Editorial

Foot ulceration in people with diabetes is an increasing problem which is costly to the NHS financially and to patients in terms of quality of life. Management is complex and involves a team approach to ensure the best results for patients. 

As many as 16 million people in the UK are estimated to have hypertension, and around 7 million of these are undiagnosed. Of those diagnosed in England, one third are not receiving optimum management. Poor detection and management of hypertension places a significant burden on the NHS, and hypertension-related conditions cost an estimated £2 billion a year. We can change this by raising awareness of the consequences of hypertension, making it simpler to diagnose, and by supporting patients to manage their own health. The benefits of doing this are huge – just a 15% increase in the number of adults in England who have had their hypertension diagnosed would add 7,000 qualityadjusted life years and reduce health and social care costs by £120 m over ten years.

Obesity is estimated to be responsible for more than 30,000 deaths each year, reducing lifespan by an average of nine years. The links between obesity, diabetes and cardiovascular disease are well documented, but overweight and obesity also causes 6% of cancers in the UK. These figures have resulted in warnings that obesity is the new smoking when it comes to risks to health and longevity. So the problem is clear. The challenge is to put into action what works.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Elevated blood pressure (BP) is the main global risk factor for premature morbidity and mortality, and the prevalence of hypertensive heart disease is not declining over time. Improved control of high BP is, therefore, fundamental to further prevention of CVD, and adoption of treatment guidelines can have a positive impact on BP-related outcomes. 

Given that cardiovascular disease (CVD) is responsible for a quarter of all deaths in the UK and is the largest cause of premature mortality in deprived areas, the NHS Long Term Plan recognises that CVD is the single biggest area where the NHS can save lives over the next 10 years.

In the 70 years since the NHS was founded there have indeed been remarkable successes in reducing mortality from common conditions, an important example being deaths due to heart and circulatory disease. Yet the statistics show that there is more to be done to prevent the toll of premature death and years of disability associated with cardiovascular disease (CVD). For this reason, we welcome the continuing focus on CVD prevention as set out in this publication, produced with the support of Public Health England and NHS England.

This article reviews the important and growing role of the NHS Health Check in tackling some of the challenges in prevention and treatment of CVD and other non-communicable diseases.

An educational workshop at the 2017 Issues & Answers conference highlighted heart valve disease and the important role of primary care in its effective management. Across the UK approximately 1.5 million people >65 years are currently affected by the disease numbers predicted to more than double to 3.3 million by 2056.