What is cardiovascular disease? How you can protect your heart health.

What is cardiovascular disease?

Cardiovascular disease is an umbrella term that refers to diseases affecting the heart and blood vessels. Combined, these diseases account for around a quarter of all deaths in the UK. There are several different causes of cardiovascular disease. These range from high blood pressure, smoking, high cholesterol levels, diabetes mellitus, genetic factors and lifestyle choices.

There are seven key types of cardiovascular disease:

1. Coronary artery disease, where blood flow to the heart muscle is disrupted, leading to chest pain, heart attacks and heart failure.
2. Heart muscle disease, where the contraction or relaxation of the heart muscle is impaired, causing shortness of breath and fluid congestion.
3. Heart rhythm disorders (arrhythmias), where the electrical signals controlling heart rhythms are altered resulting in slow or fast heart rhythm abnormalities. These can cause palpitations, breathlessness, dizziness or blackouts.
4. Heart valve disease, where one or more of the heart valves leak or become narrowed, impairing the movement of blood through the heart itself. This can result in symptoms of breathlessness, chest pain, dizziness or blackouts.
5. Stroke and transient ischaemic attacks (TIAs, also called “mini strokes”), where arteries to the brain are compromised.
6. Peripheral vascular disease, caused by narrowings in arteries going to the limbs.
7. Aortic disease, where the largest blood vessel in the body becomes stretched and its walls weakened.

What is coronary artery disease?

Coronary artery disease, sometimes called coronary heart disease or ischaemic heart disease, is the leading cause of heart attacks in the UK. It’s caused by the coronary arteries becoming clogged with fibrous, fatty or calcified deposits called plaques. As these plaques build up, they reduce blood flow to the heart and prevent it from getting enough blood to function properly.

When a piece of the plaque breaks off, a blood clot forms around it to repair the damage to the artery. This clot can completely block blood flow to the heart, causing a heart attack. Before a heart attack, some people experience symptoms of coronary heart disease like chest pain and breathlessness. But for others, the condition goes unnoticed until they have a heart attack - it’s why coronary heart disease is often referred to as a silent killer.

What causes cardiovascular disease?

A number of different factors contribute to cardiovascular disease. A contributor to cardiovascular disease is high blood pressure. Ideally, your blood pressure should be between 90/60mmHg and 130/80mmHg. Anything above this range is considered to be elevated. Consistently high blood pressure causes our arteries to lose their stretchiness and become stiff or narrow. These arteries are more likely to be clogged by fatty material, increasing your risk of a heart attack.

Type 1 and 2 diabetes are other cardiovascular disease risk factors. Diabetes leads to an increase in your blood sugar as your cells don’t absorb glucose from the blood. High levels of blood glucose can damage the walls of your arteries and make them more likely to develop plaques that can break off and cause a heart attack.

Smoking is another factor that can increase your risk of cardiovascular disease. Chemicals in cigarettes can make the walls of your arteries sticky, making it more likely for fatty material to stick to them and form plaques.

One of the main causes of cardiovascular disease is high cholesterol. Cholesterol is a fatty substance produced by your liver and released into your blood to be transported by proteins to cells to be used in their normal functions.

Cholesterol is insoluble in the blood stream but is made soluble by the formation of a molecule called a lipoprotein. There are a variety of different lipoproteins in the blood stream. The two most common are known as high-density lipoproteins (HDL cholesterol, or “good” cholesterol) and low-density lipoproteins (LDL cholesterol, or “bad” cholesterol). HDL takes cholesterol that isn’t needed by the body back to the liver and out of the blood to be broken down and passed out of your body. LDL transports cholesterol from the liver around the body in the blood, and persistently high levels can encourage fats to be taken up by blood vessel walls, resulting in them narrowing. Total cholesterol represents the sum of all the lipoproteins in the blood stream.

High cholesterol levels don’t usually produce any symptoms but can be diagnosed with a cholesterol test.

What causes high cholesterol?

Some causes of high cholesterol are linked to age, sex and genetics. As you get older, your cholesterol levels can increase, and being born male increases your risk of high cholesterol. Menopause also causes an increase in cholesterol levels.

People with a South Asian or sub-Saharan African family background may have a higher risk of high cholesterol. Other causes of high cholesterol are genetic and passed down through families like familial hypercholesterolaemia.

Lifestyle factors are also a significant contributor to high cholesterols levels, with diet playing an important role. Foods high in saturated fat, like fatty or processed meats and full-fat dairy products or foods containing them, raise the amount of “bad” LDL cholesterol in your blood.

Drinking too much alcohol can also raise your total cholesterol levels, increasing the risk of plaque formation. Smoking is another contributor to high cholesterol as it both lowers your levels of “good” LDL cholesterol and raises your levels of “bad” HDL cholesterol. 

Alongside diet, low levels of physical activity are linked to increased cholesterol levels. Combined with a poor diet, this can lead to obesity, which is also linked to high cholesterol levels.

How can I prevent cardiovascular disease?

There are a number of simple lifestyle changes you can make to improve your heart health and prevent cardiovascular disease. With the impact it has on both your cholesterol levels and blood pressure, a healthy diet can make a big difference. One of the best diets you can follow for your heart health is the Mediterranean diet. 

This diet emphasises plant-based foods and healthy fats, while limiting the amount of red meat, fatty dairy products, sweets and processed foods. It mostly consists of fresh fruit and vegetables, pulses, beans, whole grains, oily fish like mackerel and salmon, and extra virgin olive oil as a source of healthy fat. This diet has been linked to a reduced risk of cardiovascular disease and supports healthy blood sugar levels, blood pressure and cholesterol.

In general, it’s best to try and limit your consumption of saturated fats. Animal products are high in saturated fat and cholesterol, so think about switching to a predominantly plant-based diet a few days a week. Try to eat less processed meats, fatty dairy products, and cakes and sweets.

Also try to keep your carbohydrate intake relatively low, which can really help with weight loss. A high salt intake increases your blood pressure, so avoid salty foods and adding extra salt to your meals.

Getting active is another simple step to improve your heart health. The heart, like every other muscle in the body, works better with regular exercise. Alongside this, exercise helps you lose weight and lowers your cholesterol. Aim for around two and a half hours of moderate exercise or 75 minutes of intense exercise each week. Swimming and cycling are great low-impact exercises to try, but even a brisk walk will help. Where possible resistance training and high intensity interval training can provide additional health benefits and encouraged. 

Alongside being active, rest is also important to keep your heart healthy. Aim to get between seven and nine hours of sleep each night, and try to keep a consistent bedtime throughout the week.
Our modern lives can be very stressful, but stress is closely linked to our heart health. Stressful jobs can impact our heart health, and many of us are unaware of the strain we’re putting our hearts under because of this. Try managing your stress by checking in on yourself daily. Take a moment each day to stop, reflect and think about your stress levels. Think about practicing mindfulness or speaking to an expert if you’re worried about your stress levels.

Finally, cutting down on or stopping bad habits can help prevent cardiovascular disease. Stopping smoking helps lower your cholesterol, as well as reducing your risk of heart attacks, stroke and cancer. Avoid drinking more than 14 units of alcohol a week and make sure you have several drink-free days each week.

What treatments are there for high cholesterol?

The best way to lower your cholesterol is to make healthy lifestyle changes — eating healthily, limiting the amount of saturated fat you eat, exercising regularly, maintaining a healthy weight and stopping smoking.

However, if you’ve tried these and your cholesterol levels are still high, there are treatments available for high cholesterol. Statins are the most commonly prescribed medication for high cholesterol.

These work by blocking a substance that your liver uses to make cholesterol. By doing this, the liver makes less cholesterol and removes more cholesterol from the blood. 

If you’re unable to take statins, or they don’t work for you, you might be prescribed different medications by a specialist, such as ezetimibe. This lowers the amount of cholesterol your body absorbs from food and leads to a reduction in your blood cholesterol within a few weeks. There are also injections available to reduce your cholesterol, including PCSK9 inhibitors and inclisiran. However, these are generally prescribed to people who’ve had a heart attack or stroke and for whom statins haven’t worked, or those at high risk due to genetic factors.