Despite significant success in reducing premature mortality from cardiovascular disease (CVD), it remains a major cause of death and disability in Scotland.
We look at eight reasons why tackling undiagnosed medical risk factors, improving quality of care and reducing variation can change thousands of lives.
1. After 40 years of falling premature CVD deaths, progress has slowed
Data source: 
Around 22% of all premature deaths in Scotland – 4,600 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 Scotland.
Premature CVD death rates in Scotland have fallen 78% 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 progress has slowed since 2011. The reasons are unclear. We must do more.
2. We are living longer, but with more long-term conditions
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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 65.3
In Scotland today, 685,000 people live with CVD;4 at least 48,000 of those have heart failure.5 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,6 which increases the risk of other CVD conditions.
By 2030, the population in Scotland aged 65-84 will rise by 29% and those over 85 by 56%.7
We must plan for the future.
3. CVD healthcare costs Scotland hundreds of millions of pounds a year
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The direct and indirect costs of CVD to the NHS in Scotland and the wider economy are significant.
Each year, Scotland spends an estimated £800m on CVD healthcare costs. The wider economic impact of these diseases is estimated at £1.8bn.8
Meanwhile, the NHS in Scotland faces a challenging financial position in the coming years.
We can bring down this cost.
4. You’re up to 60% more likely to die early from CVD depending on where you live
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CVD risk factors such as smoking, physical inactivity and obesity are more common in deprived areas of Scotland. 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 – West Dunbartonshire – are 1.6 times more likely to die prematurely from CVD compared with people in East Renfrewshire, which has the lowest average deprivation in Scotland.9
We must close these inequality gaps.
5. We could perform better against other EU nations for premature CVD deaths
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Despite decades of success bringing down the premature CVD death rate, Scotland still ranks lower than 18 other EU nations – behind Slovenia, Cyprus and Malta.
The burden of premature death due to CVD in Scotland was 2,520 years of life lost per 100,000 population.10
We can do better. Together, we can act to reduce this burden.
Thousands 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. Thousands could benefit from earlier risk factor detection and treatment
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We know that hypertension is implicated in half of all strokes and heart attacks.11
People with AF are five times more likely to have a stroke.11
High cholesterol is common in the adult population. Raised cholesterol increases the risk of heart attack and stroke.11
However, we already have effective treatments available:
- Every 10mmHg drop in blood pressure reduces the risk of strokes and heart attacks by 20%.11
- Anticoagulation for AF prevents 66% of related strokes.11
- Every 1mmol/l fall in LDL cholesterol from statin treatment reduces yearly risk of heart attack and stroke by 25%.11
The problem is that significant regional variation in detection rate and treatment remains.
7. Better risk factor management could avoid hundreds of CVD events
The missed opportunities
16%* of adults with diagnosed hypertension (97,800 people) are not treated to guidelines
51% of adults with 10-year CVD risk above 20% (estimated at 206,200) are not treated with statins
14%* of high-risk AF patients (7,500 people) are not anticoagulated
* figures do not include QOF exception data so may not be comparable with other UK nations.
Over 3 years, optimally treating adults with diagnosed hypertension can avoid:
- 880 strokes
- 590 heart attacks
And optimally treating high-risk AF patients can avoid:
- 600 strokes
Data source: 
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.
Around 600 strokes in Scotland could be avoided over three years12 if everyone with AF was diagnosed and received appropriate anticoagulation therapy.
Arrhythmia Care Coordinators can help to enhance and optimise AF detection and management, reducing stroke incidence.
Find out more about the role of Arrhythmia Care Coordinators.
Familial hypercholesterolaemia (FH)
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.
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.
Learn more about our FH service.
A significant proportion of adults with hypertension remain undiagnosed. Of those who are, one in six are not treated to target.5
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.
Read our High blood Pressure: how can we do better? resource.
1 BHF (2018) CVD Statistics Compendium 2018.
2 Royal College of General Practitioners (2016). Responding to the needs of patients with multimorbidity: A vision for general practice
3 The King's Fund (2012) Demography: future trends
4 BHF (2018) estimate based on GP patient data and latest UK health surveys with CVD fieldwork
5 Information Services Division Scotland (2016) Quality and Outcomes Framework 2015/16
6 The Health Improvement Network (THIN) database (2017) version THIN1405
7 Office for National Statistics (2015) 2014-based National Population Projections
8 BHF analysis of European Heart Network (2017) European Cardiovascular Disease Statistics 2017 and NHS Expenditure, Population Health Analytical Services, Scottish Government 2011/12
9 BHF (2018) analysis of Office for National Statistics (2017) and National Records of Scotland (2017) mortality data for 2014-16
10 Global Burden of Disease (2015)
11 NHS England (2016) The NHS RightCare Cardiovascular Disease Prevention Pathway – Dr Matt Kearney and Miles Freeman blog post
12 BHF analysis (2018) based on NHS England/Public Health England (2017) The Size of the Prize in Cardiovascular Disease (CVD) Prevention
The CVD Challenge in Scotland
Around 685,000 people in Scotland live with the burden of cardiovascular disease (CVD). Thousands more have undetected medical risk factors. Despite significant successes in reducing CVD mortality, it remains a major contributor to premature death and health inequality. But it doesn’t need to be like this. The CVD Challenge in Scotland describes how, by working with health system leaders and governments, together we can tackle medical risk factors for CVD to save lives and reduce NHS pressures.