Understanding Cardiovascular Disease and Prevention

Heart disease is a general term that includes numerous heart-related issues, and falls under the medical umbrella term - cardiovascular disease (CVD). It is one of the leading causes of morbidity and mortality in the world, with huge implications on the quality of life for those affected, and causes massive healthcare and economic costs on a global scale.

Cardiovascular disease follows certain patterns of distribution amongst the population, as it predominantly affects males and is much more common in the older population. In terms of geographical location, this has a major impact on the overall outcome for those affected, because people that come from developing countries often have relatively worse prognosis compared to those in developed regions due to a number of reasons including access to healthcare, public awareness, lifestyle, and infrastructure.

This is a group of diseases that affects the heart and blood vessels causing conditions such as coronary artery disease (commonly known as heart attacks), cerebrovascular accidents (commonly known as strokes), peripheral vascular disease (reduction in blood flow to extremities), venous thromboembolism (formation of blood clots and blockages) and conditions involving the blood vessels of the kidneys and eyes, heart muscle itself, heart rhythm, and valves.

While the underlying mechanisms causing these conditions differ, the dominant cause of cardiovascular disease is atherosclerosis (a sticky substance called plaque that builds up inside the arteries) which is a result of a combination of controllable and uncontrollable risk factors. Those are specific factors that exist from within the person and/ or in the surrounding environment that increase an individual's risk of developing cardiovascular-associated conditions during their lifetime.

Factors that increase the risk of cardiovascular disease, which an individual cannot control include:

Age (more common in the older population).

Gender (more common in males).

Family history (genetic predisposition).

Race (certain race groups are at higher risk e.g. certain Asiatic regions).

Previous history of cardiovascular disease.

Factors that increase the risk of cardiovascular disease, which an individual cancontrol include:

Hypertension (high blood pressure).

Hyperlipidemia (high blood cholesterol).

Diabetes mellitus (high blood sugar).

Obesity.

Sedentary lifestyle and lack of exercise.

Despite the very significant nature of cardiovascular disease, it is important to know that it is certainly NOT inevitable. Thankfully, the vast majority of related conditions can in fact be prevented or at least have their impact minimised by focusing on reducing the risk factors which can be controlled.

There are numerous strategies that an individual can implement in their daily life with the aim of maximising heart health and minimising risk of heart disease, including the following:

Tobacco has numerous chemicals that can harm the heart and blood vessels, in addition to the decreased oxygen supply caused by tobacco smoke which has an added negative effect. It comes as no surprise that avoiding tobacco use, including second-hand smoke, is crucial for ensuring a healthy heart. Even for established smokers, studies have shown that quitting smoking is extremely beneficial for the health regardless of the amount and duration one has been smoking as the body’s self-healing and regenerative processes spring into action within a short period of time after quitting.

Regular physical activity has been proven to result in numerous health benefits. In addition to decreasing risk of developing heart disease, when done effectively and on regular basis, exercise has also been linked to numerous other benefits that directly contribute to an overall good health and wellbeing that include the following:

Improving stress management.

Boosting mental health (i.e. enhancing positive feelings, and reducing rates of anxiety and depression).

Helping in weight loss by enhancing metabolism.

Maintaining strong bone and muscle, as well as decreasing future risk of osteoporosis.

Improving energy levels and endurance by increasing efficiency of the cardiovascular and respiratory systems.

Decreasing risk of developing chronic diseases such as high blood pressure, high cholesterol, type II diabetes, cardiovascular disease, and even certain types of cancers.

Improving brain function and memory, in addition to reducing likelihood of developing age-related disorders e.g. dementia.

Having a positive effect on sleep patterns by improving quality of sleep and reducing incidence of insomnia.

Decreasing chronic pain caused by various conditions e.g. chronic back pain, and increasing pain tolerance.

The current recommendation relating to exercise is to aim for 150 minutes per week of moderate–intensity exercise e.g. brisk walking, or 75 minutes per week for strenuous-intensity exercise e.g. running.

To get the best benefit out of exercise, it is essential to maintain regularity in terms of frequency, duration and intensity of sessions over the course of the week, and even try to combine several rounds of strength training for added benefit.

'We are what we eat' is not just a fancy-sounding statement, because what we consume on a daily basis has a direct link to our overall health and wellbeing. In general, a healthy and balanced diet should consist roughly of 50% fruit and vegetables, 25% whole grain and 25% protein, with emphasis on variety and quality. This is, of course, in addition to drinking plenty of non-sugary fluids and limiting consumption of processed food, and those high in salt, sugar, saturated and trans fats.

Excess weight has long been associated with an increased risk of developing cardiovascular disease. This is especially true for people who tend to have central obesity (being overweight around the middle part of the body) who are much more likely to develop high blood pressure, high cholestrol and type II diabetes which, as previously explained, are all major risk factors for cardiovascular disease.

A good indicator for discovering the weight category is the body mass index (BMI), which uses the height and weight to ascertain whether or not the person has a healthy weight and therefore indicates the level of risk for developing health issues in the future.

Another useful tool is the waist circumference which measures the amount of belly fat, and provides a general guide for identifying those at an increased risk of developing cardiovascular disease according to the waist measurements below:

Males > 40 inches (101.6 cm).

Females > 35 inches (88.9 cm).

Studies have shown that losing as little as 5% weight can significantly lower risk of developing high blood cholesterol, type II diabetes and high blood pressure.

Developing good sleeping habits is crucial for good health and wellbeing. Getting a good night sleep reduces risk of developing chronic conditions such as obesity, high blood pressure, heart disease, and type II diabetes, as well as being essential for good cognitive function and mental health.

On average, the minimum recommended duration for sleep is 7 hours each night which gives sufficient time for the brain and body to recover, self-repair and regenerate. But what can we do to establish a good sleeping habit?

The following are several tips on how to achieve that:

Set up the circadian rhythm so that the sleeping time and wake-up time remain the same every day of the week, including on weekends.

Avoid using smartphones close to bedtime because blue light emitted from screens has been shown to disrupt quality of sleep.

Consumption of caffeine should be limited to the early part of the day at least 6 hours before bedtime, which is the average time it takes to eliminate half of the amount of caffeine in the body, therefore minimising its disruptive effects on sleep quality.

Daytime napping, if necessary, must be well-organised in order to avoid disrupting quality of sleep at night. They should be limited to be under 20 minutes in duration and must not take place after 2 p.m in the day.

Ensure the bedroom is at the right temperature and level of comfort.

Resolve any emotional issues e.g. anxiety and depression, that can significantly disrupt sleep quality.

Avoid strenuous physical exercise close to bedtime as this usually activates stimulating hormones which can interfere with the natural sleep cycle.

Do not rely on sedatives (sleeping pills) especially in the long term as these can affect health adversely.

Constant snoring, gasping for air, and excessive daytime sleepiness can all be symptoms of a condition called obstructive sleep apnoea which is a disorder of the upper respiratory system that involves the closure of the airways during sleep therefore resulting in oxygen deprivation. It is important to be aware of this condition as it is quite a common cause of disturbed sleep, and has serious implications if left untreated because it can potentially cause the development of cardiovascular conditions in the long term.

Physical exercise, meditation, social interaction, listening to music, or even a simple walk in the nature are all effective and healthy methods for managing the stresses of daily life. Avoid resorting to unhealthy methods such as smoking, consuming alcohol or binge eating.

Last, but certainly not least, it is absolutely necessary to perform regular tests as appropriate, to check blood pressure, blood sugar, and blood cholesterol in order to identify any issues early on and take appropriate action - which involves treatment with lifestyle changes, medications or a combination of both.

The frequency of screening tests largely depends on numerous factors such as age, medical history and family history, and must be carefully organised with the healthcare provider.

Screening is very important because there is often no associated signs or symptoms especially in the early stages, and therefore if left unchecked or untreated can significantly increase risk of developing cardiovascular disease.

Cardiovascular disease is a complex multifactorial set of conditions that wreaks havoc on many aspects of life. Treatment is often long-term and is very costly to the individual suffering from the condition, the healthcare sector and the overall economy.

Thankfully, advancement of science, research and technology have made treatment much more effective and accessible. While geographical location, economic infrastructure, and access to healthcare have always been major factors for the overall outcome of cardiovascular disease, it is important to also remember that prevention plays a key part in enabling us to exert control over its development and progression.

The wide availability of information and ultra-ease of access have permitted the rapid rise of health awareness among the general public. Through the gain of essential knowledge, we can now play a huge role in our own health and wellbeing by taking simple steps to control aspects in our daily life that can make a massive difference to our risk of developing cardiovascular disease and other serious health conditions.

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