CONTEMPORARY THEMES IN HEALTH CARE: INCIDENCE AND MANAGEMENT OF CORONARY HEART DISEASE IN THE UNITED KINGDOM
According to the World Health Organisation (WHO), cardiovascular diseases (CVD) are the leading cause of premature deaths in industrialized countries. WHO estimates that this number will reach more than twenty-three million people by the year 2030 (Williams et al., 2010). CVD are classified as lifestyle diseases since they are attributed to unhealthy behaviours in the human life. Typically, CVD is a collective term used to refer to a group of disorders with some common health determinants that are linked to atherosclerosis. Atherosclerosis is a condition that describes the stiffening of the artery walls (King et al., 2017). In the United Kingdom (UK), CVD affects about seven million people and has since been identified as the leading cause of disability and death. It is also established that CVD causes one in four premature deaths in the UK, in which it accounted for about 26% of deaths recorded in England in the year 2015. CVD has also been associated with escalating financial burdens in the UK healthcare system, in which the condition consumes over £9 billion annually, costing the UK economy over £19 billion each year (Bhatnagar et al., 2016). The annual economic cost estimates incorporate premature deaths, informal costs, and disabilities.
Coronary Heart Disease
Consequently, the coronary heart disease (CHD) is the most common type of CVD. CHD is described as the narrowing of the coronary arteries along with the blood vessels supplying blood and oxygen to the heart. It is also known as the coronary artery disease and occurs as a result of cholesterol accumulation on the artery walls. This narrows the arteries and reduces the flow of blood the heart. In some instances, the constriction of the arteries may cause a clot, which obstructs blood circulation in the heart muscles (Hollis et al., 2017). Coronary arteries are blood vessel networks found on the surface of the heart, and they function by nourishing the heart muscles. Thus, the resulting constriction due to increased cholesterol levels interferes with the normal functions of the heart, especially during physical activities. Initially, the reduction of blood supply remains asymptomatic until fatty acids build up in the coronary arteries, leading to significant symptomatic manifestations.
The existing literature indicates that CHD starts with damage or injuries along the inner walls of the coronary arteries. This causes fatty plagues to deposit and build up at the damaged wall. The deposited materials mainly consist of cholesterol along with cellular products, in which the accumulation is known as atherosclerosis. When the piece rapture, the platelets accumulate on the damaged site, in attempts to repair the blood vessel tissue. Leads to the formation of clumps, which increase the risk of blocking the coronary arteries, which reduce or prevent the blood flow to the heart (De Backer et al., 2013). This increases the risk of heart attack, which is one of the significant manifestations of CHD.
Just like CVD, CHD is classified as the leading cause of death in the UK as well as across the globe. Notably, it is estimated that CHD causes the death of one in seven men and also one in twelve women across the world. It also triggers the death of more than sixty-six thousand deaths in the UK, which translated to about 180 deaths on a daily basis or one fatality after every eight minutes. A heart attack causes most deaths in CHD. Additionally, over two million people in the UK are currently living with CHD. This indicates that CHD remains a major public health concern in the United Kingdom, and hence a contemporary theme in the healthcare system (Hollis et al., 2017). Thus, it is paramount to understand the incidence and the management of CHD in attempts to reduce the financial, human, and population costs associated with the prevalence of CHD in the UK.
Risk Factors Influencing CHD Incidence
Studies indicate that CHD is the primary cause of death among the South Asian population in the UK. This is because the risk of getting CHD is higher in the South Asian population compared to the indigenous white population. The risk is placed at 46% (in men) and 51% (in women), higher in the South Asian community living in the UK. Additionally, the South Asian community is 50% likely to die from CHD more than any other population in the UK. In other words, South Asian immigrants are 1.5% times more likely to die from CHD and other related morbidities (Danese et al., 2016). Unfortunately, this population has not also benefited from reduced CHD deaths in the last few decades as it is the case with other population groups in the UK. These observations are attributed to multifaceted socioeconomic and genetic factors characterising this population. For instance, it is estimated that the South Asian populations have high smoking levels and deprived socioeconomic status more than any other group living in the UK. Besides, most individuals from the South Asian population seek medical attention when CHD is at advanced levels, reducing the chances of survival (Bhatnagar et al., 2016). Low-income populations living in England are more prone to CHD as opposed to those living in areas with favourable socioeconomic factors. Moreover, people from black races are more likely to die from CHD compared to the white population.
Consequently, severe hypertension increases the risk of suffering from CHD by two times. The risk of getting CHD in pre-hypertension varies from one individual to another. Hypertension occurs due to elevated blood pressure and is caused by several metabolic disorders attributed to poor lifestyles such as diabetes. In particular, diabetes increases the risk of developing CVD by two to four times (King et al., 2017). Diabetes has also been associated with several CHD factors including obesity, dyslipidaemia, as well as hypertension. Nonetheless, the existing evidence shows that diabetes is a risk factor in itself. Glycated haemoglobin controls the blood pressure body mass index, along with blood lipids, which is also the primary component with influence diabetes incidences. This shows that diabetes may be considered as a risk factor in the CHD incidences. As previously observed in South Asian populations, smoking is one of the significant factors influencing CHD risks (King et al., 2017). Women who smoke are more likely to get CHD compared to men. The risk arising from smoking has been identified as the most modifiable factor in the management and prevention of CVD.
Obesity is linked to other CHD risk factors such as hypertension, diabetes, and dyslipidaemia, among others. Normally, adipose tissues release considerable bioactive mediators that alter metabolism activities, influencing insulin resistance and body mass accumulation, which are the primary type 2 diabetes precursor. These factors cause a number of health complications such as blood pressure, coagulation, and lipids alteration, causing atherosclerosis and endothelial dysfunction. Poor socioeconomic status in the UK significant factor influencing CHD occurrence (Williams et al., 2010). Trends in populations with favourable socioeconomic backgrounds in smoking, cholesterol, and blood pressure are consistent with reducing CHD mortalities, but obesity and diabetes occurrences in low-income families are contradicting some of these developments. Little has also been done to address healthcare disparities in the UK populations. Sedentary lifestyles coupled with poor diet increase the risk of CHD. This is attributed to the accumulation of calories, increasing the risk of metabolic disorders that trigger the onset of CHD and CVD mortalities (Hollis et al., 2017). It is estimated that adults who exercise fifteen minutes a day have a longer life expectancy rate and reduce the risk of major lifestyle morbidities and mortalities. Thus, this indicates that physical activities reduce the risk of CHD. Physical exercises reduce the muscle tension, which improves the blood flow throughout the body.
Contemporary CHD Management
Notably, CHD is a chronic condition that develops throughout the lifespan of an individual and symptoms are likely to manifest themselves at advanced stages. Although mortality incidences caused by the coronary artery disease has reduced in the recent past, it remains the leading cause of premature deaths in the United Kingdom (Bhatnagar et al., 2016). Preventing CHD incidents remains a considerable public health challenge for policymakers, general population, and healthcare stakeholders in the UK and the world. A review of CHD risk factors strongly shows that this condition is connected to lifestyle, particularly sedentary lifestyles, psychosocial stress, unhealthy dietary plans, and the use of tobacco products among other factors. Thus, CHD prevention and management necessitates the involvement of the concerned stakeholders at an individual, community, and institutional levels in the eradication, or minimisation of the effects of CHD and associated health complications (Williams et al., 2010). The management of CHD is guided by the contemporary cardiovascular epidemiological knowledge and evidence-based clinical practices.
Although there are some genetic and inherent factors associated with CHD susceptibility, coronary heart disease along with other cardiovascular diseases are largely linked to lifestyle behaviours. Thus, most of the recommendations are based on behaviour management, which has to be strengthened by effective and robust policies in the United Kingdom. Therefore, the control and prevention of CHD starts during the gestation period and continues to the end of life (Danese et al., 2016). This indicates that preventive, management and interventions addressing CHD target all stages in the human lifespan, with a particular focus on the middle-aged and senior citizens with established cardiovascular conditions. Individuals categorised as high-risk populations with regards to cardiovascular events are also the primary target in preventive and management strategies (Williams et al., 2010). High-risk populations include men and women with high blood pressure, smoking habits, obesity, diabetes and other health complications. Two main CVD and CHD management and prevention approaches are either categorised as population strategy or the high-risk strategy.