Dr Arvind Kohli
World Hypertension Day is observed every May 17th in order to raise awareness and promote hypertension prevention, detection and control . High blood pressure is the main risk factor to develop cardiovascular disease(CVD). The World Hypertension League has declared “Measure Your Blood Pressure Accurately, Control It, Live Longer” as the World Hypertension Day theme for . Its purpose is to communicate to the public the importance of hypertension and its serious medical complications, and to provide information on its prevention, detection, and management. It is also aimed at reducing physicians’ inertia in this context, to improve hypertension control rates.
Heart, stroke and vascular disease-also known as cardiovascular disease or CVD-is a broad term that describe the many different diseases and conditions that affect the heart and blood vessels of brain and vital organs of body Cardiovascular diseases (CVDs) are the leading cause of death globally.An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack , stroke and Pulmonary embolism
What are cardiovascular diseases?
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include:
* Coronary heart disease – a disease of the blood vessels (Coronary arteries) supplying the heart muscle;
* Cerebrovascular disease – a disease of the blood vessels(Carotid Arteries) supplying the brain;
* Peripheral arterial disease – a 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 – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth; and
* 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. Whereas lifethreatening vascular events are embolisation of clots to vital organs ,Aneurysms of major arteries which can rupture, Acute dissections in major artery in which the inner lining of artery is separated leading to disruption of flow causing malperfusion syndrome to the dependent organs or limbs
Risk factors for cardiovascular disease?
The most important behavioural risk factors of heart disease stroke and peripheral vascular diseases are unhealthy diet called atherogenic diet full of saturated fatty acids, physical inactivity, tobacco use both smoking and passive smoking and harmful use of alcohol. Biomedical risk factors are bodily states that have an impact on a person’s risk of disease. Some biomedical risk factors can be influenced by health behaviours. Others, such as type 1 diabetes, occur independently of behaviours. Biomedical risk factors for CVD include:high blood pressure (also known as hypertension) abnormal blood lipids, including raised cholesterol diabetes overweight and obesity.
There are also a number of underlying determinants of CVDs. 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
For most risk factors there is no known threshold at which risk begins. The relationship between risk and disease is continuous – there is an increasing effect as exposure to the risk factor increases. Having multiple risk factors further escalates risk. However Modifying these risk factors can reduce an individual’s risk of developing CVD prematurely and result in large health gains by reducing illness and rates of death.
Tobacco use, Smoking increases the risk of coronary heart disease by raising blood pressure, decreasing physical activity tolerance and lowering blood levels of HDL (‘good’) cholesterol. As tobacco smoke is absorbed into the bloodstream, it damages blood vessels, increases the risk of plaques and clots, and reduces blood oxygen levels.
Giving up smoking is associated with greatly improved cardiovascular function, improved quality of life and reduced risk of cardiovascular morbidity and mortality.
Hypertension Raised blood pressure (BP) is the biggest single contributing risk factor to altered global health ( WHO 2023), being one of the world’s leading risk factors for death and disability. The number of people living with hypertension doubled between 1990 and 2019, from 650 million to 1.3 billion, with the global age-standardised prevalence of hypertension in adults being 32% in women and 34% in men in 2019. This common, deadly condition is an important public health problem that leads to stroke, heart attack, heart failure, kidney damage and many other health problems. In particular, high systolic blood pressure was the single most important risk factor for early death worldwide, leading to an estimated 10.8 million avoidable deaths every year, and a burden of 235 million years of life lost or lived with a disability annually. High BP has enormous economic costs for patients and their families, health systems and national economies. .
The World Health Organization defines high blood pressure as any of the following:
Systolic blood pressure of 140 mmHg or more, or diastolic blood pressure of 90mmHg or more, or receiving medication for high blood pressure .
The risk of stroke, coronary heart disease, heart failure, peripheral arterial disease and many other forms of CVD is directly related to high levels of blood pressure.
Diabetes
Diabetes is a chronic condition marked by high levels of glucose in the blood. It is caused by the inability of the body to produce or effectively use insulin, a hormone made by the pancreas to control blood glucose levels.
Type 2 diabetes is the most common form. It involves a genetic component, but is largely preventable, and can be managed with changes to diet and physical activity, and with medications.
Diabetes is an independent risk factor for developing many forms of heart disease Over time, high blood sugar levels from diabetes can damage blood vessels in the heart, making them more likely to develop fatty deposits. Diabetes and elevated blood glucose are associated with an approximate doubling of the risk of cardiovascular disease (IDF 2019).
Diabetes and cardiovascular disease (CVD) also share risk factors. Many of the complications from having diabetes come from damage to blood vessels as a result of high blood pressure, abnormal blood lipids, and smoking.
Abnormal blood lipids
Abnormal levels of blood lipids, such as cholesterol and triglycerides – known as dyslipidaemia – can contribute to the development of atherosclerosis, a build-up of fatty deposits in the blood vessels. This build-up increases the risk of a number of cardiovascular diseases, including coronary heart disease, stroke and peripheral arterial disease.
Blood tests are used to determine levels of the most commonly measured lipids. The standard blood tests include measurement of total cholesterol, low-density lipoprotein cholesterol (LDL, or ‘bad’ cholesterol), high-density lipoprotein cholesterol (HDL, or ‘good’ cholesterol), as well as triglycerides
For most people, saturated fat in the diet is the most important factor associated with dyslipidaemia. Sufficient physical activity and a healthy diet help maintain normal blood cholesterol levels. People with dyslipidaemia may also be treated with lipid-modifying medicines such as statins.
Overweight and obesity increase the risk of chronic diseases including heart attack and stroke, and are associated with increased morbidity and mortality. Excess body fat can contribute to the development of biomedical risk factors, raising levels of blood pressure and abnormal blood lipids, and increasing the risk of type 2 diabetes.
Overweight and obesity usually occur because of an imbalance between energy intake from the diet and energy expenditure through physical activities and bodily functions. Adults with a body mass index (BMI) (kg/m2) of 25-29 are considered to be overweight but not obese, while a BMI of 30 or over is classified as obese.
Absolute cardiovascular risk
Absolute risk is a term used to define the probability of a person developing a disease within a specified time period. Absolute cardiovascular risk is the chance of an individual developing cardiovascular disease (CVD), which includes all heart, stroke and blood vessel diseases .An absolute risk approach to disease uses data for multiple risk factors. Assessing CVD risk based on the combined effect of risk factors is more accurate than looking at risk factors in isolation – because of the cumulative or influencing effects of multiple factors – and allows for more tailored risk factor management for each person Reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease.
How can the burden of cardiovascular diseases be reduced?
The key to cardiovascular disease reduction lies in the inclusion of cardiovascular disease management interventions in national health coverage packages, . Patients with cardiovascular disease should have access to appropriate technology and medication. Basic medicines that should be available include:aspirin;beta-blockers; angiotensin-converting enzyme inhibitors; statins. and Injectable heparin An acute event such as a heart attack or stroke should be promptly managed.
Sometimes, surgical operations are required to treat CVDs. They include:coronary artery bypass; balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage);Heartvalve repair and replacement; heart transplantation; artificial heart operations.use of prosthetic grafts for peripheral arterial diseases Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, patches for closing holes in the heart .devices for fixing aortic aneurysms and dissections and peripheral stents for occlusive vessel diseases
Living with Cardiovascular diseases
With Cardiovascular disease, the best thing one can do is stay vigilant. Don’t skip any medical checkups or medicine doses. Because some vascular issues run in families, sharing health information with the family can help them prevent and be on the lookout for cardio vascular disease.. In addition to the things mentioned above, one should keep taking medicines the healthcare provider prescribes and keep going for regular checkups. The alarming signs for Acute events like Confusion or dizziness. Slurred speech.A droop on one side of your face.Severe chest pain.Severe abdominal pain.Loss of vision.Weakness or severe pain in an arm or leg should be taken seriously and immediate emergency room treatment should be managed there are many lifestyle changes that can be done in order to alleviate the prognosis. By ensuring proper lifestyle changes such as healthier diet, daily exercise, smoking cessation, and regular physician checkups, patients are able to better alleviate the symptoms associated with cardiovascular disease.
(The author is CTV Surgeon)
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