Coronary heart disease: policy context

From their peak in the 1970s, incidence rates of coronary heart disease (CHD) have tended to decline in Scotland, but not at the pace of neighbouring northern European countries. CHD will remain a major public health problem in Scotland for several decades to come.

A target of a 50% reduction between 1995 and 2010 in the age-standardised death rate from CHD for people aged under 75 was set in the 1999 white paper Towards a healthier Scotland. The Scottish Executive later increased this target to a 60% reduction (see section Data: Scottish data).

In light of Scotland's poor record on heart disease and stroke, the Scottish Executive published the CHD and stroke strategy for Scotland in October 2002, following the publication of the CHD/Stroke Task Force report a year earlier. The strategy represents the culmination of 4 years' work, based upon extensive consultation with patients, clinicians and managers.

Progress of the strategy was reviewed in a supplementary report, Coronary heart disease and stroke in Scotland - Strategy update 2004, published in December 2004. One of the strategy recommendations was for all health boards to have managed clinical networks (MCNs) for CHD services, and these have been established.

Following consultation, in 2009 the Scottish Government published an updated strategy in the Better Heart Disease and Stroke Care Action Plan which broadened its remit to include other forms of heart disease (e.g. familial hypercholesterolaemia).

The aim of reducing mortality from CHD among the under 75s in deprived areas is included as part of one of the five high level purpose targets and as a specific national indicator set out by the Scottish Government in Scotland Performs:

• National Indicator 26: "Reduce mortality from coronary heart disease among the under 75s in deprived areas" (defined as the 15% most deprived data zones in Scotland, based on the Scottish Index of Multiple Deprivation (SIMD)).

Scottish Government policy on reducing health inequalities includes Equally well, the 2008 report of the Ministerial Task Force on Health Inequalities. This set out a series of recommendations addressing the social determinants of health – including education, poverty and employment – and health and wellbeing in the early years. It also called for analysis to support long-term monitoring of inequalities in a number of high level indicators, of which coronary heart disease was one. The 2008 Long-term monitoring of health inequalities report and the 2009 update presented data on: CHD - first ever hospital admission for heart attack aged under 75 years; and CHD - deaths aged 45-74 years.

There have been a number of SIGN guidelines on CHD and stroke, and Guideline 97 'Risk estimation and the prevention of cardiovascular disease' was published in February 2007.