The second major cause is smoking, which can not only lead to CHD, but a variety of other diseases and cancers, especially lung cancer4. Smoking has many ill-effects on the body. One of the greatest of these threats is atherosclerosis. This is the build up of fatty substances in the arteries and can lead to great damage to the walls of the blood vessels6. Smoking also contributes to many other diseases and illnesses such as cancers and breathing difficulties4. Because the cigarette industry is such big business in the country and smoking being very common, there are a great deal of things the government are able to do in order to discourage people from smoking and promote a healthier lifestyle. One thing that could be introduced, which is already beginning to be put into action, is the banning of smoking in public places so that not only will the public be cutting down on the amount they smoke, but also the incidence of passive smoking will be greatly reduced. In order to dissuade people from smoking, the tax could be increased on packs of cigarettes, making them more expensive. These schemes are mainly aimed at smokers themselves, but not at the non-smokers and those who aren’t fully aware of the full extent that smoking can affect the body to. Therefore, another major project that should be considered is to increase public awareness of what smoking can do to the body and the diseases it can cause. This has already been introduced recently by television adverts and posters which show quite graphically the end products of atherosclerosis. Other ways is by having health promotion programmes and community projects. As there are already many products available which will provide an alternative to cigarettes, then these should be publicised more and people encouraged to use these when they can. After introducing methods to stop or reduce smoking, the current sufferers of CHD due to smoking should also be aimed at. Because smoking causes atherosclerosis, which will lead to CHD, then more money should be invested into the development and manufacture of drugs to help reduce the clogging of the arteries.
The above table shows exactly how smoking can cause an increase in CHD deaths7. If the public were made aware of these facts then they would be able to get an idea of how serious, smoking is and how big the effect is. It shows that by simply stopping they will reduce their chances of CHD and that even though people once were smokers, they will have a much lower chance than those who still smoke. The government has already introduced some schemes such as making Nicotine Replacement Therapy (NRT) available on prescription8.
A third factor is diabetes. Those who suffer from diabetes will tend to be more at risk from suffering from vascular disease, as well as kidney problems (and therefore hypertension), eye problems, and peripheral nerve disease5. To help these people from possibly developing CHD, there needs be better control of diabetes which will help limit the effects or progression of the disease. Diabetes causes blockage and hardening (atherosclerosis) of blood vessels everywhere in the body, including coronary arteries9. Controlling diabetes significantly reduces coronary risk9. There are two forms of diabetes (type 1 and type 2), both of which ultimately lead to high blood sugar levels, a condition called hyperglycaemia. Over a long period of time, hyperglycaemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels. Currently, there haven’t been any methods of preventing type 1 diabetes as such. For Type 2 diabetes, however, there are a few ways in which it can be prevented: Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families. Type 2 diabetes, in some cases, can be prevented by9:
- Controlling weight to normal or near-normal levels, by eating a healthy low-fat, high-fibre diet.
- Regular exercise is crucial to the prevention of type 2 diabetes.
- Keeping alcohol consumption low.
- Quitting smoking.
The next factor is high cholesterol, which has been proven to have a direct link to the clogging of the arteries5. In order for this to be prevented, the government should initiate a plan or encourage GPs to start screening programmes which help recognise people who are more at risk e.g. those with hypercholesterolemia (high levels of cholesterol) and attempts at lowering their levels by improving their diets and lifestyle2. The diet should be changed to a high fibre/low fat diet which will lower cholesterol and the fibre will improve gastric motility5. These diets will help the body over the long term, if the screening process shows some people with very high levels, then drugs, such as statins, should be employed, which work by inhibiting an enzyme which controls the production of cholesterol5. Other drugs include Angiotensin-converting enzyme (ACE) inhibitors which work by dilating blood vessels and therefore, increasing blood flow9.
They can also increase the liver’s ability to remove cholesterol already in the blood. A persons diet can be improved by following a few set rules which will reduce cholesterol levels. These include: beginning the day with whole-grain bread or cereal and fruit. For lunch and dinner, make whole grains and vegetables the main course. Add a salad or vegetables if the meal is mainly meat. Eat a fruit plate or low-fat yogurt for dessert. Cut sweets and sugars to a minimum. Cook foods in olive oil or canola oil, which are high in monounsaturated fats. These fats decrease LDL and total cholesterol levels.
The fifth major factor is family history. This cannot be cured or changed in any way, but it can be recognised early and those with a family history of the disease can be placed in a higher risk group4. The methods of reducing CHD should be investigated and the other risk factors should be aimed at being prevented in order to lower the possibility of CHD developing.
CHD is a disease which does not necessarily come when a person reaches a certain age, but tends to develop over a long time, so it may begin to build up from a young age. Therefore, to cut down the number of CHD cases in the future, projects to improve the health of younger people should be contemplated. One of the biggest way of doing this would be by making more improved school meals available2. Projects such as the ‘five-a-day’ fruit scheme have begun to be put in place in schools to encourage school children to eat a piece of fruit instead of sweets or other fatty foods as snacks8.
Some ways in which the government has already begun to use are things such as rapid access chest pain clinics which were introduced in 2001 and are slowly being introduced into more areas. In addition to this, at least 75% of A&E departments are now fully equipped to provide thrombolysis, which is the breaking up of blood clots, as well as some ambulances carrying the necessary equipment8. Also, there has been the introduction of defibrillators in public such as airport terminals or shopping centres, as well as a community volunteer defibrillation scheme1.
So, the government hasn’t totally ignored CHD, but there are many more schemes which can be put into operation as well as possible expansion on current and existing projects.
References
1. News.bbc.co.uk
2. www.dh.gov.uk
3. www.americanheart.org
4. http://cancerweb.ncl.ac.uk
5. http://nhlbisupport.com/chd1/meds1.htm
6. British Heart Foundation – ‘Smoking and Your Heart’ leaflet
7. British Heart Foundation – ‘Smoking Statistics 2004’ booklet
8. ‘CHD in the evolving NHS’ booklet by Dr Roger Boyle
9. www.emedicine.com
