What is Cardiovascular Disease?

Cardiovascular disease, commonly abbreviated to CVD, is responsible for over a quarter of all deaths in the UK (26%), according to Heart UK. In 2014, it was the second main cause of death nationally. Each year, deaths number approximately 160,000, which is an average of 435 every day. Contrary to popular belief, not all of these are due to old age. Around 42,000 cardiovascular-related deaths occur prematurely.

What is cardiovascular disease?

Cardiovascular disease (CVD) is not a specific disease in itself but rather describes a group of diseases that have common risk factors that stem from the stiffening or furring of the artery walls – atherosclerosis. The diseases that come under the cardiovascular disease umbrella include stroke, coronary heart disease (CHD) and peripheral arterial disease.

What are the different types of cardiovascular disease?

Given that cardiovascular disease is an umbrella term, there are many different types of condition that can be described using this term.

The main four types are:

• Coronary heart disease (CHD).
• Strokes and TIAs.
• Peripheral arterial disease.
• Aortic disease.

Coronary Heart Disease (CHD)

Coronary heart disease (CHD) happens when the blood flow to the muscles in the heart is restricted or blocked.

This means that the heart is under increased strain which leads to the following:

• Angina – Chest pains that are caused by restricted blood flow to the heart muscles.
• Heart attacks – When the heart’s blood flow is blocked suddenly.
• Heart failure – When the heart can no longer pump blood properly around the body.

Strokes and TIAs

A stroke happens when a part of the brain’s blood supply is cut off. This can lead to brain damage or even death. A TIA – a transient ischaemic attack or “mini stroke” – is similar to a stroke but the brain’s blood flow is disrupted temporarily and resolves.

The symptoms of strokes are usually remembered with the acronym FAST:

• Face – The face droops to one side. The person might not be able to smile properly, or their eye or mouth may drop.
• Arms – The person may not be able to lift both arms over their head and keep them there as one of their arms may be numb or weak.
• Speech – Their speech may become garbled or slurred or they may not be able to talk at all. Some may not be able to understand what you are saying.
• Time – Time to dial 999. If any of these symptoms are seen in a person, you need to act FAST and call the emergency services.

Peripheral arterial disease

This disease occurs when there is a blockage in arteries in the limbs, usually in the legs.

This causes:

• Cramping or dull pain in the leg that gets worse on activity such as walking but improves with rest.
• Losing hair on the feet and legs.
• Weakness or numbness in the legs.
• Persistent open sores (ulcers) on the legs and feet.

Aortic disease

This is a group of conditions rather than a single condition that affects the aorta, the largest blood vessel in the body. It carries oxygenated blood from the heart to the rest of the body.

A common aortic disease is an aortic aneurysm, where the aorta bulges outwards due to a weakness in the vessel. Normally, this does not manifest symptomatically, but if it bursts it is life-threatening.

What causes cardiovascular disease?

The exact causes of cardiovascular disease are not yet fully understood. However, there are some significant risk factors that contribute to the risk of being diagnosed with CVD.

High Blood Pressure

High blood pressure, also known as hypertension, is a significant risk factor for strokes. The pressure of the blood travelling through the blood vessels can damage them or cause them to burst.

Tobacco Use/Smoking

Smoking or using tobacco in other ways increases a person’s risk of developing CVD as their use narrows blood vessels and damages them.

High Cholesterol

High cholesterol in the blood is often caused by diets high in some types of fat. Cholesterol can build up as fatty deposits/plaques within blood vessels and causes them to narrow. This increases the risk of developing a blood clot which can subsequently cause a stroke or heart attack.

Diabetes

Diabetes is an important risk factor for developing cardiovascular disease. This is because a person’s blood sugar levels can become dangerously high. Over time, high blood sugar can damage a person’s blood vessels as well as the nerves that control the heart. Additionally, people with diabetes are much more likely to have high blood pressure and too much cholesterol in their blood, both of which are contributory risk factors for CVD.

Obesity

Being overweight or obese increases the risk of a person becoming diabetic as well as developing high blood pressure. As mentioned above, both of these are risk factors for developing CVD.

A person is at an increased risk of CVD if their Body Mass Index (BMI) is 25 or above. Additionally, waist size is an important factor to consider. A waist measurement of 94cm or above (37 inches) if male, and a waist measurement of about 80cm or above (31.5 inches) if female, increases the risk of developing CVD.

Genetics

Inherited conditions can increase a person’s risk of developing cardiovascular disease. These include familial hypercholesterolaemia which causes high cholesterol. Additionally, if you have a family history of CVD, you are much more at risk of developing it yourself.

A family history of CVD includes:

• Having a brother or father who was diagnosed with CVD before they reached 55 years of age.
• Having a sister or mother who was diagnosed with CVD before they reached 65 years of age.

It is important to tell your GP if you think you have a family history of CVD as they will monitor you more closely.

Signs and symptoms of cardiovascular disease

There are many symptoms of cardiovascular disease and these can vary depending on the specific condition or diagnosis.

However, broadly speaking, they can include:

• Chest pain.
• Pain, weakness and/or numbness in the arms or legs.
• Breathlessness.
• Slow or very fast heart rate.
• Palpitations.
• Feeling lightheaded, faint or dizzy.
• Swollen limbs.
• Fatigue.

What are the risk factors for cardiovascular disease?

As described above, there are many risk factors for developing CVD. The greater the number of risk factors a person has, the greater their chance of developing CVD.

These risk factors, which we have already explored above, include:

• High blood pressure.
• Smoking.
• High cholesterol.
• Diabetes.
• Obesity.
• Family history/genetics.

However, aside from these main risk factors, there are other risk factors too.

Inactivity

If a person does not exercise often, they are at an increased risk of being overweight and having high cholesterol levels and high blood pressure, all of which are risk factors for CVD. Exercising often helps to keep the heart healthy and can also help to maintain a healthy weight.

Ethnic Background

People of Black African, African Caribbean and South Asian background have an increased risk of developing CVD in the UK. This is because these groups of people are more likely to have other risk factors for CVD such as Type 2 diabetes or high blood pressure.

Age

CVD is much more common in the over 50s and the risk of developing it increases as a person ages. Those who are aged over 40 should be invited by their GP for a health check every five years to monitor the potential development of cardiovascular disease and assess individual risk factors.

Gender

Men are much more likely to develop CVD at younger ages than women.

Diet

Given that high cholesterol, obesity and diabetes are risk factors for CVD, having an unhealthy diet is a contributing factor that increases a person’s risk of developing CVD.

Alcohol

Excessive use of alcohol can lead to increased cholesterol levels and increased blood pressure. It can also cause weight gain, which are all factors that increase a person’s risk of developing CVD.

Who is affected by cardiovascular disease?

According to Heart UK, CVD is most prevalent in deprived areas and contributes significantly to health inequalities across the UK. However, heart disease can affect anyone.

Having said that, when explaining the risk factors, a person is more likely to suffer from CVD if they are:

• Male.
• Over 50.
• Of South Asian, Black African or African Caribbean descent.
• Overweight with a high BMI and large waist measurement.

Living with cardiovascular disease

Bhatnagar et al. published research in 2016 entitled Trends in the epidemiology of cardiovascular disease in the UK. This research outlines that CVD mortality in the UK is declining. However, the burden of CVD is not just in the deaths but also “from those living with the disease”.

The research concludes that “despite the large reductions in mortality” from cardiovascular disease, “these conditions have remained a substantial burden to the UK, with rises in treatment and hospital admissions for all CVD”.

Many people with cardiovascular disease go on to live fulfilling and long lives, but treatment and monitoring are very much necessary. Lifestyle changes are also often needed.

How is cardiovascular disease diagnosed?

Cardiovascular disease is usually diagnosed following blood tests as well as imagining studies. Initially, a GP will take a medical history including family history and assess a person’s risk factors such as whether they smoke. Normally, a physical exam is also needed especially if a person appears to be overweight.

Blood Tests

Blood tests that are usually taken to assess a person’s risk or assess whether a person has CVD include tests for cholesterol levels, fats and lipid components including LDL, HDL and triglycerides. Blood sugar is also measured to detect diabetes as well as inflammation markers that might mean someone can develop heart disease.

If a heart attack is suspected, a blood test for Cardiac Troponin-T is taken. High levels of this and other proteins are a sign that someone has had a recent heart attack.

Electrocardiogram (EKG/ECG)

This test is painless and records the electrical activity in the heart. A person is attached to the instrument with leads and patches stuck to their chest, ankles and wrists. The machine records the heart’s activity on a special strip of graph paper. It can show how fast the heart is beating as well as its rhythm and the timing of electrical signals. It can detect angina attacks, heart attacks and arrhythmias.

Stress Tests

A stress test is where a person is attached to an EKG/ECG machine as described above but they are made to work hard and run on a treadmill or complete another form of exercise. This tests how the heart responds to exercise.

Echocardiography

Soundwaves are used in this test to create a picture of the heart in a similar way to an ultrasound pregnancy scan. This gives doctors information on the heart’s size, valves, chambers and how it is working. There may also be a doppler scan where the blood flow in and out of the heart can be seen. It also shows any areas of poor blood flow to the muscles of the heart, and any previous injuries to the heart muscle and identifies areas of muscle that are not contracting properly.

Coronary Angiography

This assessment is invasive as it involves a dye being injected into the person’s veins so that they reach the coronary arteries. This gives the observer a detailed picture of the blood vessels that are around the heart.

Cardiac Catheterisation

Another invasive procedure, cardiac catheterisation involves threading a thin tube (catheter) through the blood vessels via the groin, neck or arm. The tube is inserted using imaging guidance until it reaches the heart. This procedure is used to detect any blockages in the coronary arteries.

Chest X-ray

Chest x-rays show the size and shape of the heart as well as the lungs and major blood vessels. It is not often used to diagnose heart diseases, however, as echocardiography and other imaging studies are much better at offering information.

EBCT

EBCT stands for electron-beam computed tomography and it is used to detect calcifications or calcium deposits in the walls of the coronary arteries. These are early markers for coronary heart disease and atherosclerosis. However, this is not a routine test to detect CHD.

Cardiac MRI

Cardiac MRI (magnetic resonance imaging) uses magnets and radio waves to create a 3D image of the heart, including moving pictures.

How is cardiovascular disease treated?

The treatment for cardiovascular disease will depend on the condition that needs to be treated.

However, common treatments include:

• Lifestyle changes.
• Medication.
• A pacemaker or ICD.
• Stents.
• Heart surgery.

Lifestyle changes

These may include eating a healthier diet, trying to lose weight, stopping smoking, reducing or stopping drinking alcohol and doing more exercise.

Medication

Many medicines help to treat or reduce the symptoms of cardiovascular disease.

These may include:

• ACE inhibitors.
• Anti-arrhythmic medicines.
• Anti-coagulant medicines.
• Beta-blockers.
• Calcium channel blockers.
• Statins that lower cholesterol.
• Diuretics.
• Nitrates.

Pacemaker or ICD

Pacemakers are small electrical devices that are placed inside a person’s chest. They are used to treat arrhythmias and conditions that cause the heart to beat too slowly or even miss beats.

An ICD is a device that treats people whose heart rhythms are dangerously abnormal and could cause a cardiac arrest. If this occurs, the ICD can kick in and restore a normal rhythm. People are fitted with ICDs if they have had a life-threatening abnormal rhythm previously.

Stents

A stent is used to support a coronary artery that has narrowed or was blocked and helps restore normal blood flow to the heart. It can relieve angina symptoms as well as be used in emergency situations during a heart attack.

Heart surgery

Heart surgery may involve surgery to the heart valves, such as valve repair or replacement. Heart bypass operations are also common. This is used as a treatment for blocked arteries. A blood vessel is taken from another part of the body, and it is placed above and below a blockage so that the blood can bypass the blockage.

Ablation and cardioversion are also used to correct the heart’s rhythm where an electrical signal or shock is administered to the heart whilst under general anaesthetic. It can help to reset the heart’s rhythm.

Final thoughts

Given that cardiovascular disease is one of the leading causes of death in the UK and that many thousands of people are affected, people who are at risk of CVD must be monitored closely by their GP.