A member of the NICE guideline development group highlights issues in the latest evidence based public health guidance on cardiovascular disease prevention
This article outlines the new public health guideline issued by the National Institute for Health and Clinical Excellence on cardiovascular disease (CVD) prevention. It also discusses how nurses can support the guideline.
The guideline, Prevention of cardiovascular disease at population level, points out that if the right steps are taken, tens of thousands of lives could be saved, and the effects of heart disease and stroke avoided for millions of people. Unlike the majority of NICE guidelines healthcare professionals are not its primary target, although they can play a key role in educating patients to reinforce its message. Instead it calls on the food industry to build on the work already started in changing the nature of the food it produces.
The extent of the problem
In the UK, over five million people are living with CVD, which also results in over 40,000 premature deaths each year. However, premature CVD is largely preventable by making simple changes to diet, smoking and physical activity.
The term cardiovascular disease covers a range of conditions including coronary heart disease, stroke and peripheral arterial disease. These are frequently brought about by the development of atheroma and thrombosis, and are also linked to conditions such as heart failure, chronic kidney disease and dementia. Taking action will therefore reduce the effects of CVD on individual patients, such as disability, inability to work and social isolation. Since CVD costs the UK over £30bn a year it also has the potential for significant economic benefits.
The guideline focuses mainly on food production and its influence on the nation’s diet. Its recommendations are aimed at making small changes across the whole population, as these will translate into significant improvements in the overall health of the nation.
Manufacturers are urged to make further reductions in the salt and saturated fats found in much of the processed food sold in the UK, pointing out that reducing saturated fats could save over 10,000 lives every year. The guideline also calls for a reduction in the trans fats used in processed food. These are hydrogenated vegetable oils are found in thousands of processed foods from sweets and biscuits to ready meals. They are used because they are cheap, add bulk, have a neutral flavour and extend long shelf life. However, they have been linked to high cholesterol, which is associated with CVD, and it is estimated that banning them would prevent at least 5,000 deaths every year.
Guideline recommendations therefore include:
- Speeding up the reduction in salt intake in the population, aiming for a daily maximum for adults of 6g by 2015 and 3g by 2025;
- Encouraging manufacturers to substantially reduce “hidden” saturated fat, and considering supportive legislation if necessary;
- Ensuring low salt products and low saturated fat foods are cheaper than their higher content equivalents;
- Eliminating industrially produced trans fats from processed and takeaway food.
The experience of other countries suggests substantial benefits could be expected rapidly if the NICE recommendations were implemented. Cuba and countries in central Europe saw significant improvements just 2–3 years after diets became healthier in the early 1990s. There is clear evidence from Japan and Finland that cutting dietary salt levels works, and it is suggested that most consumers do not notice any difference in flavour as their taste buds simply adjust.
Promoting and protecting the health of children and young people, especially the most vulnerable and disadvantaged is a key aim of the guideline. Along with changes to food production, therefore, it calls for tighter regulation of the way food is marketed to children.
Further recommendations include:
- Extending restrictions on TV advertising for foods high in saturated fats, salt and sugar to 9pm;
- Establishing the Food Standards Agency’s front-of-pack traffic light labelling system as the national standard for food and drink products in England, and considering legislation if needed;
- Promoting the use of semi skimmed milk for children aged over two years.
The nurse’s role
While the guideline focuses on food manufacturers and local authorities, nurses can play a key role in educating patients on link between diet and CVD, using opportunistic brief interventions in any setting. While it may be difficult to dissuade people from buying processed food nurses can point out the benefits of fresh and home cooked foods, and also help patients to understand when buying processed foods:
- The importance of checking labels for ingredients;
- The significance of recommended daily allowances;
- How to recognise excessive amounts of saturated fats, salt and sugar.
NICE points out that we have the public health evidence on how to virtually eliminate premature heart disease and stroke. Simple actions recommended in the guideline could save tens of thousands of lives, while nurses can support these recommendations by offering patients support in making healthier food choices.
The guideline is available at nice.org.uk/PH25.
Author Simon Capewell is a public health physician, and professor of clinical epidemiology, University of Liverpool and vice chair of the NICE guidance group.