Taken to heart: Inequalities in heart disease in Scotland

Fortunately, advances in research and treatment mean that many of us can continue to live long, healthy lives while managing heart and circulatory conditions and significant progress has been to reduce the number of lives lost and cut short due to CVD. Since 1961, the average annual number of deaths from heart and circulatory diseases in the UK has fallen by nearly half and the age-standardised death rate from CVD has declined by three-quarters.

Yet despite this positive headline story, inequalities in both the incidence and outcomes of CVD remain stark, both between and within the nations of the UK. In the coming months, the IPPR and the British Heart Foundation will examine the scale of these disparities, their underlying causes, and their consequences across the three devolved nations. 

This blog, the first in a series, focusses on heart disease in Scotland. Our analysis shows that there are significant differences in both the risk factors for, and the prevalence of, heart and circulatory conditions between different areas of Scotland. In particular, people living in the most deprived neighbourhoods are less able to lead healthy lives, and this has serious consequences for their cardiovascular health.

A spotlight on Scotland

Cardiovascular disease remains a leading cause of death and disability in Scotland, and the country has one of the highest death rates from coronary heart disease in Western Europe. The Glasgow City area has the highest rate of premature (under 75) mortality from cardiovascular disease in the United Kingdom and five of the top 10 worst performing areas on this indicator are in Scotland.

Scotland has the most comprehensive and up-to-date data on disparities in cardiovascular disease (CVD) outcomes and risk factors of any of the devolved nations. For this reason, we begin our analysis of CVD inequalities by focussing on Scotland. 

Our primary source was the Primary Care Intelligence Service, which provides an April 2025 snapshot of the health conditions of patients registered with GPs across the country. This dataset covers nearly 100 per cent of GP practices and records the prevalence of health conditions by age. Its breadth and detail make it uniquely suited to examining the prevalence of CVD and its associated risk factors at a more granular level than previously possible.

This dataset uses read codes to identify whether a patient has a disease. For coronary heart disease, a patient is counted if they have ever been diagnosed with it. For heart failure, diabetes, and hypertension, a patient is only counted if they had the diagnosis before the audit date and it had not been marked as resolved by that date. 

Since CVD is more common among older people, we have used European standard rates to age-standardise the data, allowing for more accurate comparisons across different areas. We have included people aged 10 and older for the age standardisation. 

We find significant evidence of disparities across Scotland with GP practices in the most deprived areas having far greater patients with cardiovascular diseases and conditions that increase the likelihood of heart disease. 

Cardiovascular disease risk factors are more prevalent in more deprived areas

Our analysis focused on two main risk factors for heart disease: diabetes and hypertension. 

Both significantly increase the risk of cardiovascular disease. Adults with diabetes are at a two to four times higher risk of developing cardiovascular problems compared to those without diabetes. Hypertension is the primary, or one of the most important, risk factors for nearly all cardiovascular diseases acquired during life. Importantly, many cases of these conditions are preventable and thus with the right policies we can address their prevalence.

Figure 1: There is a clear socioeconomic gradient in Scotland regarding risk factors of cardiovascular disease

Average age standardised rate of patients per 100 with diabetes and hypertension by sex and Scottish index of multiple deprivation (SIMD) decile

Figure 1 shows a clear socioeconomic gradient: GP practices in more deprived areas have a higher average number of patients with both diabetes and hypertension. We estimate that GP practices in the most deprived 10 per cent of areas have 1.5 times as many men with diabetes and 1.8 times as many women with diabetes compared to those in the least deprived 10 per cent. For hypertension, the gaps are smaller but still present, with rates 1.2 times higher for men and 1.3 times higher for women in the most deprived areas.

Cardiovascular disease is more prevalent in GP practices in deprived areas

The inequalities in risk factors ultimately mean that the likelihood of cardiovascular disease is unequal. Focusing on two main cardiovascular conditions – coronary heart disease and heart failure, we can again see a strong socio-economic gradient. People on GP lists in more deprived areas are more likely to have coronary heart disease and heart failure (figure 2). 

We estimate that GPs in the most deprived areas have 1.4 times the number of male patients aged over 10 with coronary heart disease and it stands at 1.8 times the number of female patients compared to the least deprived areas. This gap stands at 1.5 times men with heart failure and 1.9 times for women. 

Figure 2: There is a clear socioeconomic gradient in Scotland regarding cardiovascular disease

Average age standardised rate of patients per 100 with coronary heart disease and heart failure by sex and Scottish index of multiple deprivation (SIMD) decile

There is significant variation in CVD rates between different areas of Scotland

This dataset we are using is unique as we can estimate the prevalence of heart conditions and its risk factors at the GP level by age band. The next analysis aggregates it up to the level of Scotland’s 31 Health and Social Care Partnerships – it shows that there is significant variation across Scotland with GPs in more urban areas having a greater proportion of patients with heart problems and conditions that are risk factors. For example, in East Ayrshire, GPs reported some of the highest numbers of patients with cardiovascular disease or related risk factors, for both men and women. By contrast, Perth and Kinross and Edinburgh recorded some of the lowest levels.

Figure 3: There is a geographic variation of cardiovascular disease and its risk factors in Scotland 

Average age standardised rate of patients per 100 with coronary heart disease, heart failure, diabetes and hypertension by sex and Health and Social Care Partnerships (men, left, and women, right)

What this means

This analysis shows that, as with many other conditions, the prevalence of CVD and the risk factors that drive it are not distributed equally. Inequalities are strongly socioeconomic in nature – people living in more deprived communities are disproportionately affected by risk factors such as diabetes and hypertension and as a result they experience higher rates of CVD. Tackling the huge health burden of CVD will therefore require putting inequalities at the centre of policy making. 

In the short term, there are positive signs. NHS Scotland’s Operational Improvement Plan identifies cardiovascular disease prevention as a priority and highlights the importance of identifying and managing unmet need. Realising the ambition set out in this plan will require dedicated resources, targeted support and proportionately greater investment in GP practices in the most deprived areas which carry the heaviest and most complex caseloads. 

In the longer term, Scotland stands at a crossroads when it comes to heart health policy. 

The Heart Disease Action Plan (HDAP) launched in 2021 has been central to driving improvements in CVD services over the past five years. However, it is due to expire in 2026, and there has been no commitment to its renewal. There is a risk that progress made against the plan’s four key priorities – prevention, timely and equitable access, workforce, and effective use of data – could stall, and that infrastructure built to monitor the quality of CVD services such as the Scottish Cardiac Audit Programme (SCAP) will be deprioritised. 

If the HDAP is not renewed and CVD instead become subsumed within a broader, more generalised Long-Term Conditions Framework (LTCF), it is vital that the attention and resources needed to enable the improvement of cardiology services in Scotland are not lost and the unique challenges of heart disease are recognised and planned for. CVD requires dedicated focus on prevention, early detection, and long-term management, and its disproportionate impact on deprived communities must remain a top priority.

Scotland has the opportunity to lead the way in reducing CVD inequalities – but only if future policy safeguards the progress already made, invests in prevention, and ensures that resources follow need. Failure to do so risks entrenching one of Scotland’s deepest and most persistent health divides.