Cardiovascular Disease

This topic area covers statistics and information relating to cardiovascular disease in Hull including local strategic need and service provision. Cardiovascular disease is also called circulatory disease. It is an umbrella name for conditions that affect the heart or circulation system. These conditions includes coronary heart disease or ischaemic heart disease, stroke and transient ischaemic attack (‘mini stroke’), atrial fibrillation, heart failure, hypertension (high blood pressure), and peripheral arterial disease as well as other heart and circulatory system conditions.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• Cardiovascular disease (also called circulatory disease) is caused by atherosclerosis (furring or stiffening of the walls of arteries). Although it may manifest itself differently in individual patients, in practice represents a single family of diseases and conditions linked by common risk factors and the direct effect they have on mortality and morbidity. These include coronary heart disease, stroke, hypertension, hypercholesterolemia, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. Cardiovascular disease affects the lives of millions of people and is one of the largest causes of death and disability in England.
• Just under one-fifth of all deaths are due to cardiovascular disease in Hull (23.4%) with 668 deaths in total which were registered during 2020. The percentage in Hull is slightly higher than England (21.8%).
• The premature (under 75 years) mortality rates from cardiovascular disease and from cardiovascular diseases considered to be preventable are statistically significantly higher in Hull compared to England, and are the highest in the region. Whilst mortality rates declined sharply in Hull from 176 to 102 deaths per 100,000 population between 2001-03 and 2011-13, the mortality rate has gradually increased since then to 118 deaths per 100,000 population for 2020-22. There are around 250 deaths every year in Hull among those aged under 75 years where the underlying cause is cardiovascular disease of which four in ten are from causes considered to be preventable.
• It is anticipated that the number of people aged 65+ years with cardiovascular disease in Hull will increase by over one-quarter in the next 20 years due to the ageing population.
• The prevalence of diagnosed coronary heart disease in 2023/24 in Hull is 10% higher in Hull compared to England (3.3% versus 3.0%), hospital admissions were 22% higher than England in 2023/24, but premature mortality rates for 2020-22 are 61% higher. The discrepancies suggest that there might be higher rates of undiagnosed CHD in Hull and/or it is less well managed among patients in Hull. There are 10,538 (3.4%) patients registered with Hull GPs who have been diagnosed with CHD in 2022/23, 1,095 hospital admissions in 2022/23, and around 140 premature (under 75 years) deaths from CHD each year (registered during 2020-22). The premature CHD mortality rate had decreased sharply earlier in the decade but has remained relatively unchanged between 2010-12 and 2019-21 with a small increase between 2019-21 and 2020-22.
• There were 4,987 (1.6%) patients diagnosed with stroke or a transient ischaemic attack (‘mini’ stroke) in 2023/24 among those registered with Hull GPs which was lower than England (1.9%) likely associated with Hull’s younger population. There were 425 hospital admissions for stroke among Hull patients in 2022/23, and an average of 40 premature deaths from stroke per year during 2020-22. Hospital admission rates and premature deaths from stroke are both statistically significantly higher in Hull compared to England, with hospital admission rates 15% higher and mortality rates around 50% higher in Hull. The premature stroke mortality rate had decreased sharply earlier in the decade but has remained relatively unchanged between 2007-09 and 2020-22
• In 2023/24, among patients registered with Hull GPs, 5,486 (1.7%) were diagnosed with atrial fibrillation and 2,579 (0.8%) were diagnosed with heart failure. Compared to England, fewer people in Hull were diagnosed with atrial fibrillation (2.2%) and heart failure (1.1%). There were 46,681 (14.8%) Hull patients had diagnosed hypertension (high blood pressure) which was the same as for England (14.8%) and 2,320 (0.7%) Hull patients were diagnosed with peripheral arterial disease which was higher than England (0.6%). Consistently nine in ten patients aged 45+ years in Hull also had a record of having had their blood pressure measured within the last five years between 2014/15 and 2019/20, but the percentage has fallen in 2020/21 and 2021/22 likely due to the COVID-19 pandemic, but the percentage only increased marginally in 2022/23 to 86.6%.
• Perhaps unsurprisingly, practices whose patients had a higher average age tended to have a higher prevalence of diagnosed cardiovascular disease.
• Hull’s population tends to be younger than England, so in some cases, it is not surprising if the prevalence is lower than England. However, to counter this, the increased levels of deprivation in Hull increases the risk of cardiovascular disease. Thus there is generally a mixed picture in relation to diagnosed prevalence when comparing Hull with England. However, it is likely that more people in Hull have undiagnosed cardiovascular disease. Furthermore, despite generally comparable rates of diagnosed disease, admission rates and mortality rates for cardiovascular disease are generally much higher in Hull which highlights the inequalities present.

The Population Affected – Why Is It Important?

All Cardiovascular Disease

Cardiovascular disease (CVD) is also known as circulatory disease. It is a common condition caused by atherosclerosis (furring or stiffening of the walls of arteries). Although CVD may manifest itself differently in individual patients, CVD in practice represents a single family of diseases and conditions linked by common risk factors and the direct effect they have on CVD mortality and morbidity. These include coronary heart disease, stroke, hypertension, hypercholesterolemia, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. Many people who have one CVD condition commonly suffer from another and yet opportunities to identify and manage these are often missed. Cardiovascular disease (CVD) affects the lives of millions of people and is one of the largest causes of death and disability in England. Significant improvements have been made in the prevention and treatment of CVD in the past ten to fifteen years following the publication of the National Service Frameworks for coronary heart disease, diabetes and renal services, and the National Stroke Strategy, with mortality rates in under 75 year olds falling by 40%.

In some people, a high cholesterol concentration in the blood is caused by an inherited genetic defect known as familial hypercholesterolaemia (FH). Siblings and children of a person with FH have a 50% risk of inheriting the condition, and those with heterozygous (defective gene from one parent only) FH have a 50% risk of coronary heart disease in men by the age of 50 years and at least 30% in women by the age of 60 years. The prevalence of heterozygous FH is estimated to be 1 in 500. Homozygous (defective gene from both parents) FH is rare with around one case per million, but symptoms appear in childhood and is associated with early death from coronary heart disease. FH also increases the risk of other CVD.

The diagnosed prevalence of a number of CVD diseases and medical conditions can be examined from data collected as part of the Quality and Outcomes Framework within primary care. Quality of care indicators are also included, and it means that high percentage of the patients diagnosed with these specific diseases and medical conditions have annual reviews which gives medical staff the opportunity to provide information and encourage their patients to improve their lifestyle behaviours to improve their health, and lower their risk of morbidity and mortality from their condition. Local analysis of the QOF data has been completed with the prevalence calculated for each GP practice and Primary Care Network group.

Coronary Heart Disease

Coronary heart disease (CHD) is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. The main causes are smoking, high cholesterol, high blood pressure and diabetes. CHD is a leading cause of death both in the UK and worldwide.  It is responsible for more than 73,000 deaths in the UK each year. About one in six men and one in ten women die from CHD. In the UK, there are an estimated 2.3 million people living with CHD. CHD generally affects more men than women, although from the age of 50 the chances of developing the condition are similar for both sexes. As well as angina (chest pain), the main symptoms of CHD are heart attacks and heart failure. However, not everyone has the same symptoms and some people may not have any symptoms before CHD is diagnosed. Nationally, CHD has the second highest disability adjusted life years and thus has a substantial impact on the quality of people’s lives.

Stroke

A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and urgent treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen. A transient ischaemic attack (TIA) is caused by a temporary disruption in the blood supply to part of the brain, causing sudden symptoms similar to those of a stroke. However, a TIA does not last as long as a stroke. The effects often only last for a few minutes or hours and fully resolve within 24 hours. A TIA can be a precursor to a stroke. The two major types of strokes are ischaemic strokes resulting from a blood clot reducing the blood supply to the brain (85%) and haemorrhagic strokes resulting from a bleed on the brain (15%).

A national campaign Stroke ACT FAST has improved awareness of treating stroke as a medical emergency. Face: “has their face fallen on one side?” – Arms: “can they raise both arms and keep them there?” – Speech: “is their speech slurred?” – Time: “time to call 999 if you see any single one of these signs”.

Strokes can cause lasting damage, affecting mobility, cognition, sight, movement of the upper limb or communication. Thus strokes can have a major impact upon individual lives and their families, and is the one of the largest causes of adult disability in the UK. Nationally, stroke has the third highest disability adjusted life years. There is also a high social and economic cost to the community. Stroke is often preventable and there are more treatment options than ever before. After stroke individual recovery can be enhanced through specialist therapy and wider social support.

One survey, by examining the population attributable risk (PAR), found that history of hypertension (PAR 35%), current smoking (19%), waist-to-hip ratio (27%), diet risk score (19%), regular physical activity (29%), diabetes (5%), alcohol intake (4%), psychosocial stress (7%), depression (5%), cardiac causes (7%) and the ratio of apolipoproteins B to A1 (25%) collectively accounted for 88% of the PAR for all stroke. Atrial fibrillation is also a risk factor for stroke.

Apoliopoprotein B is the main apolipoprotein of chylomicrons and low density lipoproteins (LDL) “bad cholesterol” and apoliopoprotin A1 is the major protein component of high density lipoproteins (HDL) “good cholesterol”.

Atrial Fibrillation

Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate. A normal heart rate should be between 60 and 100 beats a minute when resting, and is regular. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed.

If left untreated atrial fibrillation is a significant risk factor for stroke and other morbidities. Men are more commonly affected than women and the prevalence increases with age. The increase with age is relatively marked; the prevalence is estimated to be less than 2% for men aged under 65 years and around 1% or lower for women aged 65 years, but is estimated to be around 5% for men and 3% for women aged 65-74 years, then doubling to around 9% for men and 7% for women aged 75-84 years and 11% for men and women aged 85+ years.

Heart Failure

Heart failure occurs when the heart is unable to pump blood at a rate sufficient for metabolic requirements. It is caused by structural or functional abnormalities of the heart. The most common causes of heart failure in the UK are coronary artery disease and hypertension. It has a poor prognosis with 30-40% of patients diagnosed with heart failure dying within a year; thereafter mortality is less than 10% per year.

Hypertension (High Blood Pressure)

Blood pressure is measured in millimetres of mercury (mmHg) and is recorded as two numbers: the first is systolic pressure (pressure of the blood when the heart beats to pump blood out) and the second is diastolic pressure (pressure when heart rests between beats). People with hypertension (high blood pressure) rarely have noticeable symptoms. Around 30% of people in England have high blood pressure but many don’t know it. If left untreated, high blood pressure increases the risk of a heart attack or stroke. It is often referred to as a “silent killer”. The only way of knowing there is a problem is to have blood pressure measured. All adults should have their blood pressure checked at least every five years. As well as having trained staff who have periodic review of their performance, and properly validated and calibrated equipment, guidelines recommend that hypertension should be diagnosed using (24 hour) ambulatory blood pressure monitoring. The chances of having high blood pressure increase with age. Whilst there is often no clear cause, the following increase the risk of high blood pressure: obesity; family history; smoking; African or Caribbean descent; eating too much salt; not eating enough fruit and vegetables; lack of physical activity; drinking too much coffee or caffeine-based drinks; and drinking too much alcohol. Just a 2mmHg increase in systolic blood pressure increases the risk of cardiac death by 7% and stroke by 10%. Given the high prevalence of risk factors for hypertension in Hull, this puts a large proportion of Hull patients at an avoidable risk of stroke, other serious cardiac events, diabetes and chronic kidney disease.

Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a common condition, in which a build-up of fatty deposits in the arteries (a process called atherosclerosis) restricts blood supply to leg muscles. It is also known as peripheral vascular disease (PVD). Many people with PAD have no symptoms. However, some develop a painful ache in their legs when they walk, which usually disappears after a few minutes’ rest. The medical term for this is “intermittent claudication”. The risk of developing PAD increases with age. It is estimated that around one in every five people over the age of 60 are affected by the condition to some degree. Men tend to develop the condition more often than women. Smoking is the most significant risk factor for PAD as well as diabetes, high blood pressure and high cholesterol. Exercising regularly and stopping smoking can ease the symptoms of PAD and reduce the chances of the condition getting worse. If applicable, treating the underlying conditions of high blood pressure, high cholesterol and diabetes and surgery can improve blood flow in the legs. Whilst not immediately life-threatening, the process of atherosclerosis can lead to serious and potentially fatal problems such as heart attack and stroke. There is also the risk that leg tissue will begin to die (gangrene) and in severe cases this can lead to amputation of the lower leg.

Within a systematic review examining global prevalence estimates and risk factors for peripheral arterial disease, it states that about 10–20% of people with peripheral artery disease have intermittent claudication, another 50% have atypical leg symptoms, and those without exertional leg pain have poor mobility compared with individuals without peripheral artery disease. Patients with and without leg ischaemic symptoms have roughly a three-fold increase in risk of mortality and major cardiovascular events (heart attack and stroke) compared with those without peripheral artery disease.

The Hull Picture

Cardiovascular Disease

Some information is available on cardiovascular disease as a whole, such as hospital admission and mortality data. However, the majority of the information available and presented below is for specific cardiovascular diseases.

Number of People with Cardiovascular Disease

A Local Analysis of the Quality and Outcomes Framework Data (see Quality and Outcomes Framework in the Glossary for more information) has been completed for 2023/24. The diagnosed prevalence and screening measures are presented for the 28 practices in Hull, each Primary Care Network in Hull and for five deprivation and age groups, as well as for comparator geographical areas. As the file includes a number of indicators related to cardiovascular disease, the file is also included below. This includes diagnosed prevalence for coronary heart disease, stroke and transient ischaemic attack, atrial fibrillation, heart failure, left ventricular systolic dysfunction, hypertension (high blood pressure) and peripheral arterial disease as well as the percentage of the population aged 45+ years who have had their blood pressure measured within the last five years.

Further information from the Quality and Outcomes Framework, such as trends over time, are presented below for each specific cardiovascular disease.

Percentage of Deaths From Cardiovascular Disease

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of deaths with an underlying cause of cardiovascular disease by age. The percentage of cardiovascular disease deaths is higher in Hull compared to England for the majority of age groups for 2020.

For all ages, the percentage of CVD deaths has been reasonably similar to England, although for 2020 the percentage was slightly higher in Hull.

Among those aged 85+ years, the percentage of CVD deaths has shown some year-on-year variability in Hull, but has been reasonably similar to England, although for 2020 the percentage increased in Hull compared to a decrease nationally resulting in the percentage in Hull being higher than England.

For those aged 75-84 years, the percentage of CVD deaths has been reasonably similar to England over time.

Among those aged 65-74 years, the percentage of CVD deaths has shown some year-on-year variability in Hull, but has been reasonably similar to England. For 2020, the percentage increased in Hull compare to a decrease nationally resulting in the percentage in Hull being higher than England.

Among those aged under 65 years, the percentage of CVD deaths has shown some year-on-year variability in Hull, but has been reasonably similar to England until 2017. The percentage in Hull has been slightly higher than England for 2018, 2019 and 2020.

Premature Mortality Rates From Cardiovascular Disease

The premature mortality rates from cardiovascular disease in Hull are significantly higher than England and are the highest in the region for 2020-22 for men and among the highest for women.

The premature mortality rate from cardiovascular disease in Hull decreased relatively sharply between 2001-03 to 2011-13 falling from 176 to 101 deaths per 100,000 population. However, since then the mortality has increased slightly from 102 to 108 deaths per 100,000 population between 2011-13 and 2018-20 with a slightly greater increase in the last couple of years so that the latest mortality rate is 118 per 100,000 population. The last time the mortality rate was this high in Hull was for 2009-11.

In contrast, whilst the mortality rate for the region and England also showed a decrease between 2001-03 to 2011-13, that increase continued albeit at a reduced rate of decrease beyond 2011-13. The premature mortality rate from cardiovascular disease only increased for the region and England in the last 2-3 years.

As a result, the inequalities gap between Hull and England has increased since 2011-13.

For the latest three year period 2020-22, there were 760 deaths among Hull residents aged under 75 years from cardiovascular disease which is an average of 253 deaths per year.

The trend over time for males is similar with a relatively sharp decrease in the premature mortality rate from cardiovascular disease between 2001-03 and 2011-13 from 248 to 145 deaths per 100,000 population followed by a gradual increase to 168 deaths per 100,000 population for 2020-22. Again, in contrast, the mortality rate for the region and England declined the whole period with the exception of the last three years.

The premature mortality rate for 2020-22 is similar to what it was for 2009-11 in Hull.

Among men, there were 538 premature deaths from cardiovascular disease over the three year period 2020-22 which equates to an average of 179 per year. Seven in ten of all the premature deaths from cardiovascular disease in Hull were among men.

A reasonably similar pattern in the trends over time occurred for Hull women, although there were slight differences. The mortality rate decreased between 2004-06 and 2011-13 from 110 to 61 deaths per 100,000 population, then increased to a peak of 72 death per 100,000 population for 2014-16. The mortality rate then declined to a low of 60 per 100,000 population in 2017-19 but has increased since the pandemic and is 69 deaths per 100,000 population for 2020-22. Again, for the region and for England, the premature deaths from cardiovascular disease has reduced for almost 20 years, and has only increased very marginally in the 2-3 years.

Among women living in Hull, there were 222 premature deaths from cardiovascular disease over the three year period 2020-22 which equates to an average of 74 per year. Three in ten of all the premature deaths from cardiovascular disease in Hull were among women.

The trend in the premature mortality rate from cardiovascular diseases considered to be preventable follows a similar pattern to that for premature mortality rate from cardiovascular disease.

There were 310 deaths from cardiovascular disease among Hull residents prior to the age of 75 years which were considered to be preventable over the three year period 2020-22. This represents 41% of all premature cardiovascular disease deaths.

A similar pattern is also evident among men, and there were 227 male premature deaths from cardiovascular diseases considered to be preventable over the three year period 2020-22 which equates to an average of 76 deaths per year, and is 42% of all premature cardiovascular disease deaths among men.

A similar pattern is also evident among women for cardiovascular diseases considered to be preventable as was observed for all premature cardiovascular disease deaths among women. There were 82 female premature deaths from cardiovascular diseases considered to be preventable over the three year period 2020-22 which equates to an average of 27 deaths per year, and is 37% of all premature cardiovascular disease deaths among women.

Estimated Number of People in the Future Who Will Have Cardiovascular Disease

The Projecting Older People Population Information Service (POPPI) provide current estimates and future projections at local authority level of the number of people with cardiovascular disease.

They use estimates for the prevalence of cardiovascular disease for different age groups for men and women separately, and apply those prevalence estimates to Hull’s population. It is likely that this will represent an underestimate for Hull due to Hull’s high levels of deprivation.

They estimate that there are over 12,000 residents of Hull who are living with cardiovascular disease, but due to the ageing population this is anticipated to increase to around 16,000 by 2040.

Gender	Age	2020	2025	2030	2035	2040
Males	65-74	3,774	3,774	4,148	4,284	4,012
Males	75+	3,066	3,612	3,948	4,326	4,830
Females	65-74	2,415	2,499	2,751	2,814	2,604
Females	75+	3,201	3,498	3,696	4,059	4,521
Persons	Total 65+	12,456	13,383	14,543	15,483	15,967

Coronary Heart Disease

Number of People with Coronary Heart Disease

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of patients registered with Hull GPs who are diagnosed with coronary heart disease (CHD). The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas).

In 2023/24, there were 10,314 patients registered with Hull GPs who had been diagnosed with CHD. The percentage was higher in Hull compared to England (3.3% versus 3.0%).

The prevalence of CHD among patients registered with Hull GPs has been steadily and gradually decreasing since 2014/15. The prevalence for England has also decreased over the same time period, but at a much slower rate of change.

From the local analysis of the national Quality and Outcomes Framework datasets, there was a statistically significant association between average age of the practice patients and the prevalence of diagnosed CHD across the 28 practices in Hull for 2023/24. If the practices were divided into five approximately equal sized groups based on average age of patients (with each fifth having approximately one-fifth of the total registered patients in Hull) then the prevalence increased from 1.8% for the practices serving the youngest practice patients to 4.2% for the practices serving the oldest practice patients. For every increase in the average age of the patients of 10 years, the prevalence of CHD increased by 2.6 percentage points. Further analysis of diagnosed disease by the average age of practice patients is within the file above and within Local Analysis of Quality and Outcomes Framework Data.

There was no statistically significant association between the prevalence of diagnosed CHD and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019) across the 28 practices.

Hospital Admissions for Coronary Heart Disease

The directly standardised hospital admission rate for CHD for 2022/23 is 22% higher in Hull compared than England. The rate is given as the number of admissions per 100,000 population (in the European Standard Population).

The admission rate for CHD has been quite variable in Hull since 2003/04. The rate remained relatively unchanged between 20004/05 and 2006/07 at just over 800 admissions per 100,000 population, but decreased to 645 admissions per 100,000 population for 2008/09 before increasing sharply to 946 admissions per 100,000 population for 2011/12. The admission rate did then fall sharply to to 600 admissions per 100,000 population for 2014/15. The rate increased slightly for 2015/16, but remained just over 600 admissions per 100,000 population until 2017/18 when there was a further decrease to 578 admissions per 100,000 population for 2018/19. So whilst there have been quite a sharp increase and decrease between 2008/09 and 2014/15, there has been a general decrease between 2003/04 and 2018/19. There was a sharp decrease in the admission rate in Hull between 2018/19 and 2020/21 which will – at least in part – be due to the COVID-19 pandemic. The admission rate for most non-COVID-19 conditions and diseases did decrease, but in most cases, this occurred between 2019/20 and 2020/21. It is possible that there was a reduction in March 2020 which could have influenced the reduction between 2018/19 and 2019/20, but it is also possible that there was a reduction that was not influenced by the pandemic as there has been reductions over the previous 2-3 years prior to this. There has been an increase in the admission rate for CHD between 2020/21 and 2022/23, and it is possible that this is associated with a reduction during the pandemic and care and treatment has been delayed.

For the latest year 2022/23, there were 1,095 admissions for CHD among Hull residents.