Cardiovascular disease

Cardiovascular disease (CVD) is a general term for a disease of the heart or blood vessels. Blood flow to the heart, brain or body is reduced because of:

  • a blood clot (thrombosis)
  • a build-up of fatty deposits inside an artery, leading to hardening and narrowing of the artery (atherosclerosis)

Types of CVD

The three main types of CVD are:

  • coronary heart disease
  • stroke
  • peripheral arterial disease

Each type is discussed in more detail below.

Coronary heart disease

Coronary heart disease occurs when your heart's blood supply is blocked or interrupted by a build-up of fatty substances (called atheroma) in the coronary arteries. The coronary arteries are two major blood vessels that supply the heart with blood.

If your coronary arteries become narrow due to a build-up of atheroma, the blood supply to your heart will be restricted. This can cause angina (chest pains).

If a coronary artery becomes completely blocked, it can cause a heart attack.

Stroke

A stroke is a serious medical condition that occurs when the blood supply to the brain is disturbed.

Like all organs, your brain needs oxygen and nutrients provided by the blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death.

A stroke is a medical emergency. Prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.

There are two main types of stroke:

  • ischaemic (accounting for 70% of all strokes): the blood supply is stopped due to a blood clot 
  • haemorrhagic: a weakened blood vessel supplying the brain bursts and causes brain damage

Peripheral arterial disease

Peripheral arterial disease, also known as peripheral vascular disease, occurs when there is a blockage in the arteries to your limbs (usually your legs).

The most common symptom of peripheral arterial disease is pain in your legs. This is usually in one or both of your thighs, hips or calves.

The pain can feel like a cramp, a dull pain or a sensation of heaviness in the muscles of your legs. It usually comes and goes, and gets worse during exercise that uses your legs, such as walking or climbing stairs.

Impact on public health

CVD is the leading cause of death in Ireland and worldwide.

In 2010, one-third of all deaths in Ireland (9,182 deaths) were due to CVD. Of these deaths:

  • 4,625 were caused by coronary heart disease
  • 2,015 were caused by stroke

It is thought that most deaths due to CVD are premature and could be prevented by making a number of lifestyle changes It is estimated that CVD is responsible for around one in three premature deaths in men and one in five premature deaths in women.

There are nine main risk factors for cardiovascular disease (CVD) which are listed below. Many of these risk factors are linked, meaning if you have one of the risk factors you are likely to have others as well.

  • Smoking (or other tobacco use) - the toxins in tobacco can damage and narrow your coronary arteries, making you more vulnerable to coronary heart disease. Smoking can also cause high blood pressure, another risk factor for CVD (see below).
  • Poor diet - a diet high in fat can speed up the formation of fatty deposits inside your arteries, and can cause both high blood cholesterol levels and high blood pressure.
  • High blood cholesterol - this can cause narrowing of your arteries and increase your chance of developing a blood clot.
  • High blood pressure - poorly controlled high blood pressure can damage the walls of your arteries and increase your risk of developing a blood clot.
  • Lack of exercise - people who do not exercise regularly usually have higher cholesterol levels, high blood pressure and high levels of stress, and are more likely to be overweight.
  • Being overweight or obese - being overweight or obese increases your risk of developing diabetes and high blood pressure. Many overweight or obese people also have poor diets and do not exercise enough.
  • Diabetes - the high blood glucose (sugar) levels associated with type 1 or type 2 diabetes can damage the arteries. Many people with type 2 diabetes are also overweight or obese.
  • Excessive alcohol consumption - this can increase cholesterol levels and blood pressure.
  • Stress - this can increase your blood pressure and the hormones associated with stress are thought to increase your blood glucose levels.

Most of the factors that increase your risk of cardiovascular disease (CVD) are linked. This means that if you have one of these risk factors, you will probably have others as well.

For example, people who drink alcohol heavily usually have poor diets and are more likely to smoke. Obese people are more likely to have diabetes, high cholesterol and high blood pressure.

Addressing one risk factor (such as quitting smoking) will bring important health benefits, but to achieve a significant reduction in your CVD risk, you need to look at your lifestyle as a whole. In particular, you need to consider:

  • the amount of alcohol you drink
  • your diet
  • your weight
  • how much exercise and physical activity you do
  • whether you need to stop smoking

Alcohol

If you drink alcohol, do not exceed the recommended daily limits of three to four units a day for men and two to three units a day for women.

A unit of alcohol is roughly half a pint of normal strength lager, a small glass of wine or a single measure of spirits.

See your GP if you find it difficult to moderate your drinking. Counselling services and medication can help you reduce your alcohol intake.

Diet

A low-fat, high-fibre diet that includes whole grains and plenty of fresh fruit and vegetables (at least five portions a day) is recommended for a healthy heart. Limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day. Too much salt will increase your blood pressure.

Do not eat foods that are high in saturated fat because this will increase your cholesterol level. These include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods that contain coconut or palm oil

Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. These foods include:

  • oily fish
  • avocados
  • nuts and seeds
  • sunflower oil
  • rapeseed
  • olive oil

Weight management

If you are overweight or obese, you can lose weight and maintain a healthy weight with a combination of regular exercise and a calorie-controlled diet.

Regular exercise

It is recommended that adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.

Activities you could incorporate into your exercise programme include:

  • brisk walking
  • hill climbing
  • running
  • cycling
  • swimming

If you find it difficult to do 150 minutes of moderate-intensity exercise each week, start at a level you feel comfortable with. For example, do five to ten minutes of light exercise a day and gradually increase the duration and intensity of your activity as your fitness level improves.

Smoking

If you smoke, it is strongly recommended that you quit as soon as possible.

You can also call the National Smokers Quitline at 1850 201 203, or log on to www.quit.ie, or the HSE facebook page at www.facebook.com/hsequit.

Medications

If your risk of developing CVD is thought to be particularly high, you may be prescribed medication to reduce your risk.

Medications used to prevent CVD include:

  • statins, which are used to lower blood cholesterol levels
  • anticoagulants (such as warfarin or low-dose aspirin), which are used to prevent blood clots
  • angiotensin-converting enzyme (ACE) inhibitors, which are used to treat high blood pressure

There is a lot of good-quality evidence that eating and drinking habits established during childhood can continue for many years into adulthood. So while bad eating habits in childhood may not pose an immediate health risk, they could lead to serious health problems in adulthood.

Four important things to consider are:

  • the amount of salt your child eats
  • how much fat they eat
  • how much sugar they eat
  • the amount of exercise they do

Salt

Eating high levels of salt in childhood has been linked to an increased risk of high blood pressure, heart disease and stroke in adulthood.

The current recommended limits of salt for children are:

  • for children aged 0-6 months: less than 1g of salt a day
  • for children aged 7-12 months: 1g a day
  • for children aged 1-3 years: 2g a day
  • for children aged 4-6 years: 3g a day
  • for children aged 7-10 years: 5g a day
  • for children aged 11-14 years: 6g a day

It is easy to underestimate how much salt is contained in food. For example, a Happy Meal containing small fries, a hamburger and a coke contains 1.8g of salt, which is over half the recommended daily limit for a five-year-old.

Pre-packaged and ready-to-eat foods (especially those not specifically designed for children) contain high levels of salt. For example, a 200g tin of tomato soup contains 1.4g of salt.

Check the label of any foods you give your child so you can keep an eye on their daily salt consumption.

Fats and sugar

Limit the amount of saturated fat and sugar your child eats. Too much of these can lead to high cholesterol, diabetes and high blood pressure in later life. They can also increase your child's risk of becoming overweight or obese, and a diet high in sugar can cause tooth decay.

Children's foods that are high in saturated fats and sugar include:

  • chocolate
  • sweets
  • fast food such as burgers or chicken nuggets
  • fizzy drinks
  • ice cream
  • biscuits
  • crisps
  • processed foods, such as microwave meals, hot dogs and breakfast cereals that contain additional sugar

Exercise

Most children are naturally active and full of energy. However, as many of today's pastimes are inactive, such as watching TV and playing computer games, many children do not get the exercise they need.

It is now recommended that:

  • Children (under 5 years) who can walk unaided should be physically active every day for at least 180 minutes (3 hours), spread throughout the day, indoors or out.
  • Children and young people (5 to 18 years) should do at least 60 minutes (1 hour) of aerobic activity every day, which should include a mix of moderate-intensity (i.e. fast walking) and vigorous-intensity (i.e. running) activities.

This amount of exercise is enough to strengthen bones and muscles and can help prevent children putting on weight.

There are many different ways for children to exercise. Simply walking or cycling to school is a good way to start. Team sports can also be great fun and can improve co-ordination, balance and team skills.

Most community sports centres run team activities for children, such as football, basketball and volleyball. Ask your local sports centre for more information.

If your children do not like team sports, there are plenty of other fun activities for them to try, such as swimming, dance and martial arts.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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