Disease of Affluence: coronary heart disease

A heart attack occurs when the blood vessels supplying the heart muscle become blocked, starving it of oxygen and leading to the heart muscles failure or death. A wide range of risk factors can be responsible for a heart attack, often acting in combination. The incidence of these factors vary around the world and so does the occurrence of the disease

What are the risk factors?Over 300 risk factors have been associated with coronary heart disease, in MEDCs there are five major risk factors: tobacco use alcohol use high blood pressure high cholesterol obesity In developing countries with low mortality (e.g. China) the same risk factors apply, with the additional risks of under nutrition and communicable diseases.In developing countries with high mortality, (e.g. sub-Saharan Africa) low vegetable and fruit intake are also important factorsSome major risks are modifiable in that they can be treated, prevented and controlled

The impact of heart disease is measured by both deaths and disability-adjusted life years (DALYs). DALYs are an indication of the number of healthy years of life lost. The measures indicate the total burden of a disease, as opposed to just number of deaths.Since 1990, more people around the world have died from coronary heart disease than from any other cause.It's disease bruden is projected to rise from around 47 million DALYs globally in 1990 to 82 million DALYs in 2020.Variations in death rates are marked: they are lower in populations with short life expectancy. Coronary heart disease is decreasing in many more developed countries due to improved prevention, diagnosis and treatment, and in particulr reduced cigarette smoking and lower than average levels of blood pressure and cholesterol. However it is increasing in less developed countries due to increased longevity, urbanization and lifestyle changes.The World Health Organisation (WHO) states that more than 60% of the global burden of heart disease occurs in newly developing countries - is this a disturbing sign of development?

Economic costsThe economic costs of heart disease include the cost to the individual and of the family of healthcare and time off work, the cost to the government of healthcare and cost to the country of lost productivity. All of these are difficult to quantify. 'The direct cost of obesity to the NHS is £0.5 billion per year, while the indirect cost to the UK economy is at least £2 billion' - Liam Donaldson, UK chief medical officer, 2003

Prevention strategies: significant health gains for treatment of heart disease can be made over a short period of time through public health and treatment interventions. Governments are stewards of health resources and have a fundamental responsibility to protect the health of it's citizens.They can do this by educating the public, making treatments available and affordable and advising patients on health living practices. Examples of prevention strategies are: Dietitians in the UK promote the benefits for heart health of eating oily fish, more fruit and vegetables and less saturated fat in Finland, community based interventions, including health education and nutrition labeling, have led to population-wide restrictions in cholesterol levels closely followed by a sharp decrease in heart disease In Japan, government led health education campaigns and increased treatment of high blood pressure have reduced blood pressure levels in the population In New Zealand, the introduction of recognizable logos for healthy foods has led many companies to reformulate their products. The benefits include greatly reduced salt content in processed foods In Mauritius, a change from palm oil to soya oil for cooking has brought down cholesterol levels, but obesity has been unaffected

Health Education The previous prevention strategies are not effective without public understanding, support and demand. Health education is essential to promote healthy choices. Schools are an ideal venue for health education as they can provide a healthy diet, prohibit smoking and allow opportunities for excersize.WHO has initiated a number of activities to assist schools around the world, and since 2000 has coordinated World Heart Day events and activities including: medical activities such as blood pressure testing activities to engage he public in physical activities science conferences activities to promote a heart-healthy dietthe number of countries taking part in World Heart Healthy day has increased from 63 in 2000 to 120 to 2006

Policies and LegislationOnly governments can legislate for the prevention and/or control of disease. The most common legislation involves reducing tobacco smoking, which has clear links to reducing heart disease.Legislation can include advertising bans, smoke-free areas, health warnings on packets, taxation and outright bans in public places. A smoking ban was first introduced in Singapore in 1970 and 37 years later the idea was implemented in the UK.Another interesting form of legislation was introduced in the USA in 2004. The House of Representatives banned lawsuits against fast-food restaurants by obese customers who argue that they have become overweight by eating there.