The burden of heart disease

More news to suggest that governments in Europe must continue to curb the growing tide of obesity as the burden of heart disease, long linked to obesity, weighs heavily on the purse-strings of treasuries. A new study reveals previous figures were too conservative and that coronary heart disease actually costs the UK a staggering €11 billion per year - seven times more than previously thought.

The British Medical Association reports this week that coronary heart disease is the most expensive disease in the UK, costing over £7 billion (€11bn) a year in lost productivity and its impact on health care, reveals research in the publication Heart​. Worryingly, the figure is between seven and ten times higher than previously published estimates.

According to the BMA​, the authors based their findings on the numbers of UK residents in 1999 who had been diagnosed with heart disease, plus the costs of direct health care, the amount of informal care, and lost productivity and earnings.

Direct health care costs were calculated from spending on prevention, emergency and hospital care, rehabilitation and drug treatment.

In 1999 coronary heart disease cost UK health care £1.73 billion, with hospital and in-patient care, and prescriptions taking the largest slice of the monies. These figures are among some of the lowest estimated costs reported in research from other industrialised countries.

Other diseases cost the NHS more, say the authors, but heart disease is much more expensive in terms of its impact on informal care, calculated to be £2.42 billion in 1999. And its effect on productivity amounted to £2.91 billion, over three quarters of which was attributable to days lost to ill health. When added together, the total came to £7.06 billion, making heart disease the most expensive disease in the UK.

Previous estimates for the economic toll taken by heart disease have produced figures of between £775 million and £1.5 billion, but these did not take account of productivity and informal care costs, say the authors.

Lining up behind heart disease in the 'top 10' of most expensive diseases, according to published research, were back pain, rheumatoid arthritis, and Alzheimer's disease.

In a separate study published in the recent issue of Heart​​, researchers reveal that women are fast catching up with men on risks of sudden death after heart attack. Defined as death within an hour of the start of symptoms in someone who has had no previous signs of a potentially fatal illness, sudden cardiac death accounts for 60 per cent of all heart deaths in the USA - around 400,000 every year - but it has always been thought that women have around half the risk of men.

Over two years, Danish researchers monitored the progress of almost 6000 people who had had a heart attack. Their ages ranged from under 56 to over 76.

Overall, men were at higher risk (34 per cent), but the risk for women older than 66 was more than 10 per cent. An accompanying editorial points out that the study shows that men were only 1.3 times more likely to die a sudden cardiac death than women.

"It is clear that in the area of [sudden cardiac death] risk women are rapidly achieving equality with men,"​ write the researchers from the US Krannert Institute of Cardiology, Indiana, highlighting US research which shows a 21 per cent increase in risk among young women between 1989 and 1998. They said that the Danish study supports a growing body of evidence that women are increasingly at higher risk of poorer survival after a heart attack than men.

"We already know that women have a higher in-hospital mortality rate after myocardial infarction than men, with the greatest inequality observed in younger women,"​ they write."What is not clear is what (if anything) we as medical providers can do to curb this disturbing development,'"​ they conclude.

Some might argue that a drive to promote healthier eating in the population could contribute to reducing this worrying phenomenon.