Weight gain and increasing diabetes prevalence are hampering efforts to reduce heart attacks and strokes, according to a study funded by the British Heart Foundation (BHF) and published this week in the prestigious medical journal The Lancet Regional Health – Europe .
Researchers at the London School of Hygiene & Tropical Medicine found that between 1990 and 2014, a decrease in three main risk factors contributed to a decrease in the number of heart attacks and strokes. Progress in further reducing the number, however, has been stalled by increases in body mass index (BMI) and diabetes prevalence over the same period.
The team used Scottish health data to calculate the change in the number of heart attacks and strokes between 1990 and 2014. It showed that the number of heart attacks has fallen from 1,069 per 100,000 inhabitants to 276 per 100,000. Ischemic strokes (a type of stroke caused by a blood clot) decreased from 608 per 100,000 to 188 per 100,000 people.
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They found that 74 percent of this decrease in heart attacks and 68 percent in stroke were due to changes in the prevalence of risk factors. This was driven by falls in blood pressure, cholesterol levels, and the rate of smoking.
The average systolic blood pressure in Scotland fell from 140 mmHg to 129 mmHg during this period, the cholesterol level fell from 6.4 mmol / l to 5.0 mmol / l and the smoking rate among adults was more than halved.
However, the average BMI rose from 27.2 kg / m2 to 28.1 kg / m2, and the diabetes prevalence in Scotland has more than doubled from 4 to 9 percent of the population. This is estimated to have resulted in a 20 percent increase in heart attacks and a 15 percent increase in ischemic strokes due to these two risk factors.
The researchers estimate that increased diabetes prevalence contributed to almost as many heart attacks as the reduction in smoking prevented.
While the team could be confident that changes in risk factors had an impact on the frequency of heart attacks and strokes, in their analysis they looked at each risk factor in isolation, meaning that its estimated effects are likely exaggerated.
The picture is likely to be similar in Northern Ireland.
Figures show that the number of people with diabetes and obesity here has increased significantly over the past few decades. The analysis also shows that the contribution of diabetes to heart and circulatory disease is increasing in Northern Ireland.
In 1990, the proportion of deaths from cardiovascular disease in Northern Ireland related to diabetes was estimated at 12 percent. By 2019 this had doubled to 24 percent.
Dr. Anoop Shah, BHF Clinical Research Fellow at the London School of Hygiene & Tropical Medicine, led the research.
He said, “The amount that 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. This must urgently include health policy and take a holistic view of the range of risk factors that can lead to cardiovascular diseases.
“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 that governments across the UK need to pursue their bold promises in their obesity strategies. Obesity is a complex issue and we cannot rely on individual willpower and training alone to increase BMI across the population. We need to address the environmental factors that promote weight gain and the development of diabetes so that we do not lose the progress we have made in reducing the burden of cardiovascular disease. ”
Fearghal McKinney, Director of the British Heart Foundation Northern Ireland, said: “Obesity is a major public health challenge in Northern Ireland with 65 percent of adults being either overweight or obese. Being overweight or obese increases the risk of type 2 diabetes, heart attacks, and strokes.
“It is critical that the Northern Irish Executive’s new 10-year Obesity Prevention Strategy addresses the root causes of obesity so that more people in Northern Ireland can live long and healthy lives free of heart and circulatory disease.”
Why does being overweight lead to an increased risk of diabetes and how can it be combated?
Being overweight puts a strain on the interior of individual cells. In particular, overeating puts stress on the membranous network within cells called the endoplasmic reticulum (ER). When the ER has more nutrients to process than it can process, it sends out an alarm signal instructing the cell to dampen the insulin receptors on the cell surface. This leads to insulin resistance and persistently high levels of the sugar glucose in the blood – one of the clear indicators of diabetes.
To avoid obesity, cut sugars and refined carbohydrates from your diet, as the resulting increase in blood sugar stimulates the pancreas to produce higher levels of insulin.
Over time, this can lead to progressively higher blood sugar and insulin levels, until the condition eventually turns into type 2 diabetes.
It’s also a good idea to exercise regularly, avoid a sedentary lifestyle, and stay adequately hydrated.
Exercise increases the insulin sensitivity of your cells. So when you exercise, less insulin is needed to keep your blood sugar levels under control. Smoking cessation is also an important factor in reducing diabetes, as is a low-carbohydrate diet, which means your insulin levels will not go up too much after you eat. You should also remember to watch your portion sizes and increase your fiber and vitamin D intake.
How to reduce your risk of heart attack and stroke
Certain factors can increase your risk, such as smoking, kidney disease, or a family history of early-stage heart disease. Knowing your risk factors can help you and your treatment team find the best treatment plan for you. Lifestyle changes can improve many risk factors.
Again, eating a healthy diet of fruits and vegetables is key, as is cutting down on refined crab and processed meats. It is also important to be more active, watch your weight, give up smoking, and treat conditions such as high blood pressure (hypertension) and high cholesterol. Minimizing stress, getting adequate sleep, and taking care of your mental health are also important factors to consider.
If you have an illness, your doctor may prescribe statins or other drugs to control cholesterol, blood sugar, and blood pressure. Take all medication as directed. However, don’t take aspirin as a preventive measure unless your doctor tells you to. If you’ve never had a heart attack or stroke, daily aspirin treatment may not help you at all and can cause problems, including the risk of bleeding. If you’ve had a heart attack or stroke, your doctor may want you to take a low dose of aspirin to reduce your risk of another stroke.
Healthy living is the best way to delay or avoid many heart and brain diseases. Take responsibility for your health and develop healthy habits that you can maintain every day to help prevent heart disease and stroke.
