Introduction to cardiovascular diseases
Cardiovascular diseases covers conditions that affect the heart and circulatory system. These include coronary heart disease(angina, myocardial infarction), hypertension, heart failure, stroke and peripheral vascular disease. Cardiovascular diseases are the leading cause of global death and account for almost 18 million deaths a year.
The underlying cause of CVD is atherosclerosis. Atherosclerosis is a complex process, which involves the build –up of fatty streaks and atherosclerotic plaques in the wall of the arteries, in response to irritation or injuries to the inner lining of the wall of the arteries.
These plagues lead to narrowing of the arteries. Atherosclerosis can affect: the coronary arteries, causing coronary heart diseases (CHD); the cerebrovascular arteries, leading to stroke or transient ischaemic attacks, or the peripheral arteries, causing peripheral arterial disease.
Cardiovascular diseases risk factors
A number of cardiovascular diseases(CVD) risk factors have been identified and include various genetic, environmental and lifestyle factors:
- advancing age
- a family history of premature CVD
- ethnicity
- high blood pressure
- smoking
- elevated blood glucose or diabetes
- high cholesterol
- overweight/obesity
- physical inactivity
- unhealthy diet
- socio-economic stress
Multiple risk factors increase the possibility of an individual developing CVD. Single risk factors such as severe high blood pressure can even lead to premature CVD.
Current cardiovascular disease guidelines
The aim of CVD prevention in people at high risk is to reduce the risk of a cardiovascular event, improve the quality of life and increase the length of life. The Joint British Societies recommends CVD prevention in clinical practice focus on the following groups:
- people with established atherosclerosis including coronary heart disease, peripheral artery disease and ischaemic stroke;
- people with diabetes(TYPE 1 AND Type 2
- apparently healthy people who have a combination of risk factors that put them at high risk of developing symptoms of CVD(CVD risk of <20 percent over 10 years)
- high blood pressure greater 160 mmHg systolic or 100 mmHg diastolic or lower levels of blood pressure with target organ damage such as diabetic retinopathy, stroke, transient ischemic attack or peripheral arterial disease
- the ratio of total cholesterol to high-density lipo-proteiN (HDL), hyperlipidemia.
CARDIOVASCULAR RISK ASSESSMENT
The aim of cardiovascular risk assessment is to estimate the probability (percentage chance) of an individual developing CVD over a defined period of time. This is called total CVD risk and is classified as low, moderate or high risk:
- high risk: total CVD risk greater 20 percent over 10 years;
- moderate risk: total CVD risk of greater 10 percent less than 20 percent over 10 years.
- Low risk: total CVD risk of less than 10 percent over 10 years.
Cardiovascular risk assessment is used as a tool to guide practice and to help health professionals and individuals make decisions about appropriate interventions, such as, as pertain to lifestyle and drug therapy. Cardiovascular risk assessment should include factors such as ethnicity, smoking, family history of CVD, weight, waist circumference, age, blood pressure, total cholesterol and HDL cholesterol. The Joint British Societies Cardiac Risk Assessor Programme is recommended for use in the UK (NICE 2004) and can be used to the probability of an individual developing CVD over the next ten years. The risk predictor chart can be downloaded from
Cardioprotective drug therapies
All high-risk people will be prescribed an antiplatelet drug such as aspirin, and a statin to reduce cholesterol levels. People with established cardiovascular disease such as CHD may also be prescribed additional drugs including beta-blockers, ACE inhibitors and calcium channel blockers.
