Cardiovascular disease (CVD)

Cardiovascular disease (CVD) is a broad term that contains a range of conditions affecting the heart and blood vessels. These include:

• coronary heart disease (CHD) 
• stroke 
• peripheral arterial disease
• heart failure
• atrial fibrillation (AF)
• vascular dementia

Risk factors

The primary causes of CVD are modifiable risk factors such as:

• high blood pressure
• smoking 
• high cholesterol
• obesity
• diabetes
• physical inactivity
• poor diet

Non-modifiable factors can also increase the risk of CVD, such as:

• increasing age
• being male
• having family history of CVD
• certain ethnicities
• genetics

Social and environmental determinants, such as deprivation, housing, air quality, employment, also play a significant role in the onset and progression of CVD. 

Context and background

CVD is one of the leading causes of premature death and disability in England and significantly contributes to health inequalities.  

Stockton-on-Tees experiences higher rates of CVD-related mortality and emergency hospital admissions compared to the national average. People living in more deprived areas of the Borough are disproportionately affected. 

Stockton-on-Tees faces complex health challenges due to large inequalities in life expectancy and healthy life expectancy between its most and least deprived communities. CVD is a major contributor to this gap.  

The disease not only impacts individuals and families but also places a significant burden on local health and social care services and contributes to wider social and economic disadvantage.

The national picture

Nationally, around 7.6 million people in the UK live with CVD. It is responsible for approximately one in four deaths in England. The NHS Long Term Plan identifies CVD prevention as the single biggest area where the NHS can save lives over the next 10 years.  

Key ambitions include preventing 150,000 heart attacks, strokes and cases of dementia by improving the detection and management of high-risk conditions. 

The NHS Health Check programme targets adults aged 40 to 74 and is a key national initiative designed to prevent CVD by identifying risk factors early. Participation rates vary significantly across different regions and demographic groups. Improving uptake of the programme remains a priority in Stockton-on-Tees.

Recent and upcoming changes to legislation and practice

The government's upcoming Major Conditions Strategy (2025) will prioritise cardiovascular disease (CVD) at a national level. This strategy emphasises the importance of integrated prevention and care pathways throughout the health and care system. 

Recent national pilot projects have explored alternative ways to provide NHS Health Checks, including workplace settings and digital delivery for people at home. The evaluation of these pilots will help shape future models for delivering NHS Health Checks nationally.

Prevalence and risk 

Hypertension prevalence 

Around 16.7% of people in Stockton-on-Tees have a diagnosis of hypertension. This is higher than the England average of 14.8%. 

Diabetes prevalence

Around 8% of people living in Stockton-on-Tees have a diagnosis of diabetes. This is slightly higher than the England average of 7.7%.

Stroke prevalence

Stroke prevalence in Stockton-on-Tees is 2.3%. This is higher than the England average of 1.9%.

NHS Health Check Data

7.3% of the eligible population received an NHS Health Check in 2023 to 2024. This is similar to the north east average of 7.6%, and slightly lower than the England average of 8.8%.

Health outcomes

Hospital admissions due to CHD

In 2023 to 2024, 451.2 per 100,000 people in Stockton-on-Tees were admitted to hospital due to CHD. This is higher than the England average of 390.6 per 100,000 people.

Hospital admissions due to heart failure

In 2023 to 2024, 164.3 per 100,00 people in Stockton-on-Tees were admitted to hospital due to heart failure. This is lower than the England average of 179.6 per 100,000 people.

Hospital admissions due to stroke

In 2023 to 2024, 185.8 per 100,00 people in Stockton-on-Tees were admitted to hospital due to stroke. This is higher than the England average of 173.1 per 100,000 people.

Under 75 years mortality rate from CVD

Stockton-on Tees has a similar rate of under 75 years CVD mortality to England. 80.5 per 100,000 people living in Stockton-on-Tees die prematurely to CVD, which is lower than the north east average of 88.2 per 100,000 people, but slightly higher than the England average of 77.4 per 100,000 people.

CVD has a wide-ranging impact across individuals, communities, and public services in Stockton-on-Tees. 

In addition to direct health consequences, its impact includes: 

• economic disadvantage
• increased pressure on health and care services
• widening social inequalities 

CVD uses a significant proportion of NHS and local authority resources.

Hospital admissions and emergency services

Admission rates for coronary heart disease (CHD) and stroke in Stockton-on-Tees are above the national average, emergency admissions result in high acute service use and cost.

Primary care management

General practice (GP) workload is increased by high levels of hypertension, atrial fibrillation, and diabetes. This often requires multiple long-term condition reviews.

Rehabilitation and social care

Stroke survivors often require extended rehabilitation, home adaptations, and social care support. This creates pressures for both NHS community services and local authority-funded adult social care.

Deprivation

Deprivation is one of the largest contributors to CVD inequalities across Stockton-on-Tees. 

People living in more deprived areas are less likely to access preventive services (for example NHS Health Checks) and more likely to experience complications that require emergency hospital care.

Life expectancy gap 

Men in the most deprived areas of Stockton-on-Tees live nearly 12 years less than those in the least deprived. For women the gap is almost 10 years. 

A significant proportion of this difference is due to circulatory diseases, including heart disease and stroke. 

CVD prevalence 

Conditions such as hypertension, diabetes, and stroke are more common in deprived wards like Stockton Town Centre, Hardwick, and Norton North.

Age and gender 

Age

It is common for CVD to rises with age, particularly in people over 65 years. In Stockton-on-Tees, the ageing population in some wards, such as Yarm and Hartburn, is likely to drive future demand for cardiac and stroke care services. 

Gender

Men are more likely to experience coronary heart disease (CHD) and heart attacks at a younger age. In 2023 to 2024 Stockton-on-Tees NHS Health Check data, it shows men in every age group had a higher cardiovascular risk than women. 

NHS Health Check uptake in Stockton-on-Tees is lower among men aged 40 to 54, a key group for early identification of CVD risk. 

Ethnicity

South Asian communities, particularly Pakistani, Bangladeshi, and Indian populations, have higher risk of developing CHD and type 2 diabetes at younger ages. 

African Caribbean populations have increased risk of hypertension and stroke. 

In Stockton-on-Tees, 41% of white British people took up the offer of a health check. This uptake was 0.03% for Caribbean, African and other mixed groups. 

Other protected characteristics

People with learning disabilities have significantly worse physical health and shorter life expectancy, often due to undiagnosed or poorly managed physical health conditions like CVD. 

LGBTQ+ populations may face barriers to care, higher rates of smoking, and poorer experiences within healthcare settings, all of which may contribute to increased CVD risk and unmet need. 

People with mental illness are more likely to die from CVD than those without, due to a combination of lifestyle risk factors, medication side effects, and under-treatment of physical health conditions. 

Inequalities in service provision and uptake 

NHS Health Check uptake in Stockton-on-Tees is lower in men. 42.4% of assessments were in men compared to 57.6% in women, despite a higher proportion of invites to men.  

NHS Health Check uptake lower in people from more deprived areas, despite higher numbers of invitations. 

Preventive messaging and services may be less accessible for people with low health literacy, learning disabilities, or those who are digitally excluded. 

The data highlights a clear need to address CVD in Stockton-on-Tees through:

• improved prevention
• earlier diagnosis
• fair access to care
• targeted support for at-risk populations

Targeted prevention and early detection in high-risk groups

Stockton-on-Tees has higher than average prevalence of hypertension at 16.7%, diabetes at 8%, and stroke at 2.3%, all major risk factors for CVD. 

Smoking, poor diet, physical inactivity, and alcohol consumption remain prevalent in Stockton-on-Tees, particularly in more deprived wards. 

24.6% of the eligible population received an NHS Health Check in the last 5 years, lower than the England average of 27%. This suggests that a large portion of the at-risk population may be undiagnosed or unmanaged. There is a need for improved uptake of NHS Health Checks, particularly in deprived communities and among men aged 40 to 60 years, who are less likely to engage with preventative health services. 

Some communities, for example those living in the most deprived quintile, certain ethnic groups, and people with lower health literacy, face barriers to accessing primary care, as well as treatment and rehabilitation services.   

Local, regional and national strategies must support fair access to NHS Health Checks, to help prevention and early identification of CVD. 

There is a need for services that address modifiable risk factors to be accessible and inclusive.

Strengthening local service delivery and integration 

While heart failure admissions are lower than the national average, stroke and coronary heart disease hospital admissions are above national average. This suggests an increased need for prevention and early diagnosis of CVD-related conditions, and potential gaps in community-based management. 

There is a need to better integrate primary care, community health services, voluntary sector support, and community champions to ensure people at risk of CVD receive an NHS Health Check, or those living with CVD receive coordinated care.  

Supporting people living with CVD to self-manage and stay well 

People living with multiple long-term conditions, especially in deprived areas, often struggle to navigate services or maintain continuity of care. 

There is a growing population living with CVD who may benefit from targeted education, peer support, social prescribing, and digital tools to manage their health. 

Workforce and system capacity

GP practices continue to face pressures, sometimes limiting their ability to deliver NHS Health Checks, or follow-up with people at risk.

There is a need for workforce development in risk identification, behaviour change conversations, and culturally informed care. Making Every Contact Count (MECC) training for public facing staff could aid with this.

CVD is a major contributor to health inequalities and premature mortality in Stockton-on-Tees. While some health indicators, such as heart failure admissions, are favourable, others including stroke admissions, NHS Health Check uptake, and risk factor prevalence highlight challenges, particularly among deprived communities and underserved groups.  

There is a need for targeted, system-wide action to improve early detection, reduce modifiable risk factors, and ensure equitable access to preventative and long-term support services. This includes improving uptake of NHS Health Checks, enhancing service accessibility for vulnerable groups, and addressing wider social determinants of health 

To do this we will do the following in Stockton-on-Tees: 

• develop a service specification and recommission the statutory provision of NHS Health checks (current contract ends 2026)
• review NHS Health Check performance and address low or inequitable uptake (for example, providing tailored support and visits to GP practices), targeted work to address health inequalities
• take opportunities to pilot alternative provision of NHS Health Checks, to assess feasibility, improve uptake and reduce inequalities (for example, CVD Workplace Health Check Programme)
• update and distribute a patient results booklet for practices to hand out at an NHS Health Check, to aid risk communication and encourage behaviour change

Best practice in other areas include:

• moving towards community-based health check models like Bradford District and Craven
• study on CVD prevention outreach through community champions and peer educators
• implementing BloodPressure@Home scheme

Adopting approaches such as these will be essential in meeting the identified needs, closing inequality gaps, and reducing the burden of CVD in Stockton-on-Tees.

Clinical conditions strategic plan on the NHS website.