Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause
of death in the UK and account for almost 198,000 deaths each year. More than one in three
deaths (35%) are from CVD each year. The main forms of CVD are coronary heart disease
(CHD) and stroke. About half (48%) of all deaths from CVD are from CHD and more than a
quarter (28%) are from stroke (Table 1.2).
CHD by itself is the most common cause of death in the UK. Around one in five men and one
in seven women die from the disease. CHD causes around 94,000 deaths in the UK each year
(Table 1.3 and Figures 1.3a and 1.3b).
Other forms of heart disease cause over 31,000 deaths in the UK each year so in total there were
just under 126,000 deaths from heart disease in the UK in 2006 (Table 1.3).
CVD is one of the main causes of premature death in the UK (death before the age of 75). 30%
of premature deaths in men and 22% of premature deaths in women were from CVD in 2006
(Figures 1.3c and 1.3d). CVD caused just over 53,000 premature deaths in the UK in 2006
CHD, by itself, is the most common cause of premature death in the UK (Figures 1.3c and 1.3d).
About one fifth (19%) of premature deaths in men and one in ten (10%) premature deaths in
women were from CHD (Figures 1.3c and 1.3d). CHD caused almost 31,000 premature deaths
in the UK in 2006 (Table 1.3).
Other forms of heart disease cause more than 7,500 premature deaths in the UK each year. In
total there were over 38,000 premature deaths from heart disease in the UK in 2006 – around
one fifth of all premature deaths.
Recent trends in death rates in the UK
Death rates from CVD have been falling in the UK since the early 1970s. For people under 75
years, they have fallen by 40% in the last ten years (Figure 1.1a).
Death rates from CHD have been falling in the UK since the late 1970s (Figures 1.1c and 1.1d).
For people under 65 years, they have fallen by 45% in the last ten years (Figure 1.1c).
In recent years, CHD death rates have been falling slower in younger age groups and fastest in
those aged 55 and over. For example, between 1997 and 2006 there was a 46% fall in the CHD
death rate for men aged 55 to 64 in the UK, compared to a 22% fall in men aged 35 to 44 years.
In women there was a 53% fall in those aged 55 to 64 years and a 20% fall in those aged 35
to 44 years (Table 1.4 and Figures 1.4a and 1.4b). There is some evidence that these rates are
beginning to plateau in younger age groups1.
Death rates from stroke fell throughout the latter part of the twentieth century2. For people under
65 they have fallen by 30% in the last ten years (Figure 1.1e). Recently rates have declined at a
slower rate than previously, particularly in the younger age groups (Figures 1.1e and 1.1f).
A recent study aimed to explain the decline in mortality from CHD over the last two decades
of the twentieth century in Britain. Combining and analysing data on uptake and effectiveness
of cardiological treatments and risk factor trends, the authors examined how much of the
decline in CHD mortality in England and Wales between 1981 and 2000 could be attributed to
medical and surgical treatments and how much to changes in cardiovascular risk factors. They
concluded that more than half (58%) of the CHD mortality decline in Britain during the 1980s
and 1990s was attributable to reductions in major risk factors, principally smoking. Treatments
to individuals, including secondary prevention, explained the remaining two-fifths (42%) of the
Despite recent improvements, internationally the death rate from CHD in the UK is relatively
high (Table 1.5 and Figure 1.5a). In countries of Eastern and Central Europe - where death
rates have been rising rapidly recently - the death rates are generally higher than in the UK but
among developed European countries only Ireland and Finland have a higher rate than the UK
While the death rate from CHD has been falling in the UK it has not been falling as fast as in
some other countries. For example, the death rate for men aged 35 to 74 fell by 42% between
1990 and 2000 in the UK, but it fell by 48% in Australia and 54% in Norway. For women the
death rate fell by 44% in the UK but in Australia and New Zealand the rate fell by 51% and
48% respectively (Figure 1.5b).
Over the same period, the death rates from CHD in countries of Eastern and Central Europe
(most notably countries of the former USSR) have experienced substantial increases. In the
Ukraine, for example, between 1990 and 2000 death rates rose by over 60% in both men and
women (Figure 1.5b).
National and regional differences
Death rates from CHD are highest in Scotland, and the North of England, lowest in the South
of England, and intermediate in Wales and Northern Ireland. The premature death rate for men
living in Scotland is 65% higher than in the South West of England and 112% higher for women.
For more than 25 years these rates have been consistently highest in Scotland (Table 1.6).
Maps of CHD mortality by local authority in the UK demonstrate this North-South gradient
and show that the highest mortality rates are also concentrated in urban areas (Table 1.7 and
Figures 1.7a and 1.7b).
Since the 1970s the premature death rate has fallen across all social groups for both men and
women. However for men the death rate has fallen faster in non-manual workers than in manual
workers, that is the difference in death rates increased between these groups (Figure 1.8). At the
end of the 1980s the premature death rate from CHD for male manual workers was 58% higher
than for male non-manual workers. The premature death rate from CHD for female manual
workers was more than twice as high as that for female non-manual workers. Towards the end
of the 1990s the premature death rate was 50% higher for manual male workers compared with
their non-manual counterparts. During the same period the premature death rate for female
manual workers was 73% higher than their non-manual counterparts (Table 1.8).
In 1997 it was estimated that each year 5,000 lives and 47,000 working years are lost in men
aged 20 to 64 years due to social class inequalities in CHD death rates. Just under one in three
of all deaths under 65 years resulting from social class inequalities are due to CHD. In England
and Wales there is a strong positive relationship between deaths from circulatory diseases and
levels of deprivation (Table 1.9). This pattern is clear in CHD and stroke for both men and
women (Figure 1.9).
To help reduce these socio-economic inequalities, CVD inequalities targets have been introduced
in England, Scotland and Wales (Table 1.1). Data from the Central Health Monitoring Unit
show that in England there has been clear progress towards this target: the absolute gap in CVD
mortality between the fifth most deprived areas and the population as a whole, in people aged
under 75, has fallen by just over 20% since the mid-1990s (Figure 1.1b).
Among men living in the UK but born in South Asia and Eastern Europe and among women
living in the UK but born in South Asia there is a higher premature death rate from CHD than
average. Data from 2003 show that the death rate among Bangladeshi men is 112% higher and
the death rate among Pakistani women living in England is 146% higher than the average for
England and Wales (Table 1.10 and Figure 1.10a). Premature death rates from CHD for men
born in the Caribbean and West Africa and for women born in Italy but living in the UK were
lower than average (Table 1.10 and Figure 1.10a).
Men living in England but born in Bangladesh had more than twice the chance of suffering
premature death from stroke than those born in England and Wales.
The difference in the death rates between those born in South Asia and the general population
increased in the 1970s and 1980s. This is because the death rate from CHD was not falling as fast
in South Asian groups as it was in the rest of the population. From 1971 to 1991 the mortality
rate for 20 to 69 year olds for the whole population fell by 29% for men and 17% for women
whereas in people born in South Asia it fell by 20% for men and 7% for women4.
Women born in Jamaica and living in England were 76% more likely to die prematurely from
stroke than those born in England and Wales (Table 1.10 and Figure 1.10b).
Excess winter mortality
In the UK more people die of CHD in the winter months. In 2004/05, just under 7,000 people
died from CHD in England and Wales each month in June and July, compared to around 9,000
in December and January (Table 1.11 and Figure 1.11).
Excess winter mortality is the mortality that occurs in winter above that which occurs in the rest
of the year5. In 2004/05, in England and Wales, during the winter months there were around
19% more deaths than would be expected on the basis of the underlying mortality throughout
the year. This percentage is higher in older age groups, with excess winter mortality more than
twice as high in the over 85s compared to the under 65s (Table 1.12).
The amount of excess winter mortality varies considerably by region – it is highest in the West
Midlands and lowest in the North East of England. Excess winter mortality also varies from year
to year. In 1999/2000, there were nearly twice as many excess winter deaths from CHD than in
2004/05 (8,960 compared to 5,450 deaths)6.
Public health targets
Recent trends indicate that the Our Healthier Nation target to reduce the death rate from CHD,
stroke and related diseases in people under 75 years by at least two fifths by 2010 will be met
Progress towards the CVD inequalities target in England is also steady. If this continues, the
target to reduce the inequalities gap in premature death rates from CVD between the areas with
the worst health and deprivation indicators and the population as a whole by 40% by 2010 will
also be met (Figure 1.1b).
1. Allender S, Scarborough P, O’Flaherty M, Capewell S. (2008) 20th century CHD morality in England and Wales: population trends
in CHD risk factors and coronary death. BMC Public Health (in press).
2. Office for National Statistics (1997) The Health of Adult Britain. The Stationery Office: London.
3. Unal B, Critchley JA, Capewell S (2004) Explaining the decline in coronary heart disease mortality in England and Wales between
1981 and 2000. Circulation 109: 1101-1107.
4. Wild S, McKeigue P (1997) Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. BMJ 314:
5. Excess winter deaths are calculated by subtracting the actual number of deaths in winter (usually December to March), from the
number of deaths which would have been expected for this period, calculated on the basis of the actual number of deaths occurring
in the surrounding non-winter months. It is postulated that excess winter mortality is partially preventable through improvements
to cold damp housing – see Olsen N (2001) Prescribing warmer, healthier homes. BMJ 322: 748-749.
6. Office for National Statistics (2006), personal communication.
1. Department of Health (1999) Our Healthier Nation. DH: London.
2. Department of Health (2004) National Standards, Local Action: Health and Social Care Standards and Planning Framework
2005/06 and 2007/08. DH: London.
3. Welsh Assembly Government (2005) See Chief Medical Officer Wales website www.cmo.wales.gov.uk/content/work/health-gain-
4. Welsh Assembly Government (2005) See Chief Medical Officer Wales website www.cmo.wales.gov.uk/content/work/health-gain-
5. Scottish Executive (2008). Spending Review 2007, Scottish Government. The Scottish Executive: (http://www.scotland.gov.uk/
Publications/2007/11/30090722/34) and http://www.scotland....7/12/11103453/6
6. New strategies for CVD in Northern Ireland are currently being developed by the Department of Health, Social Services and Public
Table 1.1 CVD mortality targets for the United Kingdom
CVD - Target To reduce the death rate from CHD, stroke and related diseases
in people under 75 years by at least two fifths by 2010 – saving
up to 200,000 lives in total
CVD - Milestone To reduce the death rate from CHD, stroke and related diseases
in people under 75 years by at least one quarter by 2005
CVD - Inequalities To reduce the inequalities gap in death rates from CHD, stroke
target and related diseases between the fifth of areas with the worst
health and deprivation indicators and the population as a whole
in people under 75 years by 40% by 2010
CHD – Health outcome To reduce CHD mortality in 65-74 year olds from 600 per
target 100,000 in 2002 to 400 per 100,000 in 2012
CHD – Health To improve CHD mortality in all groups and at the same time aim
inequality target for a more rapid improvement in the most deprived groups
Stroke To reduce stroke mortality in 65-74 year olds by 20% by
CHD - Target To reduce mortality rates from CHD among people under 75
years by 60% between 1995 and 2010, from the 1995 baseline
of 124.6 to 49.8 per 100,000 population (standardised to the
European Standard Population)
CHD - Inequalities To reduce the death rate from coronary heart disease (CHD)
target of those aged under 75 years living in the most deprived 15%
of areas in Scotland. Reduce mortality from CHD among the
under 75s in deprived areas.
Stroke – Target To reduce mortality rates from stroke among people under 75
years by 50% between 1995 and 2010, from the 1995 baseline
of 37.5 to 18.8 per 100,000 population (standardised to the
European Standard Population)
Northern Ireland6 No target set