The Scottish Government

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2. WHERE WE ARE NOW

2.1 Considerable progress has been made since the publication of the original Coronary Heart Disease and Stoke Strategy for Scotland in 2002 and the updated version published in 2004. Outcomes have improved and services have benefited from new investment, new technology and the development of best practice clinical guidance.

Prevalence

2.2 It is estimated that 14.9% of Scottish men and 14.5% of Scottish women are living with some kind of cardiovascular disorder. The prevalence of all conditions increases markedly with age.

Figure 1: Proportion of People in Scotland with any Cardiovascular Condition by Age and Sex

Source: Scottish Health Survey 2003

2.3 The most common condition is angina, with 6.6% of men and 5.6% of women reporting that they had had this condition at some point in their lives. The biggest difference between the sexes relates to heart attacks, which is reported as being 4.2% in men and 2.4% in women.

Figure 2: Prevalence of Cardiovascular Conditions in Scotland 2003 (%)

Source: Scottish Health Survey

2.4 This prevalence is reflected in the number of patients seen each year by General Practitioners in Scotland. Although this number has declined over the past few years, it is still estimated that 82,000 patients with CHD and 24,700 patients with stroke or transient ischaemic attack visit their GP each year.

Hospitalisation

2.5CHD and stroke continue to represent two of the major causes of admission to Scottish hospitals. Non-elective admissions for heart failure have dropped very significantly over this period (Figure 3), but there has been little decline in elective admissions for heart failure (Figure 4).

Figure 3: Non-elective Admissions

Figure 4: Elective Admissions

Mortality

2.6 Across Scotland, there has been a continual downward trend in rates of cardiovascular mortality over the past 10 years. Figure 5 shows the progress that has been made towards meeting the target of a 60% reduction in premature (under 75) CHD mortality between 1995 and 2010.

2.7 Despite the achievement, the rate of decline in CHD mortality for men and women aged 35-54 years has now flattened out. The annual percentage change in men fell from 6.28% between 1986 and 2003 to 0.55% between 2003 and 2006, while there was a small increase in mortality rates amongst young men in 2005-2006. This reflects an increase in risk factors such as obesity and levels of diabetes amongst younger people and is in line with trends in other parts of Western Europe.

Figure 5: Coronary Heart Disease for ages under 75 Age Standardised (European Standard Population) Mortality rate per 100,000 Population

2.8 A further target was set in 2004, aimed at achieving an additional 27% reduction in premature mortality from CHD by 2008 for the most disadvantaged communities. The CHD mortality rate in under 75s in these communities has decreased by 18.3% from
112 per 100,000 population in 2003 to 91.6 in 2006 and if this trend continues, the 2008 target should be met.

2.9 In 2007, this target was superseded by one aiming to reduce CHD mortality among the under 75s in the most deprived 15% of areas in Scotland, using 2006 data as the baseline. However, between 2003 and 2006 the two most deprived quintiles showed an increase of 16.8% and 10% respectively and it is clear that an additional focus in such areas is required if we are to meet the new target.

2.10 The picture in terms of stroke deaths is more consistent, with latest figures showing a reduction in mortality from stroke in the under 75s from 37.5 deaths per 100,000 in 1995 to 20 deaths per 100,000 in 2006 (Figure 6). If this trend continues, the target of a 50% reduction in mortality from cerebrovascular disease in this age group should be met.

Figure 6: Cerebrovascular Disease for ages under 75 Age Standardised (European Standard Population) Mortality rate per 100,000 Population

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