Cardiovascular Disease

Cardiovascular diseases are a group of conditions that affect the heart and blood vessels. They can range from mild to severe and can be managed through lifestyle changes or medication. In India, nearly half of all adults have at least one form of heart disease, making it a widespread health issue. Early detection of CVDs is crucial as it allows for more effective treatment and management of the condition.

Overview

What is cardiovascular disease?

Cardiovascular disease encompasses a range of conditions that impact the heart and blood vessels. These diseases can affect various parts of the cardiovascular system and may present with or without symptoms. Some individuals may experience physical symptoms of cardiovascular disease, while others may not be aware of the condition due to a lack of symptoms.

Cardiovascular disease includes heart or blood vessel issues, including:

• Narrowing of the blood vessels in your heart, other organs or throughout your body.
• Heart and blood vessel problems present at birth.
• Heart valves that aren’t working right.
• Irregular heart rhythms.

How common is cardiovascular Disease?

Cardiovascular disease is very common in India. It is estimated that about 31% of all deaths in India are due to cardiovascular disease, making it the leading cause of death in the country. This is higher than the global average of 17%. Cardiovascular disease is also responsible for a large portion of the burden of disease in India, with an estimated 45% of all disability-adjusted life years lost due to cardiovascular disease. The high prevalence of cardiovascular disease in India is largely due to the high rates of risk factors such as tobacco use, unhealthy diet, physical inactivity, and high blood pressure.

SYMPTOMS AND CAUSES

What causes cardiovascular disease?

Cardiovascular disease refers to a group of conditions that affect the heart and blood vessels. There are several types of cardiovascular disease, each with its own causes. Atherosclerosis, a condition characterized by the build-up of plaque in the arteries, is a leading cause of coronary artery disease and peripheral artery disease. Coronary artery disease can also be caused by scarring of the heart muscle, genetic problems, or the use of certain medications. Arrhythmias, which are abnormal heart rhythms, can be caused by coronary artery disease, scarring of the heart muscle, genetic problems, or the use of certain medications. Valve diseases, which affect the heart valves, can be caused by aging, infections, and rheumatic diseases.

What are cardiovascular disease risk factors?

You may be more likely to develop cardiovascular disease if you have risk factors such as:

• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• Tobacco use (including vaping).
• Type 2 diabetes.
• Family history of heart disease.
• Lack of physical activity.
• Having excess weight or obesity.
• Diet high in sodium, sugar and fat.
• Overuse of alcohol.
• Misuse of prescription or recreational drugs.
• Preeclampsia or toxemia.
• Gestational diabetes.
• Chronic inflammatory or autoimmune conditions.
• Chronic kidney disease.

What are the symptoms of cardiovascular disease?

Symptoms of cardiovascular disease can include:

1. Chest pain or discomfort: This can be a feeling of pressure, tightness, or pain in the chest that can radiate to the arms, jaw, neck, or back.
2. Shortness of breath: This can be a feeling of difficulty breathing, or a feeling of not being able to get enough air.
3. Fatigue: This can be a feeling of extreme tiredness or lack of energy, even after rest or sleep.
4. Swelling: This can be swelling in the feet, ankles, or legs, which may be caused by fluid accumulation.
5. Heart palpitations: This can be a feeling of rapid or irregular heartbeats, or a sensation of the heart "skipping a beat."
6. Dizziness or fainting: This can be a feeling of lightheadedness or dizziness, or a feeling of weakness or loss of consciousness.
7. Cold sweat: This can be a feeling of cold, clammy sweat on the skin, often accompanied by chills or fever.
8. Cough: This can be a persistent or persistent cough that may produce phlegm or blood.
9. Numbness or tingling: This can be a feeling of numbness or tingling in the arms, hands, legs, or feet.
10. Abnormal skin color: This can be a bluish tinge to the skin, especially in the lips or fingertips, which may be caused by a lack of oxygen in the blood.

What conditions are cardiovascular diseases?

There are many different types of cardiovascular diseases, including but not limited to:

1. Arrhythmia: Problem with your heart’s electrical conduction system, which can lead to abnormal heart rhythms or heart rates.
2. Valve disease: Tightening or leaking in your heart valves (structures that allow blood to flow from one chamber to another chamber or blood vessel).
3. Coronary artery disease: Problem with your heart’s blood vessels, such as blockages.
4. Heart failure: Problem with heart pumping/relaxing functions, leading to fluid buildup and shortness of breath.
5. Peripheral artery disease: Issue with the blood vessels of your arms, legs or abdominal organs, such as narrowing or blockages.
6. Aortic disease: Problem with the large blood vessel that directs blood from your heart to your brain and the rest of your body, such as dilatation or aneurysm.
7. Congenital heart disease: Heart issue that you’re born with, which can affect different parts of your heart.
8. Pericardial disease: Problem with the lining of your heart, including pericarditis and pericardial effusion.
9. Cerebrovascular disease: Issue with the blood vessels that deliver blood to your brain, such as narrowing or blockages.
10. Deep vein thrombosis (DVT): Blockage in your veins, vessels that bring blood back from your brain/body to your heart.

DIAGNOSIS AND TESTS

How is cardiovascular disease diagnosed?

During the appointment, the healthcare provider will thoroughly examine the patient's body, asking specific questions about any current symptoms and obtaining a detailed history of the patient's personal and family health. To assist in the diagnosis of cardiovascular disease, the provider may also request various diagnostic tests to be conducted.

What tests might I have for cardiovascular disease?

There are several tests that may be used to diagnose and monitor cardiovascular disease:

1. Blood pressure test: This measures the force of blood against the walls of the arteries as it is pumped through the body. High blood pressure is a risk factor for cardiovascular disease.
2. Cholesterol test: This measures the levels of cholesterol in the blood, including LDL (bad cholesterol) and HDL (good cholesterol). High levels of LDL increase the risk of cardiovascular disease.
3. ECG (electrocardiogram): This test measures the electrical activity of the heart and can detect abnormalities such as arrhythmias or heart attacks.
4. Echocardiogram: This test uses sound waves to create a detailed image of the heart, allowing doctors to evaluate the heart's structure and function.
5. Cardiac catheterization: This procedure involves inserting a thin tube into a blood vessel in the arm or leg and threading it to the heart. It can be used to evaluate the health of the coronary arteries and diagnose blockages or other problems.
6. Cardiac CT (computed tomography) scan: This test uses X-rays and a computer to create detailed images of the heart and blood vessels. It can be used to identify blockages or other abnormalities.
7. Cardiac MRI (magnetic resonance imaging): This test uses a powerful magnet and radio waves to create detailed images of the heart and blood vessels. It can be used to identify problems such as blockages or damage to the heart muscle.

MANAGEMENT AND TREATMENT

How is cardiovascular disease treated?

Treatment plans can vary depending on your symptoms and the type of cardiovascular disease you have. Cardiovascular disease treatment may include:

1. Lifestyle changes: Examples include changing your diet, increasing your aerobic activity and quitting smoking or tobacco products (including vaping).
2. Medications: Your healthcare provider may prescribe medications to help manage cardiovascular disease. Medication type will depend on what kind of cardiovascular disease you have.
3. Procedures or surgeries: If medications aren’t enough, your healthcare provider may use certain procedures or surgeries to treat your cardiovascular disease. Examples include stents in your heart or leg arteries, minimally invasive heart surgery, open-heart surgery, ablations or cardioversion.
4. Cardiac rehabilitation: You may need a monitored exercise program to help your heart get stronger.
5. Active surveillance: You may need careful monitoring over time without medications or procedures/surgeries.

PREVENTION

How can I prevent cardiovascular disease?

You can't prevent some types of cardiovascular disease, such as congenital heart disease. But lifestyle changes can reduce your risk of many types of cardiovascular disease.

There are several things you can do to reduce your risk of developing cardiovascular disease:

1. Eat a healthy diet: Choose foods that are high in nutrients and low in unhealthy fats, salt, and added sugars.
2. Exercise regularly: Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week.
3. Don't smoke: If you smoke, quitting is one of the best things you can do for your heart health.
4. Maintain a healthy weight: Being overweight or obese can increase your risk of cardiovascular disease.
5. Get enough sleep: Aim for 7-9 hours of sleep per night.
6. Manage stress: Chronic stress can contribute to the development of cardiovascular disease.
7. Get your blood pressure and cholesterol checked regularly: High blood pressure and high cholesterol are both risk factors for cardiovascular disease.
8. Drink alcohol in moderation: If you drink alcohol, do so in moderation. For most adults, this means up to one drink per day for women and up to two drinks per day for men.

By making these lifestyle changes, you can significantly reduce your risk of developing cardiovascular disease.

OUTLOOK / PROGNOSIS

What is the outlook for people with cardiovascular disease?

The outlook for people with cardiovascular disease varies depending on the severity of their condition, the type of treatment they receive, and their overall health. Some people may be able to manage their condition through lifestyle changes, such as diet and exercise, and may not experience any major health complications. Others may need more intensive treatment, such as medications or surgery, and may experience more severe symptoms or complications. In general, the outlook for people with cardiovascular disease is good if they receive timely and appropriate treatment, and if they make healthy lifestyle choices. However, it is important for people with cardiovascular disease to work closely with their healthcare team to manage their condition and prevent further complications.

Does cardiovascular disease increase my risk of other conditions?

Yes, cardiovascular disease can increase your risk of other conditions such as:

1.  stroke, 
2. hypertension, 
3. diabetes, 
4.  kidney disease. 

It can also increase your risk of developing cognitive decline and dementia. It is important to manage and treat cardiovascular disease to reduce the risk of developing these additional health problems.

When should I see my healthcare provider?

Cardiovascular disease is often easier to treat when healthcare providers catch it early. That’s why it’s important to see a primary care provider every year. They can detect cardiovascular issues before symptoms start. If you have any signs of cardiovascular disease, you should see your provider immediately.

Call your doctor or seek emergency medical attention if you experience sudden:

1. Chest pain, pressure, heaviness or discomfort, especially with exertion.
2. Fainting (syncope).
3. Severe shortness of breath, especially if it’s new or progressive.
4. Pain or numbness in your arms/legs.
5. Ripping or tearing back pain.

References 

• World Health Organization. Cardiovascular diseases (CVDs). 
• Cho L, Davis M, Elgendy I, et al. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women
• Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
• Centers for Disease Control and Prevention. Multiple pages reviewed.
• Wikipedia cardiovascular diseases.