A disease of affluence: coronary heart disease

Coronary Heart Disease (CHD)
A heart attack occurs when the blood vessels supplying the heart become blocked, straving it of oxygen and leading to the heart muscle’s failur or death. A wide range of risk factors can be responsible for a heart attack, often acting in combination. The incidence of these factors varies around world and so does the ocurrence of the disease.

The impact of CHD is measured both by deaths and by disabilty-adjusted life years (DALYs). DALYs are an ndication of the number of healthy years of life lost. The measures indicate the total burden of the disease, as opposed to just the number of deaths. Since 1990, more people around the world have died from CHD than from any other cause/ Its disease burden 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. CHD is decreasing in many more developed countries due to improved prevention, diagnosis and treatment, and in particular reduced cigaretter smoking and lower than average levels of blood pressure and cholesterol. However, it is increasing in less developed countries, partly as a result of increasing longevity, urbanisation and lifestyle changes. The World Health Organisation (WHO) states that more than 60% of the global burden pf CHD ocirrs in newly developing countries. IS THIS A DISTURBING SIGN OF DEVELOPMENT??
What are the risk factors?
There are over 300 risk factors associated with CHD. Many of these are significant in all populations. In MEDCs, there are five major risk factors:
· Tobacco use
· Alcohol use
· High blood pressure
· High cholesterol
· Obesity

in developing countries with low morality, such as China, the smae risk factors apply, with the additional risks of under-nutrition and communicable diseases. In develoing countries with high mortality, such as those of sub-Saharan Africa, low vegetable and fruit intake are also imortant factors. Some major risks are modifiable in that they can be prevented, treated and controlled. There are considerable health benefits at all ages, for both men and women, in stopping smoking, reducing cholesterol levels and blood pressure, eating a healthy diet and increasing phycial activity

Economic costs
The economic costs of CHD include the cost to the individual and to the family of healthcare and time off work, the cost to the government of healthcare and the cost to the country of lost productivity. All of these are difficult to quantify:
· ‘The direct costs of physical inactivity accounted for estimated US$24 billion in healthcare costs in 1996’ WHO
· ‘Health problems related to obesity, such as CHD, cost the USA an estimated US$177 billion a year’ WHO
· ‘Expenditure in OECD countries on CHD medications increased from 9.4% in 1989 to 11% in 1997’ WHO
· Cost of healthcare to individual/the government (this will differ depending which country the patient lives in)
· Cost to the individual of having time off work
· Cost to the employer
· Cost of lost productivity to the country
Impacts on health
· Before treatment the patient can experience shortness of breath and fatigue with only light exercise.
· They can also experience swelling in their feet, ankles, legs and abdomen.
· They may also experience pain in their chest, shoulders, arms or neck (angina).
· The patient may develop a life threatening arrhythmia (irregular heartbeat that can mean the body does not receive enough blood)
· After treatment there may be side effects from the medication
· There may also be psychological effects of having a heart attack/nearly dying/the thought that it could happen again. Some people become
depressed or anxious and are referred to have professional counselling or relaxation therapy as this can increase the patient’s risk of having a heart attack.
Prevention strategies
· In order to reduce the risk of CHD leading to a heart attack/sudden death/damage to the heart important lifestyle changes must be
made. These include:
o – Regular physical activity
o – Taking prescribed medicines on a daily basis
o – Following a healthy eating plan
o – Watching ones weight
o – Not smoking
o – Not drinking too much alcohol
· The patient should visit their doctor regularly to keep track of their blood pressure and their blood sugar and cholesterol levels. Some patients may also need to visit a counsellor or therapist to help with the psychological impact of CHD
· These regular appointments may restrict the person’s freedom to travel or require them to move if they live in a remote area. They will also need time off work.

Health education – promote healthy living and eating at schools, medical activites such as blood pressure testing, activities to engage the public in physical activity, scientific conferences, activities to promote a heart-healthy diet

Policies and legislation- reducing tobacco smoking – increase the price, advertising bans, smoke-free areas, health warnings on packets, taxation and outright bans in public places.