By Marjory Inglis, health reporter

A LEADING Tayside cardiologist said there had been an “impressive decline” in heart disease among men in Tayside and Fife, but a much less dramatic decline in women.

Dr Graeme McNeill said the main factor holding back further improvement was not a lack of modern treatment options but “lifestyle factors” and smoking in particular.

He was speaking after the British Heart Foundation announced that Scottish women are twice as likely to die prematurely from coronary heart disease (CHD) as women in south-west England—despite the country’s premature death rate being almost halved in 10 years.

Statistics published by the British Heart Foundation reveal the massive progress that has been made in tackling the disease. But the foundation believes the Scottish Executive needs to continue making moves to improve public health if it is to make any headway in narrowing the gap with its UK counterparts.

Between 1994 and 2004, the number of CHD deaths among women under 75 in Scotland dropped from 160 to 81 per 100,000 of the population.

But this reduction has been bettered elsewhere. In south-west England, deaths among women under 75 have fallen from 90 to 40 per 100,000, while the English average has fallen from 142 to 54 per 100,000. Scotland’s 2004 death rate is also higher than Wales (69) and Northern Ireland (66).

“The level of services here in Tayside to treat heart disease is good,” Dr McNeill said. “Where we still lag behind is in primary prevention, that is lifestyle. We certainly have higher smoking rates among women than the south of England. Our diet is probably still not as good.”

He argued access to coronary artery by-pass grafts and angioplasty, surgical interventions aimed at prolonging and improving the lives of patients with heart disease, were not the cause of the north-south divide. The main factor was lifestyle.

Dr McNeill said people already knew the messages about giving up smoking, better diet and taking more exercise but getting them to act on that knowledge and make the lifestyle changes was “difficult.”

The wider availability of preventative drugs and the use of sophisticated technology and treatments were “undoubtedly saving lives” but great benefit would be gained from lifestyle changes.

Last month The Courier reported how health chiefs in Dundee plan to target the “unworried, unwell” in the Prevention 2010 project. They want to find those people who are at risk from preventable disease, but don’t worry about their health, in an attempt to tackle ill health early and prevent the development of chronic disease. NHS Tayside’s director of public health Drew Walker was not surprised by the statistics and said that Tayside’s figures for heart disease reflect the rest of Scotland. He hoped Prevention 2010 would help tackle heart disease locally.

“There’s nothing in these figures that we don’t know already,” he said. “We’ve known for a long time that Scotland compares unfavourably with the rest of the country in terms of the number of people who die from heart disease in the under-70 category.

“The initiative being launched in Dundee, Prevention 2010, involves significant investment in GP and primary care overall in Dundee to target the most deprived parts of the city, where the death risk is at its highest but where people are less likely to take advantage of preventative measures.

“Around £1 million per annum for two years will be spent in Dundee to see whether this can make an important difference to heart disease rates in these poorest and deprived areas.

“There is a very strong connection between heart disease and poverty. There are much higher rates in poorer communities.”

Mr Walker said the initiative would try to encourage as many people as possible to come forward to have their risk of heart disease assessed very thoroughly and if they are found to be at significant risk they will be offered a whole range of treatments and intervention which will reduce their risk of going on to develop serious heart disease or death.

“Although the numbers have come down a lot in the past 10 years the gap has not narrowed between Scotland and the rest of the country and also between the most deprived areas and the most affluent.

Ben McKendrick, British Heart Foundation policy and public affairs manager in Scotland, argued that too many people are still dying prematurely.

“We remain concerned that the improvements in smoking rates and physical activity, which have led to a decline in deaths, could be undone by the rising levels of childhood obesity.

“To prevent today’s girls and boys having their lives cut short by heart disease in future, we urge the Executive to continue making brave moves to give Scotland a chance of achieving parity with the rest of the UK.”

For men, north-west England was the next deadliest region with 210 deaths per 100,000.

Scottish health minister Andy Kerr said latest statistics showed fewer people in Scotland were having heart attacks, strokes or heart disease, and survival rates were improving.

“I am also proud that patients in Scotland still benefit from the shortest cardiac waiting times in the UK,” said the minister.

“These statistics reinforce the good progress we are making in tackling Scotland’s biggest killers.”