Cardiovascular diseases (CVDs) are disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions. Four out of five CVD deaths are due to heart attacks and strokes. Individuals at risk of CVD may demonstrate raised blood pressure, glucose, and lipids as well as overweight and obesity. These can all be easily measured in primary care facilities. Identifying those at highest risk of CVDs and ensuring they receive appropriate treatment can prevent premature deaths. Access to essential non-communicable disease NCD medicines and basic health technologies in all primary health care facilities is essential to ensure that those in need receive treatment and counselling.
Cardiovascular diseases (CVDs) take the lives of 17.7 million people every year, 31% of all global deaths. Triggering these diseases – which manifest primarily as heart attacks and strokes – are tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. These in turn show up in people as raised blood pressure, elevated blood glucose and overweight and obesity, risks detrimental to good heart health.
Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis. Coronary artery disease (CAD) is the most common type of heart disease in the United States. For some people, the first sign of CAD is a heart attack.
Too much plaque buildup and narrowed artery walls can make it harder for blood to flow through the body. Angina is the most common symptom of CAD. Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, also can develop.
A heart attack occurs when a part of the heart muscle is damaged or dies because blood flow is reduced or completely blocked. A heart attack, also called a myocardial infarction, occurs when a part of the heart muscle doesn’t receive enough blood flow. The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle.
One of 5 heart attacks is silent—the damage is done, but the person is not aware of it. Coronary artery disease (CAD) is the main cause of heart attack. A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle.
Raised blood pressure is the leading global risk factor for cardiovascular diseases and chronic kidney disease. One of the global targets adopted by the World Health Assembly (WHO) in 2013 is to lower the prevalence of raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, by 25% compared with its 2010 level by 2025. According to new research the number of people in the world with high blood pressure reached 1.13 billion, nearly doubling since 1975.
Blood pressure is a leading risk factor for cardiovascular diseases such as heart attacks and strokes, and it is treatable. Health systems in less wealthy countries must adapt to diagnose and control blood pressure so that adults may live longer and healthier lives. High blood pressure is also called hypertension.
Risk Factors for High Blood Pressure
Having certain medical conditions can increase the chances of developing high blood pressure. These conditions include re-hypertension and diabetes.
Unhealthy behaviors can also increase the risk for high blood pressure, especially for people who have one of the medical conditions listed above. Unhealthy behaviors include:
• Smoking tobacco.
• Eating foods high in sodium and low in potassium.
• Not getting enough physical activity.
• Being obese.
• Drinking too much alcohol.
The chart below shows normal, at-risk, and high blood pressure levels. A blood pressure less than 120/80 mmHg is normal. A blood pressure of 140/90 mmHg or more is too high. People with levels from 120/80 mmHg to 139/89 mmHg have a condition called prehypertension, which means they are at high risk for high blood pressure.
Blood Pressure Levels
systolic: less than 120 mmHg
At risk (prehypertension)
systolic: 120–139 mmHg
systolic: 140 mmHg or higher
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (CVD) and stroke. Cardiovascular disease is the leading cause of death among adults with diabetes mellitus.
Current recommendations for managing several CVD risk factors refer to nutrition, obesity, blood glucose, blood pressure, and cholesterol in type 2 DM. Screening for glycated hemoglobin A1c (A1c) can be used to identify individuals with DM when A1c is greater than or equal to 6.5% or as prediabetic with A1c in the range of 5.7% to 6.4%. People with prediabetes are at greater risk of developing DM. In patients with DM, targeting A1c levels below 7.0% may help reduce incidence of microvascular disease and more or less stringent A1c targets may be appropriate for selected patients.
Increased blood pressure is a major contributor to higher risk of CVD events in diabetes mellitus. A vast majority (70%–80%) of patients with type 2 diabetes mellitus have hypertension. The presence of hypertension in patients with type 2 diabetes mellitus increases the risk of MI, stroke, and all-cause mortality. Currently, most individuals with diabetes mellitus are recommended to achieve a blood pressure goal of <140/90 mm Hg.
In adult patients with diabetes mellitus, lipid levels should be measured at least annually for compliance with recommended treatment. The lifestyle modifications listed above for managing CVD risk in patients with DM, especially weight reduction, have been shown to improve most components of the lipid profile in patients with diabetes mellitus. Current guidelines suggest that most patients with type 2 diabetes mellitus should be on a statin.
Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in meters). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.
Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer.
Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.
• Help prevent harmful clots from forming in the blood vessels.
• Often prescribed to prevent first or recurrent stroke.
Antiplatelet Agents and Dual Antiplatelet Therapy (DAPT)
• Help prevent clotting in patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks, or “little strokes”) and other forms of cardiovascular disease.
• Usually prescribed preventively when plaque buildup is evident but there is not yet a major obstruction in the artery.
• Certain patients will be prescribed aspirin combined with another antiplatelet drug – also known as dual antiplatelet therapy (DAPT).
Angiotensin-Converting Enzyme (ACE) Inhibitors
• Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure.
Angiotensin II Receptor Blockers (or Inhibitors)
• Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure.
Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)
• Used for the treatment of heart failure
• Used to lower blood pressure.
• Used with therapy for cardiac arrhythmias (abnormal heart rhythms) and in treating chest pain (angina).
• Used to prevent future heart attacks in patients who have had a heart attack.
Combined alpha and beta-blockers
• Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
Calcium Channel Blockers
• Used to treat high blood pressure, chest pain (angina) caused by reduced blood supply to the heart muscle and some arrhythmias (abnormal heart rhythms).
• Used to lower LDL cholesterol.
• Used to help lower blood pressure.
• Used to help reduce swelling (edema) from excess buildup of fluid in the body.
• Used to ease chest pain (angina).
Eat a healthy diet: A balanced diet is crucial to a healthy heart and circulatory system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses with restricted salt, sugar and fat intake. Alcohol should also be used in moderation.
Take regular physical activity: At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days of the week helps to maintain healthy weight.
Avoid tobacco use: Tobacco in every form is very harmful to health – cigarettes, cigars, pipes, or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after 1 year.
Check and control overall cardiovascular risk: An important aspect of preventing heart attacks and strokes is by providing treatment and counselling to individuals at high risk (those with a 10-year cardiovascular risk equal to or above 30%) and reducing their cardiovascular risk.
- World Health Organization (WHO). Cardiovascular Diseases (CVDs). Available at: http://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
- World Health Organization (WHO): World Heart Day 2017. Available at: http://www.who.int/cardiovascular_diseases/world-heart-day-2017/en/
- What can I do to avoid a heart attack or a stroke? Available at: http://www.who.int/features/qa/27/en/
- NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015, a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet 2017; 389: 37–55
- World Health Organization (WHO). Cardiovascular Disease. Available at: http://www.who.int/cardiovascular_diseases/publications/high-blood-pressure/en/
- Center for Disease Control (CDC). Coronary Artery Disease (CAD). Available at: https://www.cdc.gov/heartdisease/coronary_ad.htm
- Center for Disease Control (CDC). Heart attack. Available at: https://www.cdc.gov/heartdisease/heart_attack.htm
- Center for Disease Control (CDC). High Blood Pressure Fact Sheet. Available at: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm
- World Health Organization (WHO). Obesity. Available at: http://www.who.int/topics/obesity/en/
- World Health Organization (WHO). Obesity Fact Sheet. Available at: http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
- World Health Organization (WHO). Global Strategy on Diet, Physical Activity and Health. Available at: http://www.who.int/dietphysicalactivity/diet/en/
- Center for Disease Control (CDC). Preventing Heart Disease: Healthy Living Habits. Available at: https://www.cdc.gov/heartdisease/healthy_living.htm
- American Heart Association and American Stroke Association. Top Ten Things to Know Update on Prevention of Cardiovascular Disease in Adults with Type 2 Diabetes in Light of Recent Evidence.
- American Heart Association. Cardiac Medications. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/TreatmentofaHeartAttack/Cardiac-Medications_UCM_303937_Article.jsp#.WwaXh4q-lhi