Health: Non-communicable Diseases

Lord Kakkar Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord Kakkar]

My Lords, I, too, join noble Lords in congratulating the noble Lord, Lord Crisp, on securing this important debate so soon after the United Nations summit on the problem of non-communicable diseases. In making my contribution, I remind noble Lords of my declarations of interest as professor of surgery at University College London and director of the Thrombosis Research Institute in London. Both institutions have active research programmes globally in the area of cardiovascular disease, the non-communicable disease that I will concentrate on.

As we have heard, non-communicable diseases now account for 63 per cent of all deaths—of the 57 million people who died in 2008. By 2020, some 52 million individuals around the world will die of non-communicable diseases. In 2008, some 25 per cent of the 57 million deaths were due to two important cardiovascular disorders: stroke and coronary artery disease.

We are making excellent progress in our own country in the management of patients with coronary artery disease and stroke. The national strategy addresses the 3 million of our citizens who suffer from cardiovascular disorders. That burden of disease was associated in 2006 with some 50,000 premature deaths in our country. It is estimated that by 2020 cardiovascular disease in the United Kingdom will be associated with some 58,000 premature deaths. Annually in our country, prescriptions for circulatory disorders cost the National Health Service some £2 billion. The total economic burden of direct and indirect costs associated with the management of cardiovascular disease in our country is estimated at some £30 billion a year. In the United States of America, the direct and indirect costs associated with the management of cardiovascular disorders come to some $400 billion a year.

It is in the developing world, in low and middle-income countries, that we see the fastest growth in cardiovascular disorders, one of the most important of all non-communicable diseases. Twice as many people in low and middle-income countries die of cardiovascular disease than they do of tuberculosis, HIV/AIDS and malaria combined. We can recognise the risk factors associated with the development of cardiovascular disorders in these developing countries. They are very similar to the risk factors that have been identified in our own population. High blood pressure, high cholesterol, lack of physical exercise, abdominal obesity, smoking and inappropriate diet are all important risk factors that can be recognised in these developing populations. As the noble Lord, Lord May, said, longevity ensures that populations are living longer in these countries, so they start experiencing cardiovascular disease.

The pattern of cardiovascular disease in low and middle-income countries appears to be quite different from the patterns seen in western countries. As we have heard, the onset of this disease is at a younger age in populations in India, in China, in Africa and in other important nations around the world. The pattern of disease in coronary artery disease, for instance, anatomically seems to be quite different, with disease more distally distributed in blood vessels, making it less amenable to the interventions that we provide for our patients successfully to treat coronary artery disease underlying coronary disease before it presents as a heart attack.

Of course, in addition to the pattern of disease and the early onset of disease, we also recognise in low and middle-income countries that the risk factors that are seen to be associated with the development of coronary artery disease are also associated with poverty in those countries. The high burden of cardiovascular disease in those countries is associated with increasing poverty in those populations.

If we look at the report by the World Economic Forum presented as part of the United Nations summit, we see that for low and middle-income countries over the period 2011 to 2025—a 14-year period—the economic loss to those communities associated with non-communicable diseases accounts for $7 trillion of lost economic output; for cardiovascular diseases it is some $3.76 trillion over that same 14-year period. That has huge impact in those nations in terms of avoidable economic burden.

If we look at this in terms of individuals, it is estimated that across Brazil, China, India, South Africa and Mexico, 21 million years of productive life are lost annually due to cardiovascular disease, a disease that is often attributed, as we have heard, to lifestyle choices, and of course to other environmental factors, but that is in many circumstances avoidable.

In driving economic benefit, therefore, there are important opportunities to be derived from targeting cardiovascular disorders and trying to promote strategies for prevention. Important public health strategies might be adopted around the world that could help reduce the risk of cardiovascular disease and its burden both for the individual and for society. Many of the strategies that have formed part of our national frameworks for targeting cardiovascular disease in the United Kingdom could usefully be adopted elsewhere in the world. We have heard during this important debate about the importance of prospectively collecting data to understand the distribution of risk factors for cardiovascular disease in low and middle-income countries, and in so doing better target our interventions that drive prevention on a population basis.

There are also some very exciting novel approaches to the prevention of cardiovascular disease at a population and an individual level. One of them is the concept of the polypill—identifying large populations and offering them; a pill that combines elements such as the statin that we have heard about from the noble Lord, Lord May of Oxford; aspirin, an agent that inhibits the activation of the blood cells in the circulation that come together to form small blood clots in the coronary arteries or the blood supply to the brain that result ultimately in a hard attack or stroke; an agent to drop blood pressure; and medications to control blood sugar. This polypill offered to populations, it is suggested, will reduce the impact of risk factors for the development of cardiovascular disease and therefore reduce the burden of that disease both clinically and, eventually, economically.

Another important approach is to target nutrition during pregnancy and in early life because it is well recognised that poor nutrition during pregnancy and in the first few weeks, months and years of life is associated with a heightened risk later in life for high blood pressure and the development of heart disease.

A third approach, which my own research institute is involved in, is the concept of vaccinating against atheroma, the disease pathology that was mentioned by the noble Lord, Lord McColl. The narrowing of the arteries is considered to be multifactorial, and there is some suggestion that an immunological response to the vessel wall as a result of chronic infection might play an important role in its pathogenesis, so vaccination across populations might be an alternative strategy to the prevention of cardiovascular disease. These are all novel ideas, with research being undertaken at many institutions here in the United Kingdom.

The research, whether conducted here and directed to populations elsewhere in the world, or conducted elsewhere in the world and directed to populations in our own country, is hugely important, because the burden of cardiovascular disease is a true global problem. In this regard, I ask the Minister what proportion of National Institute of Health research funding is directed towards the important problem of cardiovascular disease, both in improving the management for those with established disease and in the strategies targeted at risk identification and the development of biomarkers to understand better those at high lifetime risk for the development of cardiovascular disorders.

What proportion of our overseas aid budget is directed towards promoting research into cardiovascular disorders in low and middle-income countries? Potentially understanding the disease better in those nations, and therefore helping to prevent or treat it more effectively, could offer substantial economic benefits to those countries—benefits that are derived from such appropriate prevention and treatment of cardiovascular disease being directed to more beneficial areas of economic development.

Finally, I turn to the potential of using the Commonwealth—there was in your Lordships’ House some weeks ago a very interesting debate on the ongoing role of the Commonwealth—to develop a network between our own country and those with whom we have strong emotional and economic ties to pursue research into this important, chronic, non-communicable disease to determine whether that would both help us serve the people of those nations and ensure that nations on whom our own economic growth in the future is going to be dependent through export could avoid the economic and medical toll of cardiovascular disease.