CARDIOVASCULAR DISEASES
Cardiovascular
disease is caused by disorders of the heart and blood vessels, and
includes coronary heart disease (heart attacks), cerebrovascular
disease (stroke), raised blood pressure (hypertension), peripheral
artery disease, rheumatic heart disease, congenital heart disease and
heart failure. The major causes of cardiovascular disease are tobacco
use, physical inactivity, and unhealthy diet.
Cardiovascular
diseases (CVDs) are a group of disorders of the heart and blood
vessels and 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
Rheumatic heart disease – damage to the heart muscle and heart
valves from rheumatic fever, caused by streptococcal bacteria
Congenital heart disease - malformations of heart structure existing
at birth.
Deep vein thrombosis and pulmonary embolism – blood clots in
the leg veins, which can dislodge and move to the heart and lungs.
Cardiovascular
disease now ranks as the world's top cause of death, causing one
third of all deaths globally. Heart disease can no longer be seen as
the problem of overworked, overweight middle-aged men in developed
countries. In today's world, women and children too are at risk.
Already, 75% of all CVD deaths occur in the poorer regions of the
world, and this is likely to increase in the future.
G
Figure
1: (Mackay and Mensah)
lobally, cardiovascular diseases are the number one cause of
death and are projected to remain so. An estimated 17.5 million
people died from cardiovascular disease in 2005, representing 30% of
all global deaths. Of these deaths, 7.6 million were due to heart
attacks and 5.7 million due to stroke. About 80% of these deaths
occurred in low- and middle-income countries. If current trends are
allowed to continue, by 2015 an estimated 20 million people will die
from cardiovascular disease (mainly from heart attacks and strokes).
Cardiovascular disease (CVD) is the greatest cause of morbidity and
mortality in the developed and developing world. Although women
perceive breast cancer as their most common danger, they are seven
times more likely to die from CVD (Jackson, 2008).
Cardiovascular
diseases include coronary heart disease (heart attacks),
cerebrovascular disease, raised blood pressure (hypertension),
peripheral artery disease, rheumatic heart disease, congenital heart
disease and heart failure. The major causes of cardiovascular disease
are tobacco use, physical inactivity, and an unhealthy diet.
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.
The causes of CVDs are well established and well known. The most
important causes of heart disease and stroke are unhealthy diet,
physical inactivity and tobacco use. These are called 'modifiable
risk factors'. 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 are
called 'intermediate risk factors'. The major modifiable risk factors
are responsible for about 80% of coronary heart disease and
cerebrovascular disease. There are also a number of underlying
determinants of chronic diseases, or, if you like, "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 are
poverty and stress.
Often,
there are no symptoms of the underlying disease of the blood vessels.
A heart attack or stroke may be the first warning of underlying
disease. Symptoms of a heart attack include: pain or discomfort in
the centre of the chest; pain or discomfort in the arms, the left
shoulder, elbows, jaw, or back. In addition the person may experience
difficulty in breathing or shortness of breath; feeling sick or
vomiting; feeling light-headed or faint; breaking into a cold sweat;
and becoming pale. Women are more likely to have shortness of breath,
nausea, vomiting, and back or jaw pain. The most common symptom of a
stroke is sudden weakness of the face, arm, or leg, most often on one
side of the body. Other symptoms include sudden onset of: numbness of
the face, arm, or leg, especially on one side of the body; confusion,
difficulty speaking or understanding speech; difficulty seeing with
one or both eyes; difficulty walking, dizziness, loss of balance or
coordination; severe headache with no known cause; and fainting or
unconsciousness. People experiencing these symptoms should seek
medical care immediately.
Rheumatic
heart disease is damage to the heart valves and heart muscle from the
inflammation and scarring caused by rheumatic fever. Rheumatic fever
is caused by streptococcal bacteria, which usually begins as a sore
throat or tonsillitis in children.
Symptoms
of rheumatic heart disease include: shortness of breath, fatigue,
irregular heartbeats, chest pain and fainting. Symptoms of rheumatic
fever include: fever, pain and swelling of the joints, nausea,
stomach cramps and vomiting.
Early
treatment of streptococcal sore throat can stop the development of
rheumatic fever. Regular long-term penicillin treatment can prevent
repeat attacks of rheumatic fever which give rise to rheumatic heart
disease and can stop disease progression in people whose heart valves
are already damaged by the disease.
CVDs
affect many people in middle age, very often severely limiting the
income and savings of affected individuals and their families. Lost
earnings and out of pocket health care payments undermine the
socioeconomic development of communities and nations. CVDs place a
heavy burden on the economies of countries. For example, it is
estimated that over the next 10 years (2006-2015), China will lose
$558 billion in foregone national income due to the combination of
heart disease, stroke and diabetes. Lower socioeconomic groups in
high income countries generally have a greater prevalence of risks
factors, diseases and mortality,. A similar pattern is emerging as
the CVD epidemic evolves in low and middle income countries.
At
least 80% of premature deaths from heart disease and stroke could be
avoided through 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. Comprehensive and integrated action is the
means to prevent and control CVDs:
Comprehensive action requires combining approaches that seek to
reduce the risks throughout the entire population with strategies
that target individuals at high risk or with established disease
Examples of population-wide interventions that can be implemented to
reduce CVDs include: comprehensive tobacco control policies,
taxation to reduce the intake of foods that are high in fat, sugar
and salt, building walking and cycle ways to increase physical
activity, providing healthy school meals to children
Integrated approaches focus on the main common risk factors for a
range of chronic diseases such as CVD, diabetes and cancer:
unhealthy diet, physically inactivity and tobacco use
Effective
and inexpensive medication is available to treat nearly all CVDs.
After a heart attack or stroke, 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.
Effective medical devices have been developed to treat CVDs, such as
pacemakers, prosthetic valves, and patches for closing holes in the
heart. Operations used to treat CVDs 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.
There is a need for increased government investment through national
programs aimed at prevention and control of CVDs and other chronic
diseases.
Above 300 risk factors are associated with cardiovascular diseases.
Some of these risk factors are modifiable, some modifiable to some
extent and others which are not modifiable. High blood pressure,
abnormal blood lipids, use of tobacco, physical inactivity, obesity,
unhealthy diet and diabetes mellitus are all major modifiable risk
factors. High blood pressure is a major risk factor for heart attack
and the most important for stroke. High total cholesterol, LDL
cholesterol and triglycerides with low level of HDL cholesterol
increase the risk for cardiovascular diseases and stroke. Use of
tobacco increases the risks for cardiovascular diseases, especially
for those who started smoking from a very young age and are heavy
smokers; passive smoking is as risky as smoking itself and is an
additional risk. Physical inactivity increases the risk for
cardiovascular diseases by 50%. Obesity is a major risk for
cardiovascular diseases and diabetes. Low fruits and vegetables
intake in diets is estimated to be causing 31% of cardiovascular
diseases and 11% of strokes worldwide; intake of high saturated fat
also increases the risks as well by its effect on blood lipids and
thrombosis. Diabetes mellitus is also a major risk for cardiovascular
diseases and stroke.
Other
modifiable risk factors also include low socio-economic status, use
of alcohol, mental illness, use of certain medicines, psychosocial
stress, lipoprotein, left ventricular hypertrophy. Left ventricular
hypertrophy is a strong indicator of approaching cardiovascular
death. Use of some oral contraceptives and hormone replacement
therapies are a cause of increased risk. One or two drinks of alcohol
each day may reduce the risk by as much as 30% but heavy drinking
causes the heart muscle to weaken.
Factors
like ethnicity, gender, family history and advancing age are not
modifiable. Advancing age is the most powerful risk factor; risk of
stroke doubles every decade after 55 years of age. Rates of
cardiovascular diseases are higher in men as compared to women (in
premenopausal age). Risks are higher if a first-degree male relative
has had a cardiovascular disease before 55 years of age or a female
first-degree relative before 65 years of age. Fresh in the line
amongst the risks which are not modifiable are inflammation, abnormal
blood coagulation and excess of increased homocysteine in blood.
Of
the modifiable risks, use of tobacco and high levels of high
triglyceride are offer higher risks to women than men. Moreover,
diabetes, obesity and depression are more prevalent in women. Other
modifiable risks mentioned earlier are same for men and women.
There
are certain risks which are for women only and those are use of oral
contraceptive, hormone replacement therapy, polycystic ovary syndrome
and risk of a heart attack at its highest at the beginning of each
menstrual cycle. Risks which are not modifiable remain the same for
men and women.
Cardiovascular diseases are for some reasons not fully detected in
women and more so in younger ones. Women are less referred to heart
specialists, less hospitalized and so they are prescribed for
medicine and treatment less than men. Similarly, they are less
referred for exercise testing and echocardiography. Treatment of
cardiovascular diseases for women normally starts with their second
heart attack. Women respond differently to treatment than men. It
requires more research work to understand the different response to
same treatment in men and women.
The
cardiovascular response to sexual activity in men and women is
similar to other daily activities and not excessive between couples
in a long-standing relationship. The risk of an ischemic event during
sexual activity is low and death very uncommon. Sexual dysfunction is
common in cardiac patients and, in men, may occur before cardiac
symptoms, with a time interval of 2 to 5 years (Jackson, 2009).
Chances of coital sudden death are very rare. In three large studies,
death related to sexual activity was 0.6% in Japan, 0.18% in
Frankfurt, and 1.7% in Berlin. Extramarital sex was responsible for
75%, 75%, and 77%, respectively; and the victims were men in 82%,
94%, and 93% of cases, respectively (Drory, 2002). Moreover, much of
the research literature in this field has now identified erectile
dysfunction (ED) as an indicator of silent coronary artery disease
(Hodges, Kirby, Solanki, O’Donnell, & Brodie, 2007).
Table 1: (Mackay and Mensah)
Country
|
Population
in millions (2002)
|
Heart
Disease
|
Stroke
|
Rheumatic
Heart Disease
|
Smoking
Prevalence
Percentage
of smokers 18 years or above
2003
or latest available data
|
Diabetes
Percentage
of people
aged
20 years and above
with
diabetes
2000
|
Disability
DALYS
lost/1000 population
2003
or latest available data
|
Mortality
Number
of deaths
2002
|
Disability
DALYS
lost/1000 population
2003
or latest available data
|
Mortality
Number
of deaths
2002
|
MEN
|
Women
|
Austria
|
8.111
|
6
|
15,418
|
4
|
7,559
|
185
|
37.4%
|
26.3%
|
3.8%
|
Belgium
|
10.296
|
5
|
14,985
|
4
|
9,234
|
68
|
33.2%
|
22.9%
|
4.0%
|
Brazil
|
176.257
|
9
|
139,601
|
11
|
129,172
|
3,055
|
29.4%
|
18.4%
|
4.3%
|
Canada
|
31.271
|
5
|
43,246
|
3
|
15,621
|
422
|
30.0%
|
26.6%
|
8.8%
|
China
|
1,294.867
|
4
|
702,925
|
12
|
1,652,885
|
97,245
|
58.9%
|
3.6%
|
2.4%
|
Egypt
|
70.507
|
21
|
103,829
|
8
|
35,054
|
3,398
|
47.9%
|
1.8%
|
7.2%
|
France
|
59.850
|
3
|
46,132
|
3
|
37,750
|
1,136
|
42.6%
|
33.9%
|
3.9%
|
Germany
|
82.414
|
6
|
172,717
|
4
|
79,326
|
2,241
|
39.0%
|
30.9%
|
4.1%
|
Greece
|
10.970
|
7
|
16,825
|
6
|
22,694
|
10
|
53.5%
|
33.6%
|
10.3%
|
India
|
1,049.549
|
20
|
1,531,534
|
10
|
771,067
|
103,913
|
34.6%
|
3.4%
|
5.5%
|
Israel
|
6.304
|
4
|
5,705
|
3
|
2,233
|
170
|
35.8%
|
19.7%
|
6.7%
|
Italy
|
57.482
|
4
|
92,928
|
4
|
69,075
|
1,790
|
37.9%
|
29.7%
|
9.2%
|
Japan
|
127.478
|
3
|
90,196
|
5
|
134,952
|
2,585
|
52.5%
|
12.4%
|
6.7%
|
Malaysia
|
23.965
|
8
|
13,445
|
7
|
10,169
|
464
|
52.4%
|
3.0%
|
7.6%
|
Mexico
|
101.965
|
6
|
51,454
|
4
|
26,478
|
1,093
|
36.5%
|
14.3%
|
3.9%
|
Netherlands
|
16.067
|
5
|
19,045
|
4
|
12,459
|
16
|
38.3%
|
32.8%
|
3.5%
|
Norway
|
4.514
|
5
|
8,886
|
3
|
4,817
|
103
|
40.3%
|
39.0%
|
3.9%
|
Pakistan
|
149.911
|
18
|
154,338
|
9
|
78,512
|
11,604
|
30.3%
|
3.8%
|
7.75
|
Philippines
|
78.580
|
10
|
45,378
|
7
|
24,368
|
2,812
|
59.6%
|
13.8%
|
7.1%
|
Russian
Federation
|
144,082
|
27
|
674,881
|
19
|
517,424
|
8,126
|
58.1%
|
15.8%
|
4.2%
|
Saudi
Arabia
|
23.520
|
17
|
16,438
|
4
|
3,818
|
126
|
29.1%
|
1.2%
|
9.3%
|
Singapore
|
4.183
|
7
|
3,946
|
3
|
17,16
|
39
|
23.7%
|
3.2%
|
11.4%
|
South
Africa
|
44.759
|
9
|
27,013
|
11
|
30,306
|
792
|
42.4%
|
13.9%
|
3.4%
|
Spain
|
40.997
|
4
|
45,018
|
3
|
34,880
|
1,738
|
43.9%
|
31.2%
|
8.7%
|
Sri
Lanka
|
18.910
|
8
|
16,297
|
7
|
13,348
|
175
|
38.7%
|
3.1%
|
5.4%
|
Sweden
|
8.867
|
5
|
20,122
|
3
|
9,984
|
143
|
21.3%
|
24.9%
|
4.3%
|
Switzerland
|
7.171
|
4
|
10,746
|
2
|
4,508
|
112
|
37.6%
|
28.3%
|
3.9%
|
Turkey
|
70.318
|
16
|
102,552
|
13
|
62,782
|
1,584
|
51.1%
|
18.5%
|
7.3%
|
United
Kingdom
|
59.068
|
7
|
120,530
|
4
|
59,322
|
1,712
|
34.6%
|
34.4%
|
3.9%
|
United
States of America
|
291.038
|
8
|
514,540
|
4
|
163,768
|
3,479
|
27.8%
|
22.3%
|
8.8%
|
You
might know someone in friends or family who has had a heart attack or
a stroke (a brain attack). These cardiovascular diseases are
responsible for more and more people dying around the world. The
survivors of these diseases often require long term medication, care
and treatment. Moreover, these diseases can seriously affect the
lives of patients and their families and the results can even
influence the community, and yet so many heart attacks could have
been prevented. A lot of damage to blood vessels starts at very young
age. Children should therefore be taught to have a balanced and
healthy diet. Special care is also needed to keep children physically
active.
If
you think you have a risk then you should be on a lookout for
indications and you need to take steps to avoid the disease. The
following simple advices might help you to reduce the risks to a
minimum:
Stop smoking
Engaging in physical activity for at least 30 minutes on most days
of the week
Have fruits and vegetables at least five times a day
Reduce your salt intake to one teaspoon a day
Have your blood pressure checked regularly
If you are diabetic, control your blood sugar and blood pressure
Try maintaining ideal body weight
Make prior arrangements for accessibility to help in case of an
emergency
Have a detailed medical check every year
A
major heart attack is called a myocardial infarction. It usually
starts with pain or discomfort in the centre of the chest, which
lasts for more than a few minutes or keeps coming back. The
discomfort can feel like pressure, squeezing, or fullness. Pain or
discomfort may also be felt in the arms, the left shoulder, elbows,
jaw, or back. Other symptoms include:
• difficulty in breathing or shortness of breath
• feeling sick or vomiting
• feeling light-headed or faint
• breaking into a cold sweat
• becoming pale
Women
are more likely to have shortness of breath, nausea, vomiting, and
back or jaw pain. People who have had diabetes for a long time may
not feel the chest pain as much, because diabetes can damage the
nerves.
Many
people who have a heart attack die before reaching the hospital. So
act fast, every second counts. Have someone call an ambulance or take
you to the hospital right away.
Works Cited
Drory,
Y. (2002). Sexual activity and cardiovascular risk. European Heart
Journal, 4(Suppl. H), H13–H18.
Hodges,
L. D., Kirby, M., Solanki, J., O’Donnell, J., & Brodie, D.
A. (2007). The temporal relationship between erectile dysfunction and
cardiovascular disease. International Journal of Clinical Practice,
61, 2019–2025.
Jackson,
G. (2008). Gender differences in cardiovascular disease prevention.
Menopause International, 14, 13–17.
Jackson, Graham. "Sexual Response in Cardiovascular Disease."
Journal of Sex Research 46.2/3 (May 2009): 233-236. Academic
Search Elite. EBSCO. 3 Apr. 2009
<http://search.ebscohost.com/login.aspx?direct=true&db=afh&AN=37184441&site=ehost-live>.
Mackay,
J., and Mensah, G,. Atlas of Heart Disease and Stroke. World
Health Organization, 2004.
