Reducing the impact of vascular disease: the proposed Vascular Risk Programme for risk assessment and management

Abstract

increases with age, progresses faster in men than women, in those with a family history of vascular disease, in certain ethnic groups such as south Asians and people from socioeconomically deprived backgrounds. Nevertheless, the rate at which vascular disease progresses is determined by a number of modifiable factors such as smoking, diet, physical inactivity, hypertension, hyperlipidaemia, dysglycaemia and obesity. This common set of risk factors underlie all types of vascular disease – heart disease, stroke, diabetes and renal disease, supporting a shared vascular risk screening programme for preventing and managing risk in all of these conditions (Figure 1). The Department of Health has examined how a comprehensive vascular risk assessment and management programme could work in practice, including modelling of clinical and cost-effectiveness of implementation of the programme. The Introduction V ascular disease (which includes coronary heart disease, stroke, diabetes and chronic kidney disease) currently affects more than four million people in England. It causes 170,000 deaths a year in England (36% of all deaths), is responsible for one-fifth of all hospital admissions and is the largest single cause of long-term ill health and disability. In view of its high prevalence and costs, in April 2008 the Department of Health announced plans to introduce a comprehensive vascular risk assessment and management programme, based on recommendations by the National Screening Committee, for all people aged 40 to 74 years. The programme is set for a rollout in 2009–2010, is estimated to cost around £250 million per year and aims to shift the emphasis to primary prevention of vascular disease. What will it mean for general practice? Since the implementation of the National Service Frameworks there have already been significant improvements with a 40% reduction in cardiovascular deaths in people under 75 years since 1996. The reasons for this decline are complex but include improvements in diet, smoking cessation and secondary prevention strategies. However, most cardiovascular events are caused by low grades of stenosis. The risk factors for vascular disease are well documented. Having one vascular condition increases the likelihood of an individual suffering others, and they often coexist. The prevalence of vascular disease TOPICAL REVIEW