Modifiable risk factors
Overweight or obese
Approximately 25% of adults in the UK are classified as obese (based on their BMI) and in addition more than 33% are overweight. Approximately 30% of children in the UK are either overweight or obese.1
Cardiovascular disease risk increases as bodyweight increases. Distribution of body fat is also an important factor when considering risk for CVD with abdominal distribution being a significant risk.
Waist measurement is a good indicator of central adiposity.
Weight reduction advice and measures may be considered appropriate for the following patients:
- Overweight (BMI more than 25kg/m2) with lower thresholds for those of South Asian (SA) origin (BMI more than 23kg/m2).
- Obese (BMI more than 30kg/m2) with lower thresholds for those of SA origin (27.5kg/m2).
- Increased abdominal fat as defined by a waist circumference of more than 37 inches (94cm) in men or 31.5 inches (80cm) in women (35.5 inches or 90cm in SA men and 31.5 inches or 80cm in SA women).
Sedentary lifestyle
Over the past twenty five years there has been a significant decrease in general daily activity levels and only a small increase in people taking part in physical activity for leisure.
Increased use of cars associated with less walking or cycling, the use of domestic labour saving devices to simplify domestic chores and an increasingly sedentary work related activity has negatively impacted on the amount of physical activity undertaken by most adults.
Only two in three men and 50% of women in England achieve the recommended levels of physical activity.1
Physical inactivity is thought to be responsible for about 9% of premature deaths.2 Long periods of sedentary activity, such as sitting for long periods, is also associated with negative health outcomes irrespective of the individual's general level of physical activity.3
The World Health Organisation (WHO) estimates that physical inactivity is the fourth leading cause of premature mortality, higher than obesity and dietary effects. It has also been estimated that physical inactivity is the most common cause of heart disease.4
Lack of physical activity has been estimated to cost the NHS over £1billion, with an estimated further £6.5 billion being wasted through indirect costs including reduced productivity or premature mortality in working age adults in England alone.4
Being active can help people to lead happier and healthier lives whilst physical inactivity can be considered to be a silent killer.
Smoking status
In the UK nearly 20% of adults smoke. The prevalence of smoking varies by country, in England 18% of adults smoke, 22% in Northern Ireland, and 21% in Scotland and Wales.1
Cigarette smoking is the leading cause of premature death in the UK with nearly 100,000 people dying each year from smoking related conditions of which 22,000 are from cardiovascular disease directly attributed to smoking.1
On average lifelong smokers will live approximately ten years less than non-smokers.
Smoking is also a leading cause of morbidity by increasing the risk of cardiovascular conditions such as angina, stroke, peripheral vascular disease and heart failure. Second hand smoke can also lead to non-smokers being at increased risk of developing these conditions.5
Smoking exposes smokers to nicotine, tar, and harmful gases all of which can have an adverse effect on the cardiovascular system.
Nicotine has been shown to increase heart rate, blood pressure and peripheral vascular tone. Carbon monoxide reduces the oxygen carrying capacity of the blood whilst other oxidant gases have an effect on the platelets and endothelial lining increasing the tendency for the blood to clot and the consequent risk of myocardial infarction and stroke. Other chemicals within the smoke can affect the lipid component of the blood increasing the risk of atheroma development.5
The increased cardiovascular risk associated with smoking is specifically related to the type of vascular disease: for example there is a seven fold increased risk for peripheral arterial disease and only a two fold increase in coronary artery disease.4
The physiological impact of smoking has been shown to be greater for female patients and also younger patients.6
The increased risk is directly related to the amount of tobacco smoked and how long the patient has been smoking. This is typically referred to as "pack years".4
Alcohol consumption
The BHF reports that more than 33% of men and 25% of women regularly drink more than the recommended limits for alcohol.
The recommended alcohol limits for men and women is no more than 14 units weekly with a maximum of 3 units daily.
Excessive alcohol consumption has been directly linked to raised blood pressure, cardiomyopathy, coronary heart disease, arrhythmias and haemorrhagic stroke.
Binge drinking is more strongly implicated as a cause of these conditions. Binge drinking is defined as consuming more than twice the recommended number of units of alcohol in one day in one sitting i.e. more than 6 units for both men and women.