Eight reasons why we need to think differently about cardiovascular disease in England

Despite significant success in reducing premature mortality from cardiovascular disease (CVD), it remains a major cause of death and disability in England. We look at eight reasons why tackling undiagnosed medical risk factors, improving quality of care and reducing variation can change millions of lives.

1. After 40 years of falling premature CVD deaths, progress has slowed

Data source1

22% of all premature deaths in England – 33,700 a year – are caused by CVD1

Today, cardiovascular disease (CVD) continues to affect the lives of millions of people and is one of the largest causes of death and disability in England. 

Premature CVD death rates in England have fallen 80% over the last 40 years,1 largely thanks to BHF-funded research, advances in treating conditions like heart attack and stroke and the decline in smoking, as well as lifestyle changes.

But, concerningly, progress has slowed since 2011. The reasons are unclear.

We must do more.

2. We are living longer, but with more long-term conditions

Bar chart showing the predicted growth in number of people with one or more long-term condition in the UK between 2015 and 2025

Data source2

Our population is ageing. Growing life expectancy coupled with the ageing of the ‘baby boomer’ generation means the number of people aged over 65 is growing faster than those under 65.16

In England today, 5.9m people live with CVD;3 at least 435,000 of those have heart failure.4 CVD makes up a significant proportion of all long-term conditions (LTCs). Many other common LTCs also increase the risk of developing CVD.

What’s more, CVD risk increases with age: almost 8% of people in their 60s are diagnosed with coronary heart disease, for instance, and over a third will have hypertension,5 which increases the risk of other CVD conditions.

By 2030, the population in England aged 65-84 will rise by 29% and those over 85 by 61%.6 Treatment and care for people with long term conditions is estimated to take up around £7 in every £10 of total health and social care expenditure.7

We must plan for the future.

Order or download the leaflet

You can order or download the leaflet,The CVD Challenge in England, to share with your colleagues and partners today.


Want to learn more about the BHF's service innovation work? Visit our Service innovation section.

3. CVD healthcare costs England billions of pounds a year

An infographic showing the cost of CVD in England

Data source8

The direct and indirect costs of CVD to the NHS in England and the wider economy are significant.

Each year, England spends an estimated £7.4bn on CVD healthcare costs. The wider economic impact of these diseases is estimated at £15.8bn.8

Meanwhile, the NHS needs to save £22 billion by 2020, as part of the vision in the NHS Five Year Forward View.9

We can bring down this cost.

4. You’re up to 3 times more likely to die early from CVD depending on where you live

A graph showing how the CVD death rate in England rises in line with deprivation 

Data source10

CVD risk factors such as smoking, physical inactivity and obesity are more common in deprived areas of England. These increase risk of hypertension, atrial fibrillation (AF) and high cholesterol.

So the most deprived people in our society shoulder the greatest burden of death and disability from CVD.

For instance, people living in the local authority with the highest level of average deprivation – Manchester – are three times more likely to die prematurely from CVD compared with people in Hart, Hampshire, which has the lowest average deprivation in England.10

There are also big mortality variations between men and women. In 2015 in England and Wales, premature CVD death rates were 56% higher for men than women.1

We must close these inequality gaps.

5. We could perform better against other EU nations for premature CVD deaths

A chart comparing England's premature CVD death rate to other EU nations

Data source11

Despite decades of success bringing down the premature CVD death rate, England still ranks lower than nine other EU nations – behind Ireland, Denmark and Portugal.

The burden of premature death due to CVD in England was 2,028 years of life lost per 100,000 population.11

We can do better.

Together, we can act to reduce this burden.

Millions of people have undetected medical risk factors that increase their chance of developing CVD.

We can diagnose and treat them earlier.

Many with diagnosed risk factors receive sub-optimal treatment.

We can improve care.

Patients experience varying standards of care and outcomes depending on where they live.

We can innovate to improve patient outcomes.

6. Millions could benefit from earlier risk factor detection and treatment

A map of England's diagnosis rates for hypertension

Data source.12 Contains Ordinance Survey data © Crown copyright and database rights 2017

Over 13.5 million adults in England have hypertension, but 40% are not diagnosed.12 Yet, we know that hypertension is implicated in half of all strokes and heart attacks.13

Over 1.4 million adults have AF, but 30% are not diagnosed.14 Yet, people with AF are five times more likely to have a stroke.13

High cholesterol is common in the adult population. Raised cholesterol increases the risk of heart attack and stroke.13

However, we already have effective treatments available:

  • Every 10mmHg drop in blood pressure reduces the risk of strokes and heart attacks by 20%.13
  • Anticoagulation for AF prevents 66% of related strokes.13
  • Every 1mmol/l fall in LDL cholesterol from statin treatment reduces yearly risk of heart attack and stroke by 25%.13

The problem is that significant regional variation in detection rate and treatment remains. Between different Clinical Commissioning Groups, rates of undiagnosed hypertension varies from 9.4% to 14%. Between general practices, it varies from 3.8% to 20.4%.12

7. Better risk factor management could avoid thousands of CVD events

The missed opportunities

A graphic representing 20% 
20% of adults with diagnosed hypertension (1.6 million people) are not treated to NICE guidelines
 A graphic representing 51%
51% of adults with 10-year CVD risk above 20% (estimated at 2 million people) are not treated with statins
 A graphic representing 22%
22% of high-risk AF patients (177,800 people) are not anticoagulated

The potential

Over 3 years, optimally treating adults with diagnosed hypertension can avoid:

14,500 strokes, saving up to £202m

9,710 heart attacks, saving up to £72m

And optimally treating high-risk AF patients can avoid:

14,220 strokes, saving up to £242m

Data source15

8. It’s time to think differently about CVD services

The BHF has piloted and evaluated models of care that can avoid hospital admissions, improve patient outcomes and save the NHS millions of pounds a year. Now they need wider roll-out.

Atrial fibrillation

The challenge

Around 14,220 strokes in England could be avoided over three years15 if everyone with AF was diagnosed and received appropriate anticoagulation therapy.

The solution

Arrhythmia Care Coordinators can help to enhance and optimise AF detection and management, reducing stroke incidence.


Familial hypercholesterolaemia (FH)

The challenge

The inheritable FH gene leads to abnormally high blood cholesterol levels, raising an otherwise healthy person’s risk of dying from a heart attack in their 20s, 30s or 40s.

The solution

Cascade testing first-degree relatives of people with FH can help identify and treat at-risk family members. A BHF pilot has so far found over 1,400 cases and offered treatment to lower CVD risk.



Four in 10 adults with hypertension remain undiagnosed.12 Of those who are, one in five are not treated to target.4

How can we do better?

The BHF and partners in primary care, public health and the third sector came together to produce a resource that highlights these problems and offers solutions.




1 BHF (2016) CVD Statistics Compendium 2017

2 Royal College of General Practitioners (2016). Responding to the needs of patients with multimorbidity: A vision for general practice

3 BHF (2017) estimate based on GP patient data and latest UK health surveys with CVD fieldwork

4 NHS Digital (2016) Quality and Outcomes Framework 2015/16

5 The Health Improvement Network (THIN) database (2017) version THIN1405

6 Office for National Statistics (2015) 2014-based National Population Projections

7 Department of Health (2012) Long-term conditions compendium of Information: 3rd edition

8 BHF analysis of European Heart Network (2017) European Cardiovascular Disease Statistics 2017

9 NHS England (2016) NHS Five Year Forward View Recap briefing for the Health Select Committee on technical modelling and scenarios [PDF]

10 BHF (2017) analysis of Office for National Statistics mortality data for 2013-15 

11 Global Burden of Disease (2015)

12 Public Health England (2016) Hypertension prevalence estimates for local populations. Updated with 2015/16 population for national figures

 NHS England (2016) The NHS RightCare Cardiovascular Disease Prevention Pathway – Dr Matt Kearney and Miles Freeman blog post

14 Public Health England (2015) Atrial Fibrillation prevalence estimates for local populations. Updated with 2015/16 population

15 NHS England/Public Health England (2017) The Size of the Prize in Cardiovascular Disease (CVD) Prevention

16 The King's Fund (2012) Demography: future trends

Order or download the leaflet

Order or download the leaflet, The CVD Challenge in England, to share with your colleagues and partners today.


Want to learn more about the BHF's service innovation work? Visit our Service innovation section.