Heart Health: prevention, evidence and policy
Primary, high-risk and secondary prevention
The principal aim of primary prevention is to decrease the risk of developing symptomatic disease in individuals and populations and its effectiveness can be monitored through incidence rates. Risk factors such as serum cholesterol and blood pressure tend to follow a statistically normal distribution in the general population (although skewed a little to the right). A population approach seeks to prevent or delay the onset of CVD by shifting the whole population curve to the left.
The principal aim of high-risk primary prevention is to focus only on that small number of individuals above a certain threshold (e.g. by defining “hypercholesterolaemia” or “hypertension”) or estimated from risk prediction charts to be at higher absolute risk.
The principal aim of secondary prevention is to prevent further illness and death in those individuals who are already symptomatic (prevalence) and its effectiveness can be monitored through case fatality rates.
Cardiovascular Disease: A Guide to Primary Prevention in Scotland
In 2002 the Scottish Executive launched its National CHD (cardiovascular disease) and Stroke Strategy. One of its primary recommendations was for all NHS Boards to develop CHD and stroke prevention strategies. This cardiovascular disease (CVD) guide was produced to support this process. Although the guide specifically relates to preventing CVD it is important to note that it may also be of use to those involved in wider health improvement and local health improvement planning.
Chapter 1 introduces the guide, charts Scotland’s current position in relation to CVD and maps out what is currently happening at a national level to combat it. Chapter 2 maps out a framework for local primary prevention, identifying key modifiable risk factors. It goes on to explore how local primary prevention strategies could link with local health planning. Chapters 3, 4 and 5 present recommendations for local action in the key topic areas of physical activity, smoking and diet and nutrition respectively. For each recommendation, a summary of the evidence is presented together with any relevant local or national policy. Examples of current practice in Scotland are presented and a series of barriers to local implementation of the recommendation, together with levers for overcoming these barriers are also given.
- Front cover
- Contributors and acknowledgments
- Executive summary
- Figures and tables list
- Chapter 1 Introduction
- Chapter 2 Mapping out a framework for primary intervention
- Chapter 3 Physical activity
- Chapter 4 Tobacco
- Chapter 5 Diet and nutrition
Cholesterol Screening and Health Checks
A review of the evidence concerning the question of whether cholesterol testing, either on its own or as part of a wider “health check”, should be offered to the Scottish general public.
SIGN Guidelines 93-97 (external link)
A series of five clinical guidelines published in February 2007, covering prevention and treatment of heart disease.
The National Institute for Health and Clinical Excellence (NICE): Off-pump Coronary Artery Bypass (OPCAB (external link)
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on off-pump coronary artery bypass (OPCAB). This site provides five reports relating to OPCAB. NICE is an independent organisation that provides guidance on the promotion of good health and the prevention and treatment of ill health. NICE produces health guidance for health professionals in the areas of public health, technologies, and clinical practice.
Evidence
Also see the CHD, Risk Factors and Life circumstances sections for related information
- Physical Activity
National Institute for Health and Clinical Excellence (NICE): Coronary Disease (external link)
NICE is an independent organisation that provides guidance on the promotion of good health and the prevention and treatment of ill health. NICE produces health guidance for health professionals in the areas of public health, technologies, and clinical practice.
The National Institute for Health and Clinical Excellence (NICE): Off-pump Coronary Artery Bypass (OPCAB) (external link)
This 2004 Department of Health report sets out the latest research evidence of the health benefits of physical activity. The document is aimed at those concerned with formulating and implementing policies or programmes that utilise the promotion of physical activity, sport, exercise and active travel to achieve health gain.
The Clinical Evidence Physical Activity Review (external link)
This is a review of relevant evidence-based reports concerning physical activity, provided by BMJ Clinical Evidence. The BMJ Clinical Evidence is an international peer reviewed journal publishing systematic reviews. The reviews are designed to provide clinicians with access to the very latest and most relevant medical knowledge for treatment decisions.
Journal of Sports Sciences Special Issue. From Evidence to Policy: reflections on emerging themes in health-enhancing physical activity (external link)
This is the 25th Anniversary volume of the Journal of Sports Sciences. The journal publishes articles on various aspects of the sports sciences covering a number of disciplinary bases, including anatomy, biochemistry, biomechanics, psychology, sociology, ergonomics, kinanthropometry and other interdisciplinary perspectives. All research and review articles in this journal have undergone peer review based on initial editor screening and anonymous (double-blind) refereeing by at least two referees.
Centers for Behavioral and Preventative Medicine: Physical Activity Research Center (external link)
This is an American organisation with centres dedicated to the research and promotion of physical activity. Studies focus on primary and secondary prevention of cardiovascular disease and cancer.
Physical Activity and Health (external link)
This Scottish Government site provides information about the Scottish Executive's programme of action to increase the nation's physical activity and the policy behind it.
The Community Guide: Physical Activity (external link)
The Community Guide is an American organisation that provides systematic reviews of the effectiveness of population-based interventions to increase physical activity. The Community Guide specifically reviews the effectiveness of informational approaches, behavioural and social approaches, and environmental and policy approaches to increasing physical activity.
Cardiovascular Disease: Physical activity
This is an extensive report examining the link between health and physical activity. This report on physical activity is a selection from the above mentioned Cardiovascular Disease: A Guide to Primary Prevention in Scotland.
Physical Activity and Environment Programme: Final Scope (2006) (external link)
The purpose of this report is to improve environmental factors that promote physical activity. This National Institute for Health and Clinical Excellence (NICE) report comes at the request of the Department of Health. NICE is an independent organisation that provides guidance on the promotion of good health and the prevention and treatment of ill health. NICE produces health guidance for health professionals in the areas of public health, technologies, and clinical practice.
Health Scotland Commentary on NICE Public Health Intervention Guidance 2: Physical Activity.
Four commonly used methods to increase physical activity: brief interventions in primary care and other settings (January 2007)
- Food
Clinical Evidence Diet and Nutrition Review (external link)
This is a review of relevant evidence-based reports concerning diet and nutrition, provided by BMJ Clinical Evidence. The BMJ Clinical Evidence is an international peer reviewed journal publishing systematic reviews. The reviews are designed to provide clinicians with access to the very latest and most relevant medical knowledge for treatment decisions.
Food Standards Agency (external link)
The Food Standards Agency is an independent Government department set up by an Act of Parliament in 2000 to protect the public’s health and consumer interests in relation to food.
Scottish Nutrition and Diet Resources Initiative (external link)
The Scottish Nutrition and Diet Resources Initiative (SNDRI) provides a range of accessible diet-sheets to the public and health professionals in Scotland. SNDRI publications are evidence based, peer reviewed, and free from commercial bias
US Guide to Community Preventive Services: Diet and Nutrition Systematic Reviews (external link)
The Community Guide is an American organisation that provides systematic reviews of population-based interventions addressing nutrition. The Community Guide specifically reviews the effectiveness of school-based nutrition programs, food and beverage advertising to children and community approaches to increase fruit and vegetable intake.
Cardiovascular Disease: Diet and nutrition
This is an extensive report examining the strong correlation between Unhealthy diets and cardiovascular disease (CVD). This report on diet and nutrition is a selection from the above mentioned Cardiovascular Disease: A Guide to Primary Prevention in Scotland.
- Weight
Counterweight Project Team. A new evidence-based model for weight management in primary care: the Counterweight programme (2006) (external link)
Health Scotland Commentary on Public Health aspects of NICE Clinical Guideline 43: Obesity: Guidance on the prevention, identification, assessment and management of obesity in adults and children. (May 2007)
- Smoking
ASH Scotland (external link)
ASH Scotland is a voluntary organisation that campaigns for tobacco control legislation in Scotland. The organisation is an experienced source on tobacco related issues.
Tobacco Information Scotland (external link)
This Website offers a list of various organisations and networks working in smoking and tobacco control.
Centre for Tobacco Control Research, University of Strathclyde (external link)
The Centre for Tobacco Control Research (CTCR) conducts applied research in the areas of smoking behaviour, prevention and quitting. The CTCR provides evidence-based research to support the creation of effective public policy.
Clinical Evidence Tobacco Review (external link)
This is a review of relevant evidence-based reports concerning tobacco use provided by BMJ Clinical Evidence. The BMJ Clinical Evidence is an international peer reviewed journal publishing systematic reviews. The reviews are designed to provide clinicians with access to the very latest and most relevant medical knowledge for treatment decisions.
National Institute for Clinical Excellence: Tobacco Programmes (external link)
The National Institute for Health and Clinical Excellence (NICE) has several smoking guidance sections, each containing numerous reports:
- Preventing the uptake of smoking by children
- Workplace Smoking
- Smoking cessation - bupropion and nicotine replacement therapy
- Smoking cessation - varenicline
NICE is an independent organisation that provides guidance on the promotion of good health and the prevention and treatment of ill health. NICE produces health guidance for health professionals in the areas of public health, technologies, and clinical practice
US Guide to Community Preventive Services: Tobacco Systematic Reviews (external link)
The Community Guide is an American organisation that provides systematic reviews of the effectiveness of population-based interventions to increase physical activity. The Community Guide specifically reviews the effectiveness of tobacco prevention, cessation and exposure reduction programs.
Partnership Action on Tobacco and Health (external link)
Partnership Action on Tobacco and Health (PATH) is an initiative, managed by ASH Scotland, which aims to reduce the number of people that smoke in Scotland.
Cardiovascular Disease: Chapter 4 Tobacco
This is an extensive report examining the strong link between tobacco use and ill health. This report on smoking is a selection from the above mentioned Cardiovascular Disease: A Guide to Primary Prevention in Scotland.
Health Scotland Commentary on NICE Public Health Intervention Guidance 1. Smoking cessation. Brief interventions and referral for smoking cessation in primary care and other settings (January 2007)
Scottish Policy
Also see the Physical activity, Food, Weight and Smoking sections for related policy information.
- Coronary heart disease (CHD)
Towards a Healthier Scotland. A White Paper on Health (1999) (external link)
The Scottish Executive’s plan recognises CHD as a national priority, setting a national target for its reduction by 2010. It also recognises however that to further accelerate the decline in CHD, programmes need to go beyond the simple risk factor and disease focused approach and also address the underlying determinants of health.
Our National Health: A Plan for Action, A Plan for Change (2000) (external link)
This document explains the Scottish Executive’s plans for the NHS. It identifies CHD as a national clinical priority, setting a number of clinical aims and targets for the NHS in relation to CHD. The document further outlines plans for the national demonstration project programme, including the creation of a CHD National Learning Network.
CHD Taskforce Report (2001) (external link)
In response to the Acute Services Review (June 1998, paragraph 86), a CHD Task Force was created to develop the clinical network of cardiac services in Scotland. The Task Force published its findings in this 2001 report which includes 45 separate recommendations.
CHD and Stroke Strategy for Scotland (2002) (external link)
This report outlines 24 recommendations for implementing the findings of the above mentioned CHD Taskforce. The Recommendations are separated into the following headings:
- Background
- Summary of Recommendations
- The CHD/Stroke Strategy
- Prevention
- Managed Clinical Networks for CHD and Stroke Workforce Issues
- Information Technology and the Development and Use of Databases
Delivering for Health (2005) (external link)
This document describes in practical terms the Scottish Government’s plan of action to implement its vision of health service. It builds on the National Framework for Service Change to provide a template for the future NHS Scotland.
Coronary Heart Disease & and Stroke in Scotland. Strategy Update 2004 (external link)
Reports on progress with the implementation of the Coronary Heart Disease (CHD) and Stroke Strategy
A refreshed version of the 2002 strategy will be published by the Scottish Government in January 2008.
- Risk factors
The Scottish Health Survey 2003 Volume 1: Cardiovascular Disease and
Associated Factors (external link)
The first of four volumes of the 2003 Scottish Health Survey. It reports the prevalence of self-reported CVD conditions for the Scottish adult population (ages 16+). It examines CVD prevalence by socio-demographic characteristics, and looks at the used of health services and treatment for CVD. Results for four blood analytes (total cholesterol, HDL-cholestrol, fibrinogen and C-reactive protein , associated with risk factors for cardiovascular disease, are also reported. The chapter investigates the relationship between various risk factors and CVD, and describes trends in specific conditions and blood analytes in 1995, 1998 and 2003. Comparisons with England are also presented, based on the 2003 HSE.
Towards a Healthier Scotland. A White Paper on Health (1999)
Chapter 4 Action: Lifestyles (external link)
This section of the Scottish Executive’s 1999 report examines how lifestyle influences CHD. This includes the CHD risk factors of smoking, unhealthy diet, physical inactivity and alcohol misuse.
Improving Health in Scotland - The Challenge (2003) (external link)
This paper builds on Towards a Healthier Scotland, providing framework for programmes and policy to improve the health in Scotland. This is the first phase in a series which will be published on the subject.
Let's Make Scotland More Active: A strategy for physical activity (external link)
This is the broad framework of objectives and priorities for the development of physical activity in Scotland. Implementation plans will be published in 2003/04.
At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer (external link)
This document is particularly aimed at the NHS, specifically public health and Primary Care Trusts. The report sets out the latest research evidence of the benefits of physical activity for health. The document is aimed at those concerned with formulating and implementing policies or programmes that utilise the promotion of physical activity, sport, exercise and active travel to achieve health gain.
National Smoking Strategy – Smoking Kills (1998) (external link)
This report outlines three primary aims: to reduce smoking in children and young people, to help adults, particularly the disadvantaged, and to help pregnant women give up smoking. The report also outlines the UK government’s comprehensive tobacco policy involving a range of measures to reduce smoking deaths in the UK. Some of these measures include: tobacco advertising and marketing, taxation, smoking cessation, anti-tobacco campaigns, passive smoking in the workplace and public places, international aspects, protection of children and establishing a range of aims and UK targets.
Review of the Scottish Diet Action Plan (2006) (external link)
Since July 2005 Health Scotland has been co-ordinating a review of the implementation of the Scottish Diet Action Plan between 1996 and 2005.
Eating for Health: The Scottish Diet Action Plan (1996) (external link)
This Scottish Government report provides the framework for improving Scotland’s diet and sets out a wide range of action (71 recommendations) to help achieve Scotland’s dietary targets for 2005.
Eating for Health - Meeting the Challenge: Co-ordinated Action, Improved Communication and Leadership for Scottish Food and Health Policy 2004 (external link)
This report from the Scottish Government outlines strategies for dietary health in Scotland. The findings are based on collaboration with partner organisations which have built upon the recommendations in the above mentioned report The Challenge (2003).
- Life circumstances and inequalities
Deprivation and Health in Scotland (1998) (external link)
This ISD Scotland publication provides an up-to-date overview of inequalities in health with respect to material deprivation in Scotland.
Towards a Healthier Scotland. A White Paper on Health (1999)
Chapter 3 Action: Life Circumstances (external link)
This chapter of the Government’s report examines how adverse life circumstances are vitally linked to reducing health inequalities in Scotland.
Social Justice Report, Social Justice...a Scotland where everyone matters (external link)
This report from the Scottish Executive outlines 10 long-term targets for the achievement of Social Justice and 29 milestones marking progress towards the targets. These include goals of reducing CHD in specific age groups.
Chief Medical Officer Annual Report. Health in Scotland 2001: Working in Partnership to Improve Life Circumstances (external link)
This report focuses on tackling deprivation and social exclusion and improving life circumstances in Scotland. The report outlines the work being undertaken to improve education and housing in disadvantaged areas, health initiatives specifically designed to reduce health inequalities and tackle adverse life circumstances (such as the health demonstration projects, healthy living centres and social inclusion partnerships), action across Executive Departments, action by HEBS and PHIS, and action at NHS Board level.
UK policy
Department of Health: Coronary heart disease (external link)
The Department of Health (DH), which aims to improve the health and wellbeing of people in England, provides extensive information and publications regarding coronary heart disease.
National Service Framework: Coronary Heart Disease (external link)
The National Service Framework (NSF) is the English equivalent to the Scottish CHD and Stroke Strategy and it aims to improve the prevention, diagnosis and treatment of CHS. The NSF is more prescriptive than the Scottish Strategy, outlining priorities, approaches, effective interventions, targets and milestones.
The NSF for CHD: Winning the war on heart disease (Progress report 2004) (external link)
This Department of Health report “details the progress which has been made in implementing the Coronary Heart Disease National Service Framework” since it's publication in March 2000.
National Service Framework for Wales (external link)
This is the Welsh CHD strategy which is similar to the above mentioned English NSF. The Welsh NSF has a detailed action plan to implement its CHD strategy.
Department of Health CHD Information Strategy (external link)
This report supports the CHD National Service Framework document and the NHS Plan. One aim of the information strategy is to identify further work that needs to be done to support CHD and cardiac care.
International Task Force for the Prevention of CHD (external link)
This organisation aims to inform the international management of CHD. Specifically, this international task force provides strategies and information regarding the prevention of CHD.
Young at Heart: Towards a Generation Free From CHD (external link)
This National Heart Forum report contains recommendations for a national plan for children’s and young people’s health and well-being, with an emphasis on CHD. Regarding life circumstances, the report sets forth comprehensive national strategies focusing on young people’s nutrition, physical activating, and smoking habits.