Cardiovascular Disease (Heart and Blood Vessel Disease)

What cardiovascular disease is

The cardiovascular system includes the heart and the network of arteries and veins that carry blood around the body. Cardiovascular disease includes any condition that damages this system. The most common underlying process is atherosclerosis: cholesterol, inflammatory cells and other material build up as plaque in the artery walls over decades. Plaques narrow arteries and reduce blood flow. If a plaque ruptures, a clot forms on it and can suddenly block the artery, causing a heart attack or stroke.

Types of cardiovascular disease

Risk factors

Factors you can change

• High blood pressure: the single biggest risk factor for stroke and a major one for heart attack.
• High LDL cholesterol: see high cholesterol.
• Smoking and vaping: damage artery linings and promote clots. Risk falls substantially within a few years of quitting.
• Diabetes: roughly doubles the risk of heart disease and stroke.
• Obesity, especially around the waist.
• Physical inactivity.
• Unhealthy diet: high in salt, saturated fat, processed meat and added sugar, low in fruit, vegetables and fiber.
• Too much alcohol.
• Poor sleep and untreated sleep apnea.
• Chronic stress and depression.

Factors you cannot change

• Age: risk rises steadily with age.
• Sex: men develop it earlier. Women's risk rises after menopause.
• Family history of early heart disease or stroke.
• Ethnicity: some groups, including South Asian and Black Americans, have higher rates of certain cardiovascular diseases.
• Other conditions: chronic kidney disease, rheumatoid arthritis, lupus, HIV, and pregnancy complications such as preeclampsia and gestational diabetes all raise lifetime risk.

Symptoms

CVD is often silent until a major event. Warning symptoms include:

• Chest pain, pressure or discomfort, especially with exertion
• Shortness of breath with exertion or lying flat
• Palpitations or an irregular heartbeat
• Swelling of the legs and ankles
• Tiredness and reduced exercise tolerance
• Dizziness or fainting
• Calf pain on walking
• Sudden neurological symptoms (stroke)

Women, older adults and people with diabetes more often have less typical symptoms of a heart attack, such as breathlessness, nausea, tiredness, or back or jaw pain without obvious chest pain.

How cardiovascular risk is assessed

Your doctor can estimate your 10-year risk of heart attack and stroke using calculators that combine age, sex, blood pressure, cholesterol, diabetes, smoking and kidney function. Routine checks include:

• Blood pressure at least every 1 to 2 years, more often if raised
• Cholesterol (lipid panel), typically every 4 to 6 years for adults at average risk
• Blood sugar or HbA1c
• Weight and waist measurement
• Coronary artery calcium scoring in selected people when the risk estimate is uncertain

People with symptoms may need an ECG, echocardiogram, stress test, CT coronary angiography, ankle-brachial index, or carotid ultrasound.

Treatment

Treatment depends on the specific condition and includes:

• Lifestyle changes for everyone
• Medicines: blood pressure medicines, statins and other cholesterol-lowering drugs, antiplatelet drugs such as aspirin for people with established disease, anticoagulants for atrial fibrillation, diabetes medicines that also protect the heart and kidneys, and heart failure medicines
• Procedures: angioplasty and stents, bypass surgery, valve repair or replacement, ablation for arrhythmias, pacemakers and defibrillators
• Cardiac rehabilitation after heart attacks and procedures

Daily aspirin is no longer recommended for most people who have not had a heart attack or stroke, because bleeding risk can outweigh benefit. Ask your doctor before starting or stopping it.

Preventing cardiovascular disease

The American Heart Association's Life's Essential 8 sums up the key steps:

1. Eat better: vegetables, fruit, whole grains, legumes, nuts, fish and healthy oils. Limit salt, processed foods, red and processed meat, and sugary drinks.
2. Be more active: at least 150 minutes of moderate activity a week, plus strength training.
3. Quit tobacco and avoid secondhand smoke and vaping.
4. Get healthy sleep: 7 to 9 hours for adults.
5. Manage weight.
6. Control cholesterol.
7. Manage blood sugar.
8. Manage blood pressure: aim for under 130/80 mmHg for most adults, as advised by your doctor.

Frequently asked questions

What is cardiovascular disease?

Cardiovascular disease is a group of conditions affecting the heart and blood vessels. It includes coronary artery disease, heart attack, stroke, heart failure, peripheral artery disease, heart rhythm problems and valve disease. Most cases are caused by plaque buildup in the arteries.

What are the main risk factors for cardiovascular disease?

The main modifiable risk factors are high blood pressure, high LDL cholesterol, smoking, diabetes, obesity, physical inactivity, unhealthy diet and excess alcohol. Age, male sex, family history and some medical conditions also raise risk but cannot be changed.

What are the early signs of cardiovascular disease?

It is often silent for years. Early signs can include chest discomfort or breathlessness with exertion, unusual tiredness, palpitations, leg swelling and calf pain when walking. High blood pressure, high cholesterol and high blood sugar usually cause no symptoms, so regular checks are important.

Is cardiovascular disease the same as heart disease?

Not exactly. Heart disease refers to conditions of the heart itself, such as coronary artery disease and heart failure. Cardiovascular disease is broader and also includes diseases of blood vessels elsewhere, such as stroke, peripheral artery disease and aortic aneurysm.

Can cardiovascular disease be prevented?

Much of it can. Not smoking, eating a healthy diet, staying active, sleeping well, keeping a healthy weight, and controlling blood pressure, cholesterol and blood sugar substantially lower the risk of heart attack and stroke. Medicines such as statins help people at higher risk.