Efforts to reduce the number of heart attacks and strokes will be stalled by weight gain and increasing diabetes prevalence, the research says.
According to a study, decreases in three main risk factors between 1990 and 2014 contributed to a decrease in the number of heart attacks and strokes.
However, progress in further reducing the number has been hampered by increases in body mass index (BMI) and diabetes prevalence over the same period.
Researchers at the London School of Hygiene & Tropical Medicine used Scottish health data to calculate the change in the number of heart attacks and strokes in Scotland between 1990 and 2014.
They found that the number of heart attacks fell from 1,069 per 100,000 people to 276 per 100,000 people.
Ischemic strokes (a type of stroke caused by a blood clot) decreased from 608 per 100,000 to 188 per 100,000 people.
Research funded by the British Heart Foundation (BHF) also found that 74% of this decrease in heart attacks and 68% in stroke are due to changes in the prevalence of risk factors.
This was caused by drops in blood pressure, cholesterol levels, and the rate of smoking, researchers say.
However, the average BMI increased from 27.2 kg / m2 to 28.1 kg / m2, and the prevalence of diabetes more than doubled in Scotland during this period, from 4% to 9% of the population.
It has been estimated that this resulted in a 20% increase in heart attacks and a 15% increase in ischemic strokes due to these two risk factors.
The increased prevalence of diabetes contributed to almost as many heart attacks as the decline in smoking prevented, the researchers estimate.
But while the team could be confident that changes in risk factors had an impact on the incidence of heart attacks and strokes, they looked at each risk factor in their analysis in isolation, meaning that their estimated effects are likely exaggerated.
Researchers say the picture is similar across the UK, with data suggesting that the number of people diagnosed with diabetes and developed obesity has increased over the past few decades.
Analysis also suggests that the contribution of diabetes to heart and circulatory diseases is increasing.
In 1990, the number of deaths from cardiovascular disease-related diabetes was 19%. By 2019 it was 26%.
Dr. Anoop Shah, BHF Clinical Research Fellow at the London School of Hygiene & Tropical Medicine who led the research, said: “The extent to which various risk factors contribute to heart attacks and strokes has shifted over the past 25 years. Weight gain and diabetes now play a more important role in the development of these disorders.
“Health policy urgently needs to include them and take a holistic view of the range of risk factors that can lead to cardiovascular disease.
“There is a time lag between people who get diabetes and develop cardiovascular disease.
“We must act now to address these important risk factors, or we risk seeing the effects of these increases for decades to come.”
Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation said: “While it is great to see the positive impact that public health measures, such as smoking bans, have had on the number of people who have had heart attacks in recent years Having suffered strokes for 25 years it is worrying that increasing BMI and diabetes prevalence appear to be slowing progress.
“Obesity is a leading cause of type 2 diabetes, and this study shows the government must pursue the bold promises made in the 2020 obesity strategy.
“Obesity is a complex issue and we cannot rely solely on the willpower and training of individuals to solve the problem of increasing BMI across the population.
“We need to address the environmental factors driving weight gain and the development of diabetes in order not to lose the advances we have made in reducing the burden of cardiovascular disease.”
Research published in The Lancet Regional Health – Europe was also supported by the Academy of Medical Sciences.
