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CARDIOVASCULAR DISEASE
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Cardiovascular disease includes all the diseases of the heart and circulation including coronary
heart disease (angina and heart attack), heart failure, congenital heart disease and stroke.
Also known as heart and circulatory disease.
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CARDIOVASCULAR DISEASE
There are also two types of factors that lead to increased risk of having CVD. They are categorised into:
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Changeable/ Modifiable Risk factors:
-Hypertension (high blood pressure). Likely to cause Coronary heart disease as High blood pressure
puts additional force on the artery walls, which can damage the artery walls. The injured arteries are
likely to become hardened as scar tissue forms in the artery, reducing its elasticity.
-Abnormal Blood levels, whereby there is a high level of cholesterol in the blood. High levels of Low
density Lipoproteins (which transport cholesterol from the liver to the blood add to the total level of
cholesterol in the blood). Whereas low levels of high density lipoproteins don't reduce the amount of
cholesterol in the blood when the levels are too high, as they are considered to be a good type of
cholesterol.
-Smoking and Tobacco intake increases risk of CVD as the carbon monoxide produced damages the
endothelium of the arteries, leading to atheromas as white blood cells are attracted to repair damage.
The carbon monoxide also binds with the haemoglobin irreversibly (as Hb has a higher affinity for CO
compared to O2), meaning less oxygen is pumped to respiring cells and tissues. This also forces the
cardiac muscle to respire aerobically (without oxygen) when deprived of oxygen. This leads to Angina
and CHD. The risk is significantly increased for heavy smokers and if the subject started smoking from
a young age, as the heart was deprived of oxygen for a longer period of time, compared to a person
who recently picked up smoking.
-Physical inactivity leads to CVD, as it leads to obesity and high blood pressure (hypertension as
mentioned above). It is said that exercise manages to increase levels of High density lipoproteins
(good cholesterol), and may even reduce levels of Low Density Lipoproteins (bad cholesterol which
increases the total levels of cholesterol in the blood).
-Type 2 Diabetes makes you twice as likely to have CVD than someone who doesn't have type 2
diabetes. This is due to people with type 2 diabetes often having a High blood pressure, Abnormal
cholesterol and triglicerides level (fats) , obesity, poorly controlled blood sugars.
-A diet high in saturated fat is said to increase the risk of heart disease and stroke, however new
research has questioned this; in the BMJ (British medical journal), Dr Aseem Malhotra has stated that
the advice to avoid saturated fats has paradoxically increased the risk of obesity and heart disease
as fats have been replaced with sugars for taste. This has also lead to a rise in cases of Type 2
diabetes. There are two main types of LDLs involved here. The one associated with Saturated fat
intake - Large buoyant (type A) LDL particles is not the LDL linked with Cardio vascular disease. The
second type of cholesterol - smaller, denser (type B) is linked with CVD, and this is not present in
saturated fats.
-Stress is considered to be a contributing risk factor to heart disease although it is not completely
understood. Emotional stress, behaviour habits, socioeconomic status are all said to be main causes
of stress. Researchers have identified many reasons why stress may affect the heart; they raise the
heart rate and blood pressure, and thus the hearts need for oxygen,as well as angina. During stress
hormones are also released by the nervous system as well as the amount of clotting factors being
released in the blood.
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Unchangeable/ Non Modifiable Risk factors:
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-As a person gets older, the risk of CVD doubles each decade after the age of 55, as our hearts
capacity and power decreases. The hearts wall may thicken, arteries may stiffen and harden, reducing
elasticity..
-If there is family history of CVD, the risk is increased due to hereditary factors.
-Males are at greater risk of heart disease, whereas pre menopausal women are protected due to their
sex hormones produced. However, after menopause, their risk increases to become similar to a males
risk.
-Ethnic origin is also a factor as among some racial and ethnic groups people are more at risk of
developing severe high blood pressure (African-Americans), who also have a higher risk of CVD
compared to whites.
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-Anxiety regarding their wellbeing and how diagnosis will affect their lifestyle
-A patient feels guilty for lifestyle choices which they believe has lead to their condition of CHD.
-People with CHD may socially isolate themselves as a result of depression as a possible side effect
from the medication.
-Depression may lead to the patient becoming less motivated and lead less functional roles in life.
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Physical changes that have to be made
-Changes in Diet
-Surgical route:
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Case study: Merseyside
Merseyside is a county in North West England, with a population of 1.38 million. It borders Lancashire (to the
north east), Greater manchester (to the east) and Cheshire (to the south and south west).
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-Merseyside is part of the North West Public Health Observatory (NWPHO), which means it has to
produce a public information report on tackling CHD. It attempts to do this by bringing together local
and national information resources, to enhance links between the environment, lifestyle and health.
-The report will also look into details such as Key socio-economic factors, as well as key behavioural
risk factors for CHD.
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The report focuses on key causes and high risk factors of CHD, such as smoking and then considers and acts
upon methods suggested to reduce levels of smoking. The report mentions: smoking cessation services,
helplines, school programmes, and media campaigns. It then goes into more detail, talking about how each
point should be implemented and developed. For example, to expand upon the cessation services, the report
mentions that there should be primary care advice, as well as specialist clinics and one to one sessions.
The full list of initiatives:
-Initiatives to reduce the prevalence of CHD risk factors in the population (diet, physical activity for all
age ranges including incentives for employees o cycle/ walk to work, and including all age ranges in
this - from children to the elderly being involved in physical activity)
-Key environmental factors (Air pollution, Passive smoking, Water quality, poverty- material ,
employment and job security)
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-Initiatives to reduce Social
Inequalities (behavioural
factors,
material,psychosocial)
-Prevention of CHD
(methods and plans of
action):
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Also included are:
There have also been training and development projects in merseyside, to implement the National service
Framework (NSF) fro Coronary Heart disease.
The project:
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1. A comprehensive, ongoing nurse education programme in CHD treatment and management.
2. Clinical support network groups, both within specialties (ie heart failure management) and
across areas of provision of CHD management (ie nurses from primary, secondary and tertiary care who
manage the same patients at different stages of their treatment).
3. Site visits to other areas to examine the delivery of care for patients with CHD, learn from their
experiences and share information regarding effective initiatives.
4. An annual conference to share the benefits of the project both locally and nationally.
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Informal Care
Breakdown of figures:
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Informal Care: 8.3 billion pounds
Production loss: 8.3 billion pounds
Healthcare: 14.1 billion pounds
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production loss
healthcare
Heart Of Mersey
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-Their upstream population based approach is cost effective and is more effective in reducing CHD levels as it
has a greater impact than medical interventions or individually based approaches.
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-To promote a healthier environment whereby premature death and disability form CVD/CHD
is reduced.