Dr. M Chabok
Consultant Cardiologist (Intervention)
- Phone: +44 1895 283508
- secretary@drchabokcardiologist.co.uk
CVD
“ An estimated 2.8 million men and 2.8 million women in the UK are living with CVD. The British Heart Foundation estimates that around 111,000 people have a stroke for the first time every year.”
Lifestyle targets
1. Do not smoke
2. Maintain ideal body weight for adults (body
mass index 20– 25 kg/m2) and avoid central
obesity (waist circumference in white
Caucasians 102 cm in men and 88 cm in
women, and in Asians 90 cm in men and 80 cm
in women)
3. Keep total dietary intake of fat to 30% of
total energy intake
4. Keep the intake of saturated fats to 10% of
total fat intake
5. Keep the intake of dietary cholesterol to 300
mg/ day
6. Replace saturated fats by an increased intake
of monounsaturated fats
7. Increase the intake of fresh fruit and
vegetables to at least five portions per day
8. Regular intake of fish and other sources of
omega 3 fatty acids (at least two servings of fish
per week)
9. Limit alcohol intake to 21 units per week for
men or 14 units per week for women
10. Limit the intake of salt
11. Regular aerobic physical activity of at least
30 mins per day, most days of the week, should
be taken (for example, fast walking/swimming)
Source Joint British Societies’ Guidelines
CVD is a major public health problem. CVD
prevention can help keep people’s hearts healthy
and prevent strokes. The best way to prevent
cardiovascular disease is for people to eat better
and be more active.
CVD includes coronary heart disease (CHD),
stroke and peripheral arterial disease. These
conditions are frequently brought about by the
development of blockages in the arteries. They are
also linked to conditions such as heart failure,
chronic kidney disease and dementia.
Cardiovascular disease (CVD) is generally due to
reduced blood flow to the heart, brain or body. It is
increasingly common after the age of 60, but rare
below the age of 30.
Some countries have much more cardiovascular
disease than others and, unfortunately, the UK sits
at the top of the table – just like the average
cholesterol levels.
In England in 2007, CVD led to nearly 159,000
deaths (accounting for nearly 34% of all deaths in
England). Most premature deaths from CVD – that
is, among people aged less than 75 – are
preventable.
An estimated 2.8 million men and 2.8 million
women in the UK are living with CVD. The
British Heart Foundation estimates that around
111,000 people have a stroke for the first time
every year.
Despite recent improvements, death rates in the
UK from CVD are relatively high compared with
other developed countries (only Ireland and
Finland have higher rates).
Stop smoking, eat healthier foods, increase aerobic
physical activity, and achieve optimal weight and
weight distribution are central to CVD prevention.
Modifiable Risk Factors
In more than 90% of cases, the risk of a first heart
attack is related to nine potentially modifiable risk
factors (Yusuf et al. 2004):
• Smoking/tobacco use
• Poor diet
• High blood cholesterol
• High blood pressure
• Insufficient physical activity
• Overweight/obesity
• Diabetes
• Psychosocial stress
• Excess alcohol consumption.
Smoking, obesity and a physically inactive
lifestyle are among the top risk factors for
developing Coronary Heart Disease (CHD). In
2007, over 20,000 deaths from cardiovascular
disease in England were related to smoking. That’s
why the NSF has driven forward major
developments in prevention.
Stroke
A stroke is a serious medical condition that occurs
when the blood supply to part of the brain is cut
off. There are two main types of stroke. The most
common type (an ischaemic stroke) is when one of
the blood vessels leading to or in the brain is
blocked. The second type (haemorrhagic stroke) is
when a blood vessel in the brain bursts, causing
bleeding into the brain.
A transient ischaemic attack (TIA), often called a
‘mini- stroke’, happens when the blood supply to
part of the brain is interrupted for a short time. The
symptoms are the same as for a stroke, but they
usually last only a few minutes or hours, and
disappear altogether within 24 hours.
Causes of stroke
Stroke is a largely preventable condition. Many of
the key risk factors such as smoking, high blood
pressure, obesity and high cholesterol levels can be
reduced by making lifestyle changes.
There are some risk factors for stroke that cannot
be changed, including:
• age (higher risk if you are over 65)
• family history
• ethnicity (higher risk in south Asian, African and
Caribbean)
• your medical history (previous stroke, TIA or
heart attack)
Cutting the risk
Strokes can usually be successfully treated and
also prevented. Eating a healthy diet, taking
regular exercise, drinking alcohol in moderation
and not smoking will dramatically reduce your risk
of having a stroke. Lowering high blood pressure
and cholesterol levels with medication also lowers
the risk of stroke substantially. Reducing the risks
can rapidly reduce the likelihood of developing
CVD.
Diet
A poor diet is a major risk factor for a stroke.
High-fat foods can lead to the build-up of fatty
plaques in your arteries and being overweight can
lead to high blood pressure.A low-fat, high-fibre diet is recommended,
including plenty of fresh fruit and vegetables (five
portions a day)and whole grains. Salt intake is a
major determinant of CVD in the UK, mainly due
to its effect on blood pressure. On average,
70%–90% of people’s intake comes from salt
added during the manufacturing process; only
10–30% comes from adding it during cooking or at
the table. You should limit the amount of salt that
you eat to no more than 6g (0.2oz) a day because
too much salt will increase your blood pressure.
Six grams of salt is about one teaspoonful.
Exercise
Combining a healthy diet with regular exercise is
the best way to maintain a healthy weight. Having
a healthy weight reduces your chances of
developing high blood pressure. Regular exercise
will make your heart and blood circulatory system
more efficient. It will also lower your cholesterol
level and keep your blood pressure at a healthy
level. Regular exercise can help you lose weight.
For most people, 30 minutes of vigorous exercise a
day at least five times a week is recommended.
The exercise should be strenuous enough to leave
your heart beating faster, and you should feel
slightly out of breath. Examples of vigorous
exercise are going for a brisk walk or walking up a
hill.
Want to know more?
www.nhs.uk/LiveWell/Fitness/Pages/Fitnesshome.
aspx
Smoking
Smoking doubles your risk of having a stroke. This
is because it narrows your arteries and makes your
blood more likely to clot.
If you stop smoking, you can reduce your risk of
having a stroke by up to half. Not smoking will
also improve your general health and reduce your
risk of developing other serious conditions, such as
lung cancer and heart disease.
The NHS Smoking Helpline can offer advice and
encouragement to help you quit smoking. You can
call on 0800 022 4332, or visit
http://smokefree.nhs.uk
Want to know more?
www.nhs.uk/LiveWell/Smoking/Pages/stopsmokin
gnewhome.aspx
Alcohol
Excessive alcohol consumption can lead to high
blood pressure and an irregular heartbeat (atrial
fibrillation).Both are major risk factors for stroke.
Because alcoholic drinks are rich in energy (high
incalories) they also cause weight gain. Heavy
drinking multiplies the risk of stroke by more than
three times.
Want to know more?
www.nhs.uk/LiveWell/Alcohol/Pages/Alcoholhom
e.aspx
Treatment
Individuals at high cardiovascular risk warrant
intervention with lifestyle changes and
consideration for drug therapy, to reduce their
absolute risk. Whether or not surgery is needed,
anyone with narrowing of the carotid artery should
be given antiplatelet drugs to reduce blood
clotting. They should also be offered advice and/or
medication for controlling blood pressure and
reducing cholesterol (NICE Clinical Guidance 68).
Antiplatelet medicines reduce the risk of clots
forming in the blood. This reduces your risk of
having a stroke or heart attack. Low-dose aspirin
(usually 75mg a day) may be given to you if you
are considered to be at risk of having a heart attack
or stroke. You may be considered to be at risk if
you:
• have high cholesterol
• have high blood pressure
• have diabetes
• smoke
Scottish National Clinical Guidance recommends
asymptomatic individuals without established
atherosclerotic disease but with a calculated
cardiovascular risk of >20% over ten years should
be considered for treatment with aspirin 75 mg
daily.
However, Low-dose aspirin should not be taken if
you have:
• an active (bleeding) peptic ulcer
• haemophilia or any other bleeding disorder
• an allergy to aspirin or to non-steroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen
or diclofenac
All adults over the age of 40 years who are
assessed as having a ten year risk of having a first
cardiovascular event >20% should be considered
for treatment with simvastatin 40 mg/day
following an informed discussion of risks and
benefits between the individual and responsible
clinician.
For patients who face many years of risk after
diagnosis of a significant carotid narrowing (with
or without symptoms), early surgery called a
carotid endarterectomy to remove the blockage is
the most important and effective intervention to
reduce still further the risk of stroke.
For more information visit:
Stroke Association, 0845 3033 100,
www.stroke.org.uk
Northern Ireland Chest, Heart and Stroke
Association, 0845 7697 299, www.nichsa.com
Different Strokes, 0845 130 7172,
www.differentstrokes.co.uk
http://www.nhs.uk/NHSEngland/NSF/Pages/Coro
naryheartdisease.aspx
http://guidance.nice.org.uk/CG68