8 Cardiovascular Disease

Objectives:

• Define cardiovascular disease
• Identify the types of cardiovascular disease
• Identify risk factors that predispose for heart disease and stroke
• Assess personal risk of Cardiovascular Disease

What Is Cardiovascular Disease?

Cardiovascular disease (CVD) generally refers to conditions that involve narrowed or blocked blood vessels. The term is often used interchangeably with heart disease. However, heart disease is just one type of cardiovascular disease. Other types of CVD include stroke, high blood pressure, angina (chest pain), and rheumatic heart disease. This chapter will focus on heart disease and strokes.

Heart Disease

Heart disease is a disorder of the blood vessels that can lead to heart failure. This disorder can be congenital and/or the result of lifestyle. Most people associate heart disease with heart attacks. A heart attack, also known as a myocardial infarction, happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart. When a person is experiencing a heart attack, they will have crushing chest pains, profound shortness of breath, left arm pain, radiating jaw pain or middle back pain. These signs and symptoms indicate that a person should seek immediate medical assistance.

Click on the link below for more information about how to recognize and respond to a heart attack victim:

• Recognizing and Responding to a Heart Attack

Other types of heart disease include:

• Coronary artery disease: damage or disease in the heart’s major blood vessels
• High blood pressure: A condition in which the force of the blood against the artery walls is too high.
• Cardiac Arrest: Sudden, unexpected loss of heart function, breathing, and consciousness.
• Congestive heart failure: A chronic condition in which the heart does not pump blood as well as it should.
• Arrhythmia: Improper beating of the heart, whether irregular, too fast, or too slow.
• Peripheral artery disease: A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.

• Congenital heart disease: An abnormality in the heart that develops before birth.

Many people believe incorrectly that heart disease can be cured with surgery and medication. This is a myth. Heart disease is a lifelong condition. Although procedures, such as bypass surgery, can increase blood flow to the heart, the arteries remain damaged. Additionally, this condition will steadily worsen without major lifestyle changes.

Combating America’s Number 1 Killer

Heart disease remains the leading cause of death in America, and in most other countries worldwide. However, the death toll from this disease has been declining steadily for decades, falling 60% since its peak in the mid 1960s. In addition, the death rate from stroke, the third most common cause of death, has declined by about 75 percent since the early 1960s (NIH, 2017). The death rates from these diseases have fallen as awareness about the devastating effects of smoking, high cholesterol, high blood pressure, and obesity has increased. Researchers believe that heart disease in America will continue to decline if more people begin to eat healthier diets, exercise more, and stop smoking.

Stroke

Strokes are the fifth leading cause of death and a leading cause of disability in the United States. This type of CVD affects the arteries leading to the brain and blood vessels within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. When that happens, part of the brain cannot get the blood and oxygen it needs and as a result, brain cells begin to die.

A stroke that occurs as the result of a blockage is called an ischemic stroke. A hemorrhagic stroke is the result of a rupture and accounts for only 20% of all strokes.

The Cincinnati Stroke Scale provides early warning signs of a stroke:

• F = Face: Is one side of the face drooping down?
• A = Arm: Can the person raise both arms, or is one arm weak?
• S = Speech: Is speech slurred or confusing?
• T = Time: If the conditions listed above are present call 9-1-1 immediately! Time is critical!

What Causes CVD?

The 4 conditions listed below, all of which are beyond a person’s control, can be linked to cardiovascular disease:

• Age

There is a strong correlation between CVD and age. As a person ages, the risk for CVD increases also. Although, with males, the risk seems to be when they are younger and females seem to be at higher risk post-menopausal.

• Sex

Males have a higher risk for CVD, especially at younger ages. Women experience higher risk later in their lives. Click on the link below to learn more about The Heart Truth Program, a program focused on raising awareness about women’s risk for heart disease and ways for reducing that risk:

The Heart Truth Program

• Race

African Americans have the highest risk factor for CVD.

• Family History/ Race

A person’s genes can be one of the strongest predictors of CVD, but also has the smallest correlation to to CVD overall.

The 4 conditions listed below are also linked to cardiovascular disease but are within a person’s power to change:

• Tobacco use

The strongest predictor of CVD is the use of tobacco. The use of tobacco accounts for 30% of CVD risk. There is a significant reduction in risk for those who do not use tobacco.

• Obesity

Those that have a BMI greater than 30 have a higher than normal risk than those that do not have a BMI greater than 30. “The “obesity epidemic” experienced by the United States over the past several decades threatens to reverse important progress against heart disease.

• Diet

CVD can be correlated to high intake of saturated fat and cholesterol.

Risk of dietary cholesterol intake can be correlated to atherosclerosis.

• Diabetes

This condition is viewed as seriously as any of the other factors, such as smoking, high blood pressure, and high blood cholesterol, that a person can control. In fact, those with Type II diabetes have the same level of risk for a heart attack as those who have already had a heart attack.

Personal Risk Assessment

What Is Your Number?

The following screening tests are used to a assess a person’s risk for developing CVD

• Lipoprotein Profile

What: A blood test that measures total cholesterol, LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (another form of fat in the blood). The test is given after a 9- to 12-hour fast.

Why: To find out if you have any of the following: high blood cholesterol (high total and LDL cholesterol), low HDL cholesterol, or high triglyceride levels. All affect your risk for heart disease.

When: All healthy adults should have a lipoprotein profile done at least once every 5 years. Depending on the results, your doctor may want to repeat the test more frequently.

• Blood Pressure

What: A simple, painless test using an inflatable arm cuff.

Why: To find out if you have high blood pressure (also called hyper- tension) or prehypertension. Both are risk factors for heart disease. When: At least every 2 years, or more often if you have high blood pressure or prehypertension.

• Fasting Plasma Glucose

What: The preferred test for diagnosing diabetes. After you have fasted overnight, you will be given a blood test the following morning.

Why: To find out if you have diabetes or are likely to develop the disease. Fasting plasma glucose levels of 126 mg/dL or higher in two tests on different days mean that you have diabetes. Levels between 100 and 125 mg/dL mean that you have an increased risk of developing diabetes and may have prediabetes. Diabetes is an important risk factor for heart disease and other medical disorders.

When: At least every 3 years, beginning at age 45. If you have risk factors for diabetes, you should be tested at a younger age and more often.

Online Risk Calculator

If you know your cholesterol levels and your blood pressure, you can use one of the calculators linked below to assess your risk of developing cardiovascular disesase:

American College of Cardiology Risk Calculator

Framingham Heart Study Risk Calculator