Cardiovascular diseases (CVDs) - meaning, risk factors and clinical features

Cardiovascular diseases (CVDs) are the leading cause of death and disease burden in many countries across the world. The number of people living with cardiovascular disease is increasing due to factors like population ageing and improved treatments that have resulted in people living longer with CVD.

What are Cardiovascular diseases
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include:

coronary heart disease – disease of the blood vessels supplying the heart muscle;
cerebrovascular disease – disease of the blood vessels supplying the brain;
peripheral arterial disease – disease of blood vessels supplying the arms and legs;
rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
congenital heart disease – malformations of heart structure existing at birth;
deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots. The cause of heart attacks and strokes are usually the presence of a combination of risk factors, such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol, hypertension, diabetes and hyperlipidaemia.

What are the risk factors for cardiovascular disease?
The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of developing a heart attack, stroke, heart failure and other complications.

Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. In addition, drug treatment of diabetes, hypertension and high blood lipids may be necessary to reduce cardiovascular risk and prevent heart attacks and strokes. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behaviour.

There are also a number of underlying determinants of CVDs or "the causes of the causes". These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.

What are common symptoms of cardiovascular diseases?
Symptoms of heart attacks and strokes
Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease. Symptoms of a heart attack include:

pain or discomfort in the centre of the chest;
pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.

In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale. Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.

The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of:

numbness of the face, arm, or leg, especially on one side of the body;
confusion, difficulty speaking or understanding speech;
difficulty seeing with one or both eyes;
difficulty walking, dizziness, loss of balance or coordination;
severe headache with no known cause; and
fainting or unconsciousness.

People experiencing these symptoms should seek medical care immediately.

What is rheumatic heart disease?
Rheumatic heart disease is caused by damage to the heart valves and heart muscle from the inflammation and scarring caused by rheumatic fever. Rheumatic fever is caused by an abnormal response of the body to infection with streptococcal bacteria, which usually begins as a sore throat or tonsillitis in children.

Rheumatic fever mostly affects children in developing countries, especially where poverty is widespread. Globally, about 2% of deaths from cardiovascular diseases is related to rheumatic heart disease.

Symptoms of rheumatic heart disease
Symptoms of rheumatic heart disease include:

shortness of breath,
fatigue,
irregular heart beats,
chest pain and
fainting.

Symptoms of rheumatic fever include:

fever,
pain and swelling of the joints,
nausea, stomach cramps and vomiting.

Why are cardiovascular diseases a development issue in low- and middle-income countries?

At least three quarters of the world's deaths from CVDs occur in low- and middle-income countries.
People in low- and middle-income countries often do not have the benefit of integrated primary health care programmes for early detection and treatment of people with risk factors compared to people in high-income countries.
People in low- and middle-income countries who suffer from CVDs and other noncommunicable diseases have less access to effective and equitable health care services which respond to their needs. As a result, many people in low- and middle-income countries are detected late in the course of the disease and die younger from CVDs and other noncommunicable diseases, often in their most productive years.
The poorest people in low- and middle-income countries are affected most. At the household level, sufficient evidence is emerging to prove that CVDs and other noncommunicable diseases contribute to poverty due to catastrophic health spending and high out-of-pocket expenditure.
At macro-economic level, CVDs place a heavy burden on the economies of low- and middle-income countries.

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Reference(s)
1). World Health Organization: Cardiovascular diseases (CVDs) - WHO Fact Sheets. Accessed 20.10.17. Available here: http://who.int/mediacentre/factsheets/fs317/en/
2). NHS Choices: Cardiovascular disease. Accessed 22.10.17. Available here: https://www.nhs.uk/conditions/Cardiovascular-disease/Pages/Introduction.aspx
3). Australian Government Department of Health: Cardiovascular disease. Accessed 22.10.17. Available here: https://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio