-I89) Men 1,161 84 83 20 681 45 66 19 Women 1,546 99 92 21 576 35 55 14 Total 2,707 183 175 41 1,257 80 121 33 Coronary heart disease (CHD) is the most common cause of death in the UK CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION CHAPTER 1 MORTALITY CARDIOVASCULAR DISEASE STATISTICS, 2015 BRITISH HEART FOUNDATION 20 21 TRENDS IN AGE‑STANDARDISED MORTALITY RATES Age-standardised death rates from CVD, CHD and stroke have been declining in the UK since 1969, for both deaths at all ages and premature deaths under 75. Deaths for CVD were coded differently in Northern Ireland until 1979 and so rates before this year would not be comparable with the rest of the UK. Between 1980 and 2013, age-standardised CVD death rates declined by 69 per cent in England, 67 per cent in Wales and Scotland, and 74 per cent in Northern Ireland (Table 1.3, Figure 1.3). Premature death rates also declined significantly during the same period, with a 77 per cent decrease for...