Preventing cardiovascular disease

Many newspapers today reported on recommendations from a UK health watchdog on measures to reduce the population’s risk of cardiovascular disease (CVD). The guidance, issued by the National Institute for Health and Clinical Excellence (NICE), makes a series of recommendations, including a ban on trans fats in foods and the mandatory use of the Food Standard Agency's traffic light system on all food and drink products sold in England.

The recommendations may not all be implemented. A Department of Health spokesperson said: “The best way to prevent cardiovascular disease is for people to eat better and be more active.

“Today's recommendations are extensive and wide ranging but it is not practical to implement certain proposals in this guidance, for example on the mandatory use of traffic lights.”

Who is the guidance for?

The guidance is mainly aimed at people and organisations whose actions affect the cardiovascular health of the population. This includes the government, NHS, local authorities and industry (for example, food manufacturers). The guidance also states that it may be of interest to members of the public.

Why has NICE made these recommendations?

These recommendations aim to reduce cardiovascular disease in the general population.

What are the recommendations?

NICE has made two sets of recommendations. The first is aimed at people who make policies, and the second at people responsible for regional cardiovascular prevention programmes and other groups.

The following are some of the suggested key policy goals and the recommended actions to achieve them:

Reduce the population’s consumption of salt

Accelerate the reduction in salt intake among the population. Aim for a maximum intake of 6g a day per adult by 2015 and 3g a day by 2025.
Promote the benefits of a reduction in the population’s salt intake to the European Union (EU). Introduce national legislation if necessary.
Ensure low-salt products are sold more cheaply than their higher-salt equivalents.
Clearly label products that are naturally high in salt and cannot meaningfully be reformulated. Use the Food Standards Agency-approved traffic light system. The labels should also state that these products should only be consumed occasionally.

Reduce the population’s consumption of saturated fat

Encourage manufacturers, caterers and producers to substantially reduce the amount of saturated fat in all food products. If necessary, consider supportive legislation. Ensure no manufacturer, caterer or producer has an unfair advantage as a result.
Create the conditions whereby products containing lower levels of saturated fat are sold more cheaply than products with high saturated fat, considering legislation if necessary.

Protect the population from the harmful effects of trans fats

Eliminate the use of industrially produced trans fatty acids (IPTFAs) for human consumption.
In line with other EU countries (specifically Denmark and Austria), introduce legislation to ensure that IPTFA levels do not exceed 2% in the fats and oils used in food manufacturing and cooking.
Establish guidelines for local authorities to independently monitor IPTFA levels in the restaurant, fast-food and home food trades using existing statutory powers (in relation to trading standards or environmental health).

Protect children and young people under 16

Protect children and young people under 16 from all forms of marketing, advertising and promotions (including product placements) that encourage an unhealthy diet.
Develop a comprehensive, agreed set of principles for food and beverage marketing aimed at children and young people. They should be based on a child’s right to a healthy diet.
Extend TV advertising scheduling restrictions on food and drink high in fat, salt or sugar (as determined by the Food Standards Agency’s nutrient profile) up to 9pm.
Develop equivalent standards, supported by legislation, to restrict the marketing, advertising and promotion of food and drink high in fat, salt or sugar through all non-broadcast media. This includes manufacturers’ websites, use of the internet generally, mobile phones and other new technologies.
Ensure that restrictions for non-broadcast media on advertising, marketing and promotion of food and drink high in fat, salt or sugar are underpinned by the Food Standards Agency nutrient profiling system.

Rapidly implement a single traffic light labelling system in England

Establish the Food Standards Agency’s single, integrated, front-of-pack traffic light colour-coded system as the national standard for food and drink products sold in England. This includes the simple, traffic light, colour-coded visual icon and text that indicate whether a food or drink contains a high, medium or low level of salt, fat or sugar. It also includes text to indicate the product’s percentage contribution to the guideline daily amount (GDA) of each category.
Consider using legislation to ensure universal implementation of the Food Standards Agency’s front-of-pack traffic light labelling system.

Support physically active travel

Ensure guidance for local transport plans supports physically active travel. This can be achieved by allocating a percentage of funds to schemes that support walking and cycling as modes of transport.
Create an environment and incentives that promote physical activity, including physically active travel to and at work.
Consider and address factors that discourage physical activity, including physically active travel to and at work. An example of the latter is subsidised parking.

Make sure public sector catering is healthy and balanced and prevents CVD

Ensure publicly funded food and drink provision contributes to a healthy, balanced diet and the prevention of CVD. Ensure public sector catering practice offers a good example of what can be done to promote a healthy, balanced diet. This includes catering in schools, hospitals and public sector work canteens.

Restrict the positioning of take-away and other food outlets

Empower local authorities to influence planning permission for food retail outlets in relation to preventing and reducing CVD. Specifically, encourage local planning authorities to restrict planning permission for take-away and other food retail outlets in specific areas (for example, within walking distance of schools). Help them implement existing planning policy guidance in line with public health objectives.

Other recommendations include

Encourage best practice and transparency for the commercial sector.
Assess the effect of government policy on CVD, and ensure these assessments are adequately incorporated into the policy-making process.
Ensure that European Union common agricultural policy includes the promotion of health and reduction of disease.
Monitor and analyse all appropriate data to inform CVD prevention policy, including the intake of salt, trans fatty acids, saturated fatty acids and monounsaturated and polyunsaturated fatty acids in different population groups.
Local practice recommendations addressing how to plan, develop and run effective regional CVD prevention programmes.

More information on all these recommendations can be found on the NICE website.

Does this guidance apply to me?

This guidance is aimed at improving the health of the population as a whole. It makes recommendations to people who can make changes to improve population health.

However, the principles underlying the recommendations also apply to individuals. For example, most people should reduce their salt, saturated fat and trans fat intake, as well as increasing their levels of physical activity.

Related NICE guidance focuses more on individuals, including guidance on stopping and preventing smoking and tobacco control, physical activity, obesity, high blood pressure and mother and child nutrition.

What can I do to reduce my risk of CVD?

Individuals can reduce their risk of CVD by not smoking, keeping physically active and having a healthy, balanced diet. More information on all of these can be found on the NHS Choices website.