Why is Coronary Heart Disease the UKs Biggest Killer - Essay Example

Coronary Heart Disease - UK’s biggest killer Coronary Heart Disease (CHD) is the leading cause of death in the UK, accounting for over a quarter of all deaths in England and Wales (Buck, Godfrey, Killoran & Tolley, 1996). Office for National Statistics (ONS) shows that one in every five men and one in every six women dying from this disease (BBC News, 2006). The most common factors responsible for the development of CHD include high levels of bad cholesterol or LDL (Medical News Today, 2008), obesity (Prentice, 1997), smoking status and level of consumption, sedentary lifestyle, and hypertension (Buck et al. 1996). These factors responsible for high level of CHD suggest an inadequate standard of care and a failure of the medical practice. The medical practices focus on acute management and not on preventive care which could serve to reduce the incidence of CHD in the UK. CHD is a term which describes what happens when the heart’s blood supply is blocked or interrupted when the fatty substances build up in the coronary arteries (NHS, 2009). Fatty deposits (also known as atheroma) on the walls of the arteries narrow down the arteries, which restricts the blood supply to the heart. Researchers investigating the biochemical characteristics have discovered a new chromosomal region to be associated with the bad cholesterol or low density lipoprotein (LDL). Researchers have been working on the hypothesis that genetic variation could influence the inheritance of biochemical traits which pose risks for CHD or other heart related problems (Medical News Today, 2008). Common genetic variation can influence biochemical parameters, is what their research suggests. There is ample evidence to link genetic factors to the levels of serum cholesterol, blood pressure and diabetes. Heredity is also responsible for the development of the disease (Neufeld & Goldbourt, 1983). The male-female ratio also varies across nations and different ethnic groups. In addition, there are differences in the anatomic and histologic distribution patterns of the coronary arteries apart from the inherited disorders of metabolism. Hence, heredity has a major role to play in the CHD disease. At the embryo stage itself some are marked for early changes in the coronary arteries and others for onset at a later stage. Before CHD reaches a critical stage and clinical manifestations takes place, several physiologic and biochemical variables intervene. The genetically controlled arterial wall explains the difference in susceptibility of the arterial wall response to factors like cholesterol, hypertension and diabetes. There is no satisfactory explanation of why the disease is dominant in males than females and also higher prevalence among Western white persons than the ethnic blacks and Jews. Even though heredity plays a critical role in CHD, the nature and degree of their inheritance has not been defined. It has been explained by some as mostly reflecting common environment such as common eating habits but then again, the genetic component is predominant in the variability of these factors. CHD is the result of a complex interplay between environmental and genetic factors (Drenos et al, 2009; Neufeld & Goldbourt, 1983). In the high risk people blood phenotypes such as lipid and lipoprotein particles, proteins involved in inflammation and coagulation, and metabolites and markers of oxidant stress, cluster together which makes it difficult to ascertain the nature and direction of biological relationships between markers. According to some researchers, the variation of low-density lipoprotein (LDL) cholesterol also depends to a large extent on heredity. This suggestion carries weight because there is no explanation even for the cholesterol level variation. It has been difficult to find a correlation between dietary habits and serum cholesterol levels. Thus the controversy between environmental components and the genetic effect continues. Hypertension is supposed to be hereditary and hypertension leads to CHD. The tendency for high pressure at all age is inherited. Diabetes too varies depending upon the genetic factors. In the UK, people suffering from Type I and Type II diabetes are more likely to be at a risk of CHD because diabetes also affects the pressure. In diabetics, CHD may even develop below the age of thirty. This is because diabetes can change the makeup of the blood vessels and this can lead to CHD. Diabetes leads to several metabolic disorders (such as abnormal abdominal fat tissue, plaque build up in artery walls, insulin resistance, intolerance to glucose, elevated blood pressure and high levels of fibrinogen or plasminogen activator inhibitor) and the cumulative effect results in CHD (The Global Diabetes Community, 2010). The incidence of CHD varies according to age and sex, depends on the presence and level of risk factors, in addition to the socio-economic group, and region (Buck et al. 1996). CHD is a major killer in the oldest sectors of the population. In 1991, while only a small percentage of the population scored highly on four risk factors, over half the population had more than one risk factor as per the table below: Source: Buck et al. This study suggests that biological age has an impact. After controlling for age, those with less than three risk factors have a very low risk of ever being diagnosed with the CHD but those with three or four risk factors are at an elevated risk. Apart from age-standardization, characteristics such as social class also help to explain the incidence and presence of CHD. Both government statistics and independent research have shown that higher social class has lower CHD mortality than the number of CHD deaths in lower social class. Pater (2001) analyzes the main determinants of population-wide coronary heart disease prevention. The author finds that lack of preventive care, lack of compliance by the patients and lack of structured and systematic information of different treatments and decisions are responsible for the high incidence of the CHD in the UK. Patients are unwilling to accept responsibility for their own health and their rights in the times to come is going to increase, placing the onus on the medical practice. However certain factors such as raised blood pressure and high cholesterol have been universally accepted as the high risk factors for CHD. The figure below demonstrates the relationship between cardiovascular risk factors and cardiovascular diseases: Source: Pater (2001). While Buck et al highlight the age and the socio-economic background that induces CHD, Pater charts out how each of the behavioural risk factors associated with the sedentary lifestyle has a biological impact on the health, leading to high risk for CHD. Once smoking is reduced, the chance of myocardial infarction is reduced and within 2-3 years, the risk is similar to those who have never smoked. This implies the extent of biological changes that smoking can bring into the human body. Lack of physical activity has been associated with an increased risk of death from CHD. If the total serum cholesterol is >6 mmol/l the chances of CHD mortality increases. Dietary irregularities can increase the risk of CHD deaths and certain food should be avoided or added as they cause biological changes in the system. For instance, reduction of saturated fat and cholesterol, along with increase in polyunsaturated fat can reduce the CHD mortality. Supplements like stanol esters and plant sterols to food reduce the cholesterol absorption, and margarine can reduce plasma cholesterol concentrations by ten percent. Lack of control of these items can increase the chances of CHD mortality. Alcohol consumption of between 8 to 14 units has been considered to have the lowest CHD mortality rates. However, drinking above 21 units does increase the mortality rates, although the types and pattern of alcohol drinking has not been slept out. Those suffering from diabetes mellitus, hypertension and obesity fall under the high risk category of CHD mortality. The figure below shows the preventive strategies in CHD: Source: Pater (2001). This figure shows that acute coronary event starts many years before the actual event occurs. Age as been mentioned by Buck et al. as a variable and Pater too suggests that in the late thirties and forties, an individual may be able to sustain coronary events but they do run a risk of coronary events at a later age – maybe in their sixties or even later. It usually takes about ten years to develop CHD (death, non-fatal myocardial infarction and angina) and hence the treatment should start even as minor symptoms are detected. Thus, the high incidence of CHD in the UK is based on certain factors, which makes the CHD as the single largest killer in the UK. Incidences of diabetes in the UK are high which is again dependent on the sedentary lifestyle, obesity and the habit of smoking. All these lead to higher levels of blood pressure. Moreover, hereditary and genetic factors also contribute to the incidences of CHD. It has been established that the actual coronary event occurs much later while the damage to the heart and the system starts much earlier. Studies indicate that even if smoking is reduced, biological changes in the body can reduce the incidences of myocardial infarction. Similarly, small changes in dietary habits and lifestyle can lead to biological changes in the human body, thereby reducing the impact and occurrence of the CHD. References BBC News, 2006, Heart disease is biggest killer, retrieved online 01 March 2010 from: http://news.bbc.co.uk/2/hi/health/5016720.stm Buck, D Godfrey, C Killoran, A & Tolley, K 1996, Reducing the burden of coronary heart disease: health promotion, its effectiveness and cost, HEALTH EDUCATION RESEARCH, 11 (4), 487-400 Drenos et al, 2009, Integrated associations of genotypes with multiple blood biomarkers linked to coronary heart disease risk, Human Molecular Genetics, 18 (12), 2305-2316 Medical News Today, 2008, Genetic Factors Behind UKs Biggest Killer Revealed, retrieved online 01 March 2010 from: http://www.medicalnewstoday.com/articles/93628.php Neufeld, HN & Goldbourt, U 1983Coronary heart disease: genetic aspects, American Heart Association, 67 (5), 943-954 NHS, 2009, Coronary heart disease, retrieved online 01 March 2010 from: http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx Pater, C 2001, The current status of primary prevention in coronary heart disease, retrieved online 01 March 2010 from: http://www.trialsjournal.com/content/pdf/cvm-2-1-024.pdf Prentice, AM 1997, Obesity—the inevitable penalty of civilisation? retrieved online 01 March 2010 from: http://bmb.oxfordjournals.org/cgi/reprint/53/2/229.pdf The Global Diabetes Community, 2010, Diabetes and Heart Disease, retrieved online 01 March 2010 from: http://www.diabetes.co.uk/diabetes-complications/heart-disease.html Read More