Thursday, 26 January 2012

Heart attacks - and why there are fewer of them...


A great deal of this represents a triumph for awareness and medical intervention - in the UK, the NHS done good! But there are some interesting side issues that should matter a lot to public health folk:

For the last 70 years we have been in the grip of a heart disease epidemic that began in the 1940s, rose to a peak in the 1970s and then began to fall. All Western countries were affected and all followed broadly the same pattern.

And two things public health people liked to finger for this epidemic - fat and smoking - seem to be less to blame than we thought. On fat:

Total fat consumption in the UK has changed little – down from 40 per cent of average calories in the 1980s to 38 per cent today (though there has been a bigger reduction in the most harmful type, saturated fat).

In 2000, a pan-European study by the World Health Organisation was unable to show a convincing link between heart disease levels and fat consumption in the 21 countries studied.

And smoking:

Smoking, meanwhile, makes blood more likely to clot and is a known cause of heart attacks. But smoking peaked in the 1940s and then began to decline, just as the heart disease epidemic was taking off.

The truth seems to be that those endless nannying public health campaigns are, at best, a very minor part of this change:

The Oxford researchers conclude that just under half the decline in heart attack death rates in England over the last decade is due to better hospital treatment; the rest is due to changes in lifestyle and the widespread use of pills to lower cholesterol and blood pressure.

Do you think BHF and the like will admit they were wrong about smoking and fat? Somehow I doubt it!


1 comment:

Anonymous said...

I expect various lifestylers will claim the decrease for their own hobby horse, but for what it's worth, heres my guess.

"widespread use of pills to lower cholesterol and blood pressure."

"Increasingly, doctors are suggesting statins should be given to people with risk factors but no obvious disease, which is called primary prevention. This is to prevent disease occurring in the first place.
But is the threat of cardiovascular disease so great that statins may as well be added to the water supply?

This was the debate held recently by doctors at the annual meeting of Heart UK - a patient and science charity for cholesterol.

Mass treatment

Dr John Reckless, chairman of Heart UK and a consultant endocrinologist at Bath University, put forward the case.
"The whole point of the debate is to bring out the fact that we are under-treating and the fact that a lot more people could benefit."
"Dr Reckless said preventing cardiovascular disease was important across the board - in the elderly and the young, in men and women, and in those with diabetes or high blood pressure or any of the other conditions that might go along with it.


"Statins are thought to be taken by one in three people over 40. Up to seven million people in England take them, costing the NHS at least £450 million a year. A large proportion of these are at a low risk of heart problems and take the drugs to ward off future disease.

Experts who advocate the use of statins say they have helped prolong thousands of lives by preventing heart attacks and other cardiovascular events."

Nothing like hedging your bets, is there?

"I have analyzed the data which the Institute of Medicine included and failed to include in its report and today, I reveal that the report failed to consider data from three countries (England, Scotland, and Wales) which seem to clearly show that the smoking bans in these countries had no significant short-term effect on acute coronary events.

These data are all national data which include all hospital admissions at all hospitals in these countries."