Preventing and Predicting Cardiovascular Diseases

Preventing and Predicting Diseases. Personalized and Participatory Medicine.

CARDIOVASCULAR DISEASE FACTS

  • CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause (1).
  • An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths(1). Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke (2).
  • Low- and middle-income countries are disproportionally affected: over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women (1).
  • The number of people who die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3. million by 2030 (1,3). CVDs are projected to remain the single leading cause of death (3).
  • Most cardiovascular diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes and raised lipids.
  • 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure (4). This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease (5).

CARDIOVASCULAR DISEASE FACTS

What are cardiovascular diseases?

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include:

– Coronary heart disease – disease of the blood vessels supplying the heart muscle;
– Cerebrovascular disease – disease of the blood vessels supplying the brain;
– Peripheral arterial disease – disease of blood vessels supplying the arms and legs;
– Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.
– Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.

What are the risk factors for cardiovascular disease?

The most important risk factors of heart disease and stroke are lifestyle: unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Behavioural risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease (1).

The effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of developing a heart attack, stroke, heart failure and other complications.
Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. The cardiovascular risk can also be reduced by preventing or treating hypertension, diabetes and raised blood lipids.

Policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behavior.

There are also a number of underlying determinants of CVDs, or “the causes of the causes”. These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.

How can the burden of cardiovascular diseases be reduced?

Very cost effective interventions that are feasible to be implemented even in low resource settings have been identified by WHO for prevention and control of cardiovascular diseases.

Heart disease and stroke can be prevented through healthy lifestyles: healthy diet, regular physical activity and avoiding tobacco smoke. Individuals can reduce their risk of CVDs by engaging in regular physical activity, avoiding tobacco use and second-hand tobacco smoke, choosing a diet rich in fruit and vegetables and avoiding foods that are high in fat, sugar and salt, and maintaining a healthy body weight and avoiding the harmful use of alcohol.

People at high risk can be identified early in primary care, using simple tools such as specific risk prediction charts. If people are identified early, inexpensive treatment is available to prevent many heart attacks and strokes.
Survivors of a heart attack or stroke are at high risk of recurrences and at high risk of dying from them. The risk of a recurrence or death can be substantially lowered with a combination of drugs – statins to lower cholesterol, drugs to lower blood pressure, and aspirin.
In addition surgical operations are sometimes required to treat CVDs. They include coronary artery bypass, balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation, and artificial heart operations.
Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.
There is a need for increased government investment in prevention and early detection through national programmes aimed at prevention and control of noncommunicable diseases including CVDs.

OVERVIEW OF CURRENT RECOMMENDATIONS

Heart disease can be improved — and prevented — by making certain lifestyle changes. The following lifestyle changes can help anyone who wants to improve his or her heart health:

– Stop smoking. Smoking is a major risk factor for heart disease, especially atherosclerosis. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is the best way to reduce your risk of heart disease and its complications.
– Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. Optimal blood pressure is less than 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
– Check your cholesterol. Ask your doctor for a baseline cholesterol test when you’re in your 20s and then at least every five years. If your test results aren’t within desirable ranges, your doctor may recommend more frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you’re at very high risk of heart disease – if you’ve already had a heart attack or have diabetes, for example – your target LDL level is below 70 mg/dL (1.8 mmol/L).
Keep diabetes under control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
– Get moving. If you have heart disease, exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for heart disease. If you have a heart arrhythmia or heart defect, there may be some restrictions on the activities you can do, so be sure to talk to your doctor first. With your doctor’s OK, aim for 30 to 60 minutes of physical activity most days of the week. Even if you can’t make time for one 30- to 60-minute exercise session, you can still benefit from breaking up your activity into several 10-minute sessions.
– Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial.
– Maintain a healthy weight. Being overweight increases your risk of heart disease. Weight loss is especially important for people who have large waist measurements — more than 40 inches (101.6 centimeters, or cm) for men and more than 35 inches (88.9 cm) for women — because people with this body shape are more likely to develop diabetes and heart disease.
– Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
– Practice good hygiene habits. Staying away from other people when they are sick and regularly washing your hands can not only prevent heart infections but also can help prevent viral or bacterial infections that can put stress on your heart if you already have heart disease. Also, brushing and flossing your teeth regularly can prevent germs in your mouth from making their way to plaques in your heart, which could worsen cardiovascular disease.

HeartScore – The interactive tool for predicting and managing the risk of heart attack and stroke

REFERENCES AND CONTINUED READING

  • Global status report on noncommunicable disaeses 2010. Geneva, World Health Organization, 2011.
  • Global atlas on cardiovascular disease prevention and control. Geneva, World Health Organization, 2011.
  • Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11):e442.
  • Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2224–2260.
  • The global burden of disease: 2004 update. Geneva, World Health Organization, 2008.