Cardiovascular inequalities in Wales: an analysis

Introduction

Health inequalities are a critical priority for BHF and for the NHS. Unfair differences in cardiovascular risk and outcomes are not inevitable. Instead, these differences are often rooted in systemic inequalities in society and our health and care systems.

In 2024, we published a report that analysed health inequalities relating to deprivation in Wales across the cardiovascular disease (CVD) pathway. This report found evidence of significant inequalities across the CVD pathway, often to the detriment of the most deprived parts of Wales.

Now, in light of two more years of data on CVD in Wales, we have decided to update our Wales report. We analysed data on CVD and its risk factors in Wales from several sources, including the National Survey for Wales, Digital Health and Care Wales, and the Office for National Statistics.

Download the full report or read the summary of findings on this page.

• Download the full report in English (PDF, 1.66MB, 17 pages)
• Download the full report in Welsh (PDF, 1.78MB, 20 pages)

Our report findings

Risk factors are concentrated in more deprived communities

More than 70% of the CVD burden in Wales is estimated to be attributable to modifiable risk factors. Looking at the most important risk factors for CVD we see a consistent deprivation gradient, with more people in the most deprived communities living with hypertension, diabetes, and obesity.

Hypertension

High blood pressure is the leading modifiable risk factor for CVD in Wales and is associated with around half of heart attacks and strokes. Around 750,000 adults are estimated to have high blood pressure, but only around 540,000 are recorded on GP hypertension registers. This suggests that up to 210,000 people could be undiagnosed and missing effective treatment.

Among primary care clusters, the age-standardised prevalence of diagnosed hypertension was 16.5% in the most deprived quintile, compared with 13.9% in the least deprived—almost 20% higher.

Diagnosis alone is not enough. In June 2025, only 51.3% of patients diagnosed with hypertension in Wales were treated to target, compared with 66.8% in England. Identifying people earlier and helping more patients achieve effective blood pressure control could prevent heart attacks and strokes, particularly in communities with the highest burden.

Diabetes

More than 230,000 adults in Wales have diagnosed diabetes, around 90% of them type 2. Diabetes damages blood vessels over time and greatly increases the risk of cardiovascular disease.

The age-standardised prevalence of diagnosed diabetes in primary care clusters was 9.6% in the most deprived quintile and 6.8% in the least deprived. In relative terms, prevalence was more than 40% higher in the most deprived quintile. This difference was statistically significant.

Obesity and smoking

In 2022/23, 32% of adults in the most deprived quintile were living with obesity, compared with 22% in the least deprived—a gap of 10 percentage points. A high body mass index is associated with more than one in six cardiovascular deaths in Wales.

Smoking shows an even steeper inequality. Prevalence was 21.8% in the most deprived areas and 7.5% in the least deprived, meaning smoking was almost three times as common. More than 1,100 CVD deaths in Wales each year are estimated to be attributable to smoking.

Morbidity

In the most deprived parts of Wales more people are living with CVD

The higher burden of risk factors is reflected in diagnosed CVD. We used age-standardised prevalence data from primary care clusters, stratified into deprivation quintiles, to understand the diagnosed prevalence of cardiovascular diseases (i.e. how many people are diagnosed with these diseases in a particular area and point in time). We found statistically significant differences between the most and least deprived groups.

Coronary heart disease

Prevalence was 3.5% in the most deprived quintile and 2.9% in the least deprived—more than 20% higher. More than 110,000 people in Wales are living with coronary heart disease.

Heart failure

Prevalence was highest in the most deprived quintile at 1.4%, compared with 1.1% in the middle quintile, where it was lowest. More than 46,000 people have a GP-recorded diagnosis, although hospital data suggests the true number may be higher.

Stroke and transient ischaemic attack

Prevalence was 2.2% in the most deprived quintile and 1.9% in the least deprived. In Wales there are around 7,000 hospital admissions for stroke each year, and over 74,000 people living in Wales have survived a stroke or TIA.

Although the percentage-point differences may appear small, they affect large populations and represent substantial additional illness, disability, pressure on families and demand on health and care services.

Mortality

More people die from CVD at a young age in the most deprived parts of Wales

CVD causes more than one in four of all deaths in Wales, or around 9,300 each year. People living in more deprived areas of Wales are far more likely to die from cardiovascular disease at a young age than those living in less deprived areas. We calculated premature (under-75) age-standardised mortality rate from cardiovascular disease in Wales’s 22 local authorities by WIMD rank as a three-year average of 2022-24. This shows a clear association between deprivation and CVD mortality at the local authority level, with more deprived areas having significantly higher premature CVD mortality rates than less deprived areas.

Monmouthshire, the least deprived local authority in Wales, had the lowest age-standardised rate of premature death from CVD at 59 per 100,000 people. In Blaenau Gwent, the most deprived local authority, the death rate was more than double this, at 121 per 100,000. This was the highest rate of any local authority.

Discussion

The healthcare journey for cardiovascular disease patients is complex, and health inequalities exacerbate this further. In Wales, there are clear and consistent gaps between the most and least deprived areas when it comes to identifying, diagnosing and treating cardiovascular disease. From the greater burden of risk factors and cardiovascular conditions, to higher rates of premature mortality, the most deprived communities in Wales are at a disadvantage when it comes to their heart health. More broadly, the impact of socio-economic deprivation can be seen in the differences in life expectancy and healthy life expectancy. In 2022–24, in the most deprived areas of Wales, men and women were expected to live 18 and 19 fewer years in “good” health, respectively, compared to people living in the most affluent areas.

Limitations

There are several limitations to this analysis. The lack of deprivation data in several health indicators related to cardiovascular disease in Wales prevents us from commenting on some aspects of the cardiac pathway. This is the case for secondary care, where inconsistencies in data collection makes it impossible to robustly ascertain whether patient deprivation is associated with the number and length of elective and emergency care episodes.

While we can describe some of the disparities in CVD prevalence and mortality across Wales, there is a clear absence of data relating to access and quality of care by deprivation level. This includes data on cardiac rehabilitation and management of cardiovascular conditions.

Multiple methods of measuring deprivation were used across the report, with varying levels of certainty. For obesity and smoking data, deprivation quintile was ascertained at a more granular level than the primary care cluster or local authority-level data. Analysing deprivation patterns using higher-level geographies (e.g., cluster-based quintile or local authorities) makes it harder to identify the true association between deprivation and CVD. There can be large disparities in the wider determinants of health within these areas. In these cases, our findings may not represent the true association between deprivation and the CVD metric in question, as outlying areas and populations in these local authorities or primary care clusters may skew the results.

The data used in this analysis were not granular enough to stratify by other patient demographics, which we recognise as another limitation. The effects of deprivation may be confounded by other social and demographic factors. Our UK-wide Bridging Hearts report highlights the significant role played by sex, gender and ethnicity in influencing cardiovascular health.

Conclusions

In summary, there is a clear association between deprivation and cardiovascular disease in Wales. This is the case across the patient journey, from prevention to outcomes; the higher rates of CVD risk factors in more deprived areas are a clear contributor to the stark differences in premature CVD mortality between the most and least deprived communities in Wales. The persistent gap in the prevalence of CVD and its risk factors according to deprivation – despite significant advances in the treatment of CVD over recent decades – is also testament to just how much of the CVD challenge is driven by socioeconomic conditions and not just individual differences in lifestyle. This demonstrates the importance of adopting a holistic approach to CVD prevention and health care in Wales.