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Around 7.6 million people in the UK are living with heart and circulatory disease, which remains one of the UK’s biggest killers. Most cases are preventable, with around 70 per cent being attributed to modifiable risk factors such as obesity and smoking. Yet, millions of people are unaware that they are at high risk, despite living with some of the key underlying causes, such as high blood pressure or high cholesterol.
Around one in three adults in the UK has high blood pressure which, according to Blood Pressure UK, is responsible for more than half of all strokes and heart attacks. High blood pressure rarely causes any symptoms, and half of people affected aren’t diagnosed or receive treatment.
Around 49,000 people under 75 in the UK die from heart and circulatory disease each year. According to the British Heart Foundation’s (BHF) Hearts Need More report in September 2024, up to 11,000 early deaths from heart and circulatory diseases in England each year could be avoided by 2035 with the help of a Heart Disease Action Plan from the UK Government. The charity is campaigning for improved management of high blood pressure and high cholesterol, addressing long waiting lists for heart care and NHS staff shortages, and introducing mandatory measures to incentivise the food industry to make everyday foods healthier.
Impact of obesity
According to the British Heart Foundation, living with excess weight or obesity is associated with one in six heart and circulatory disease deaths in the UK. Excess weight, especially around the waist, can lead to a build-up of fat in the arteries (atherosclerosis) and increase the risk of high blood pressure, high cholesterol and type 2 diabetes.
Around 64 per cent of adults in the UK are living with obesity or excess weight. Pharmacy teams are well-placed to offer personalised healthy eating and weight management advice and support, through conversations at the pharmacy counter or as part of a formal weight management service. They can also refer eligible customers to the 12-week NHS Digital Weight Management Programme at: pharmacy.wmp.nhs.uk. This programme offers online access to weight management services to people living with obesity who also have a diagnosis of either diabetes, high blood pressure or both.
Common conditions
Coronary heart disease
Coronary heart disease affects around 2.3 million people in the UK. It’s caused by a build-up of fatty plaques (atheroma) in the coronary arteries by a process called atherosclerosis. Eventually, the arteries become so narrow that not enough blood reaches the heart. Coronary heart disease develops slowly and may cause angina (see next), shortness of breath, feeling faint, feeling sick and indigestion-like symptoms. Some people don’t realise they have blocked arteries unless they have a heart attack. Coronary heart disease may be treated with medicines, a coronary angioplasty with or without a stent (to unblock narrowed arteries) or heart bypass surgery.
Angina
Angina is a type of chest pain, tightness or discomfort that happens when the blood flow to the heart is reduced. It can also cause pain or discomfort in the shoulders, arms, jaw, back and stomach, sometimes with other symptoms such as fatigue, dizziness and sweating. Angina symptoms usually stop after a few minutes. They mainly occur when the heart works harder, such as when walking briskly or uphill, but some people also get angina symptoms when they’re resting. Other common triggers include cold weather, emotional stress and eating a heavy meal. Angina is often treated with medicines, such as nitrate sprays, patches and pills.
Heart attack
A heart attack is a medical emergency, so it’s important to call 999 immediately. The symptoms vary from person to person, but include sudden pain or discomfort in the chest that doesn’t go away, spreading to the left or right arm, or to the neck, jaw, back or stomach. For some people, the pain or tightness is severe, while for others it may be more like indigestion. A heart attack can also make people feel sick, sweaty, light-headed or short of breath.
Most heart attacks are caused by coronary heart disease, when a blood clot forms over a broken fatty plaque in a coronary artery. If the clot blocks the artery, blood and oxygen can’t reach the heart muscle. Most people need to have emergency treatment to get the blood flowing again, then take medicines to reduce their chances of having another heart attack. It’s also important to treat any underlying causes, such as high blood pressure or high cholesterol.
If a customer reports chest pains, shortness of breath and/or dizziness, refer them to the pharmacist.
Atrial fibrillation
Atrial fibrillation causes the heart to beat irregularly and often too fast. This is due to abnormal electrical signals in the heart, but the cause isn’t clear. Atrial fibrillation may cause blood clots, which increase the risk of a stroke. Its symptoms include palpitations, chest pain, tiredness and shortness of breath. Atrial fibrillation may be treated with medicines or procedures to control the rate and rhythm of the heart.
Stroke
Strokes cause around 34,000 deaths in the UK each year. They are the fourth single leading cause of death and the biggest cause of severe disability in the UK. A stroke happens when the blood flow to part of the brain is disrupted, so the brain cells die or become damaged. Causes include a blood clot in an artery or a burst blood vessel. A mini-stroke (transient ischaemic attack or TIA) usually resolves after a few seconds or minutes. Stroke is a medical emergency that needs immediate treatment.
“Act F.A.S.T.” is used to recognise the signs of a stroke:
Facial weakness: Can the person smile? Has their mouth or eye drooped?
Arm weakness: Can the person raise both arms?
Speech problems: Can the person speak clearly, and can they understand what you’re saying?
Time: It’s time to call 999 immediately if you see any of these symptoms.
Heart failure
More than a million people in the UK are living with heart failure. Their heart hasn’t stopped working, but isn’t as efficient as it should be, so not enough blood is being pumped around their body. Symptoms include fainting or feeling lightheaded, feeling increasingly tired, a new, persistent cough, shortness of breath and swelling in the feet and ankles. Common causes of heart failure include a heart attack, cardiomyopathy (heart muscle disease), abnormal heart rhythms or high blood pressure. There’s no cure for heart failure, but treatments such as a pacemaker or surgery, or medicines to improve the symptoms and heart function, can aid quality of life.
“More than a million people in the UK are living with heart failure”
Prevention advice
Most cardiovascular conditions can be prevented (or partly prevented) with lifestyle changes. According to Cardiovascular Disease Prevention Guidelines published by the European Society of Cardiology (ESC) in 2021, everyone should follow certain recommendations, even if they’re not considered to be at high risk of cardiovascular disease. These include stopping smoking, following a healthy lifestyle, and achieving a systolic blood pressure of less than 160 mmHg (as a bare minimum).
Pharmacy teams are ideally placed to offer advice on common cardiovascular risk factors, with many pharmacies running NHS or private weight management and/or smoking cessation services, as well as NHS Health Checks.
“In England, people over the age of 40 are invited to have an NHS Health Check to assimilate their cardiovascular risk of having a heart attack within the next 10 years,” say Regina Giblin, BHF senior cardiac nurse, and Victoria Taylor, BHF senior dietician. “Scotland, Wales and Northern Ireland have similar programmes. If a patient’s blood pressure is normal at this check, they will be invited to come back to have their NHS Health Check every five years. If their blood pressure is elevated, an appointment will be made with their GP to discuss further testing and treatment if required, as well as lifestyle changes.”
People with existing heart and circulatory conditions, or at particular high risk, may be prescribed medicines by their GP to lower some risk factors, such as high blood pressure or high cholesterol. Statins are the most commonly prescribed medicines in the UK.
“Statins are medications that reduce the level of cholesterol in the blood and protect the insides of the arteries,” say Regina and Victoria. “These are recommended for people who have high cholesterol levels and are at risk of developing heart and circulatory diseases. If someone has had a heart attack or stroke, statins are recommended to reduce the risk of further events.”
High blood pressure often doesn’t show symptoms, so encourage customers to check their levels in the pharmacy or at home.
Eating for a healthy heart
Most people should get all the nutrients they need for good heart health from a healthy, balanced diet and don’t need to take any specific dietary supplements, according to the British Heart Foundation (BHF). Research shows that some nutrients may be particularly heart friendly. For example, oats and barley contain beta glucans, which is a type of soluble fibre that helps to stop cholesterol from being absorbed into the body. Plant sterols and stanols (phytosterols), found in cholesterol-lowering margarines, milks and yoghurts, have also been shown to help people maintain healthy blood cholesterol levels. However, having too many of certain dietary supplements may be bad for the heart.
Eating more oily fish, which contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is often recommended to reduce the risk of heart disease – omega-3 fatty acids may reduce blood levels of triglycerides (which have been linked to a higher risk of a heart attack and stroke), for example. But recent research published in the British Medical Journal in May 2024 found that taking omega-3 supplements regularly may increase the risk of some heart conditions including atrial fibrillation. There are claims that garlic can lower cholesterol and blood pressure, due to its active ingredient allicin, but research has been mixed, while antioxidant vitamins such as vitamin A, vitamin E and beta-carotene have been linked to an increased risk of cardiovascular death.
If pharmacy customers already have a heart condition, they should speak to their doctor before taking any non-prescribed supplements, due to the risk of medicine interactions. For example, vitamin K and omega-3 fatty acids may interfere with warfarin (an anti-coagulant), while St John’s Wort, often taken for a low mood, may interact with several heart medicines.
“Living with excess weight or obesity is associated with one in six heart and circulatory disease deaths”
Lifestyle changes
Maintaining a healthy weight and taking regular exercise can help to reduce the strain on the heart and circulation, reducing the risk of cardiovascular disease. The 2021 ESC Guidelines recommend that adults of all ages should aim for at least 150-300 minutes per week of moderate intensity physical activity, or 75-150 minutes per week of high intensity activity. Even if adults can’t meet these recommendations, they should aim to be as active as possible.
“Walking is one of the best forms of physical activity,” says Martin Unerman, cardiac rehabilitation exercise trainer in Bushey, Hertfordshire. “It helps to reduce body weight, increases bone density and gets people outside into the fresh air. If people already have a cardiac condition, it’s never a good idea to do high intensity exercise, such as HIIT. Their heart rate should be gently raised and held in a steady state rather than peaking and troughing quickly.”
The Mediterranean diet, which is rich in legumes, wholegrains, nuts, fruits and vegetables with a high flavonoid content, is considered to be particularly heart friendly. Other recommended dietary changes include eating oily fish at least once a week, reducing added sugar intake, and drinking no more than 14 units of alcohol per week on a regular basis. Eating too much salt is a major cause of high blood pressure. According to the BHF, reducing the UK’s average daily salt intake by 40 per cent could result in 135,000 fewer new cases of coronary heart disease by 2035.
Recent research presented at the ESC Congress 2024 in London looked at the effect of different types of fat on the risk of heart disease. Saturated fats are found in foods such as butter, red meats, cakes, pastries and biscuits, whereas polyunsaturated fats, including omega-3 and omega-6, are found in foods such as oily fish, sunflower oil and some nuts.
“The results suggest that a diet high in saturated fat may negatively change cardiovascular disease risk factors even when a person doesn’t gain weight,” says Nikola Srnic, MD/DPhil candidate at the University of Oxford. “On the other hand, we saw protective effects if a person ate a diet high in polyunsaturated fat. Although our study is ongoing, our findings so far suggest that even when you are not gaining weight, different fats can have drastically different effects on health in a short time frame.”
Cardiac rehabilitation
If someone has had a heart attack, recent heart surgery or been diagnosed with heart failure, they should be offered cardiac rehabilitation (cardiac rehab) by their hospital team. This phased programme can improve their chances of recovery by offering expert advice, exercise sessions, regular assessments and the chance to meet other people with similar experiences.
“Phase III cardiac rehabilitation, after initial hospital treatment, is post-discharge from the hospital or outsourced in a clinic using hospital staff, to deliver a programme of exercise and health advice in a clinically safe and appropriate way,” says Martin. “Patient progress is monitored over a six-to-eight-week programme. Phase IV involves long-term cardiac rehabilitation in the community.”
If a patient hasn’t been referred for cardiac rehabilitation, they can ask their GP for a referral or contact their local cardiac team directly. Signpost them to the BHF’s Heart Helpline: 0808 802 1234 which can provide further contact details.
Smoking and alcohol consumption can lead to many issues with heart health.
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