2.7.1. Cardiovascular Disease: Risk and Prevention
What Is Cardiovascular Disease?
Cardiovascular disease generally starts with atherosclerosis, or a hardening of the arteries, a chronic condition so common that most people show signs of it by the time they turn thirty. However, the beginning signs of atherosclerosis have been observed in children as young at 12 years. [1] As atherosclerosis develops, arteries start to narrow and harden when fats accumulate along their inner walls and form plaques. A plaque is made of fat, cholesterol, calcium, and other substances found in blood.
Plaque formation causes arteries to narrow and harden, which elevates blood pressure because the vessels can’t expand effectively to accommodate blood pulses. Higher blood pressure strains the heart and causes more damage. Arterial walls can become so weakened due to high blood pressure that they balloon and form what is known as an aneurysm. If the aneurysm bursts, it becomes a life-threatening event. The plaques themselves can also rupture due to a spike in blood pressure or a tremor along an arterial wall, and the body responds to this perceived injury by forming blood clots. These clots are serious health threats, whether they are stationary (a thrombus) or moving (an embolus). A stable clot can slowly kill off surrounding tissue, or grow so big that it blocks blood circulation and causes thrombosis. When a moving clot becomes stuck in an artery too small for its passage, it cuts off blood flow and causes cell death. This is referred to as an embolism. Blood clots in heart cause heart attacks and in the brain cause strokes.
There are numerous risk factors for cardiovascular disease; some are modifiable and others are not.
Table 2.7.1.1 The Risk Factors for Cardiovascular Disease
| Unmodifiable risk factors | |
| Age | Risk increases for men at forty-five, and for women at fifty-five. |
| Sex | Men have a higher risk than women, though the risk for women steeply rises after menopause. |
| Family history | The more family members who have heart disease, the greater the risk. |
| Modifiable Risk Factors | |
| Cigarette smoking | Nicotine constricts blood vessels, and carbon monoxide damages their inner lining, which increases the risk of atherosclerosis. |
| Obesity | Excess weight worsens other risk factors. |
| Diabetes | This condition is associated with an increased risk of heart disease. Both types have certain risk factors in common, including obesity and high blood pressure. |
| Physical inactivity | Lack of exercise is associated with heart disease. |
| Cholesterol levels | High levels of blood cholesterol can increase the risk. A high level of low-density lipoprotein (LDL), or the “bad” cholesterol, is a common contributing factor. However, a low level of high-density lipoprotein (HDL), or “good” cholesterol, can also promote atherosclerosis. |
Source: Cardiovascular Diseases
Heart Disease
Heart disease is a disorder of the blood vessels that can lead to heart failure. Heart disease is the second leading cause of death in Canada [Heart Disease in Canada. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html. Updated on February 10, 2017. Accessed on January 25, 2020]. This disorder can be congenital and/or the result of lifestyle. Most people associate heart disease with heart attacks. A heart attack, also known as a myocardial infarction, happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart.
Other types of heart disease include the following:
- coronary artery disease: Damage or disease in the heart’s major blood vessels
- high blood pressure: A condition in which the force of the blood against the artery walls is too high.
- cardiac Arrest: Sudden, unexpected loss of heart function, breathing, and consciousness.
- congestive heart failure: A chronic condition in which the heart does not pump blood as well as it should.
- arrhythmia: Improper beating of the heart, whether irregular, too fast, or too slow.
- peripheral artery disease: A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.
- congenital heart disease: An abnormality in the heart that develops before birth.
The good news: [2]
- The number of new Canadians diagnosed with heart disease has decreased by just under 30%.
- In Canada, the death rate in individuals with a known heart disease has decreased by 23%.
Figure 2.7.1.1 Heart Disease in Canada
Stroke
This type of CVD affects the arteries leading to the brain and blood vessels within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. When that happens, part of the brain cannot get the blood and oxygen it needs and as a result, brain cells begin to die. Women are disproportionally affected by stroke in Canada with 45% more women dying of stroke than men [(Dis)connected. Heart and Stroke Foundation. https://www.heartandstroke.ca/-/media/pdf-files/canada/2019-report/heartandstrokereport2019.ashx. Updated in 2019. Accessed on January 26, 2020.]
A stroke that occurs as the result of a blockage is called an ischemic stroke. A hemorrhagic stroke is the result of a rupture and accounts for only 15% of all strokes.
The Cincinnati Stroke Scale provides early warning signs of a stroke:
| F | Face: Is one side of the face drooping down? |
| A | Arm: Can the person raise both arms, or is one arm weak? |
| S | Speech: Is speech slurred or confusing? |
| T | Time: If the conditions listed above are present call 9-1-1 immediately! Time is critical! |
In 2019, the Heart and Stroke foundation released a full report on Heart, Stroke and Vascular Impairment in Canada.
Heart, Brain and Mind Connection
The body is a highly interconnected unit. Increasingly there is evidence connecting heart, brain and mind health. The brain is the control system for the whole body. When there is stress, coming from and internal or external source, the heart can be negatively affected. The heart is responsible to pumping nutrient and oxygen rich blood throughout the body. When the heart is not doing its job properly the health of the rest of the body is sacrificed. This is particularly important in the brain as if the brain is oxygen or nutrient deprived it cannot function properly, affecting the rest of the body. Altered blood flow in the brain has additionally been associated with the development of cognitive impairment and dementia. Individuals with stroke and heart failure are 2.2 and 2.6 times more likely to experience cognitive impairment. [3]
Hypertension
High blood pressure (hypertension) should be taken seriously. Increased blood pressure is the leading risk for death in countries like Canada.[4] About 19% of the Canadian adults population has high blood pressure and 9 in 10 Canadians will develop high blood pressure or hypertension during their lives.[5] High sodium consumption is a main cause of high blood pressure. Hypertension is also associated with higher body weight. Hypertension is a major cause of heart attacks and strokes, yet it has no symptoms until blood pressure reaches very high levels, which is why it is known as “the silent killer.” The only way to find out if you have high blood pressure is to get an accurate reading of your resting blood pressure rate. This is is best done by a medical professional after sitting and resting for several minutes so your blood pressure can stabilize to resting levels. Blood pressure should be monitored regularly. Blood pressure is made up of two numbers. The systolic or top number represents the force of the blood against your artery walls when your heart pumps. The diastolic or bottom number represents the force in your artery walls when your heart is resting.
Table 2.7.1.2 Blood Pressure Categories
| Blood pressure categories | Blood pressure |
| Low risk | 120/80 mmHg |
| Medium Risk | 121–139/80-89 mmHg |
| High Risk | 140+/90 mmHg |
Having high blood pressure can damage the lining of arteries throughout the body. This means that all organs and tissue can be affected by high blood pressure. Additionally, if high blood pressure is untreated it can lead to atherosclerosis which can results in conditions such as the following:
- stroke
- heart attack
- heart failure
- kidney failure
- peripheral vascular disease
- impotence
- retinal/ eye damage
There are several modifiable and unmodifiable risk factors for hypertension.
Table 2.7.1.3 The Risk Factors for Hypertension
| Unmodifiable risk factors | |
| Age | After fifty-five, the risk of developing high blood pressure is 90 percent. |
| Race | African-Americans are more likely to develop hypertension, manifest it at a younger age, and have higher blood pressure readings. |
| Family history | There is a strong genetic component to high blood pressure, and an individual’s risk goes up along with the number of family members who have hypertension. |
| Modifiable Risk Factors | |
| Weight | Roughly 60 percent of people with hypertension are obese. |
| Sodium consumption | The more salt in a person’s diet, the more likely they are to have high blood pressure. |
| Alcohol | Drinking more than two drinks per day for men and one drink for women increases the likelihood of hypertension. |
| Diet | In addition to salt and alcohol consumption, other dietary factors increase chances of developing hypertension. |
There are lots of things you can do to keep your blood pressure in a healthy range. These include the following:
- make sure you have your blood pressure checked at least once a year
- maintain a healthy body weight
- eat a healthy balance diet with reduced fat
- reduce the amount of salt in your diet
- check with your health care provider to see if you should eat foods that are rich in potassium as potassium can lower blood pressure
- participate in regular physical activity
- be smoke-free
- limit alcohol intake
- find healthy ways to manage stress
- follow the DASH diet
Public Blood Pressure Machines
Using public blood pressure machines is a convenient way to track your blood pressure. However, using these machines should not replace regular doctor appointments, and they cannot inform you what are the next steps if you have high blood pressure.
To get accurate readings you have to
- sit quietly for a least 5 minutes before taking your blood pressure,
- avoid eating, smoking, doing heavy physical activity or drinking tea or coffee for at least 2 hours before taking your blood pressure, and
- place your arm on the table at about heart level.
What Causes CVD?
The following four unmodifiable risk factors, which are beyond a person’s control, can be linked to cardiovascular disease:
- age: There is a strong correlation between CVD and age. As a person ages, the risk for CVD increases also. Although, with males, the risk seems to be when they are younger and females seem to be at higher risk post-menopausal.
- sex: Males have a higher risk for CVD, especially at younger ages. On average males are diagnosed with heart disease 10 years younger than women. Men are 2 time more likely to suffer a hear attack than women.[6] Women experience higher risk later in their lives.
- race: African Americans have the highest risk factor for CVD.
- family history: A person’s genes can be one of the strongest predictors of CVD, but also has the smallest correlation to to CVD overall.
The following five modifiable conditions are also linked to cardiovascular disease, but these are within a person’s power to change:
- tobacco use: The strongest predictor of CVD is the use of tobacco. The use of tobacco accounts for 30% of CVD risk. There is a significant reduction in risk for those who do not use tobacco.
- obesity: Those that have a BMI greater than 30 have a higher than normal risk than those that do not have a BMI greater than 30. “The “obesity epidemic” experienced by the United States over the past several decades threatens to reverse important progress against heart disease.
- diet: CVD can be correlated to high intake of saturated fat and cholesterol. Risk of dietary cholesterol intake can be correlated to atherosclerosis.
- diabetes: This condition is viewed as seriously as any of the other factors, such as smoking, high blood pressure, and high blood cholesterol, that a person can control. In fact, those with Type II diabetes have the same level of risk for a heart attack as those who have already had a heart attack.
- alcohol use: High alcohol intake is associated with cardiovascular disease. Keeping alcohol intake to the recommended levels can reduce you risk of heart disease.
Personal Risk Assessment
Early detection and treatment of conditions related to heart disease can reduce your risk of developing heart disease and death.
There are three screening tests used to a assess a person’s risk for developing CVD: lipoprotein profile, blood pressure, and fasting plasma glucose.
Lipoprotein Profile
What: A blood test that measures total cholesterol, LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (another form of fat in the blood). The test is given after a 9- to 12-hour fast.
Why: To find out if you have any of the following: high blood cholesterol (high total and LDL cholesterol), low HDL cholesterol, or high triglyceride levels. All affect your risk for heart disease.
When: All healthy adults should have a lipoprotein profile done at least once every 5 years. Depending on the results, your doctor may want to repeat the test more frequently.
Blood Pressure
What: A simple, test using an inflatable arm cuff.
Why: To find out if you have high blood pressure (also called hypertension) or prehypertension. Both are risk factors for heart disease.
When: At least every 2 years, or more often if you have high blood pressure or prehypertension.
Fasting Plasma Glucose
What: The preferred test for diagnosing diabetes. After you have fasted overnight, you will be given a blood test the following morning.
Why: To find out if you have diabetes or are likely to develop the disease. Fasting plasma glucose levels of 126 mg/dL or higher in two tests on different days mean that you have diabetes. Levels between 100 and 125 mg/dL mean that you have an increased risk of developing diabetes and may have prediabetes. Diabetes is an important risk factor for heart disease and other medical disorders.
When: At least every 3 years, beginning at age 45. If you have risk factors for diabetes, you should be tested at a younger age and more often.
Steps to Reducing the Risk of Cardiovascular Disease
Diet and nutrition can play a significant role in reducing the risk of cardiovascular disease. It is helpful to lower sodium intake, increase consumption of dietary fiber, and limit consumption of saturated fat, which promotes plaque formation. In addition, it is important to replace refined starches and added sugar, which can boost triglycerides, with whole grains, fruits, and vegetables. Eating foods rich in omega-3 fatty acids, especially fish, using alcohol in moderation, and opting for low or no-fat dairy products can all help reduce your cardiovascular disease risk. Emphasizing vegetable-based sources of protein, such as beans and legumes, can be beneficial, as well as consuming more soy products. It is also important to maintain a healthy weight and avoid smoking or chewing tobacco.
- https://link.springer.com/article/10.1007%2Fs00467-014-2836-1 ↵
- Heart Disease in Canada. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html. Updated on February 10, 2017. Accessed on January 25, 2020 ↵
- (Dis)connected. Heart and Stroke Foundation. https://www.heartandstroke.ca/-/media/pdf-files/canada/2019-report/heartandstrokereport2019.ashx. Updated in 2019. Accessed on January 26, 2020. ↵
- My Blood Pressure Action Plan. Heart & Stroke. https://www.heartandstroke.ca/-/media/pdf-files/canada/health-information-catalogue/en-get-your-blood-pressure-under-control-v21-web.ashx?la=en&hash=20493566724F3F87387717A720D49F60521C1CF2. Updated in 2015. Accessed on January 29, 2020. ↵
- [My Blood Pressure Action Plan. Heart & Stroke. https://www.heartandstroke.ca/-/media/pdf-files/canada/health-information-catalogue/en-get-your-blood-pressure-under-control-v21-web.ashx?la=en&hash=20493566724F3F87387717A720D49F60521C1CF2. Updated in 2015. Accessed on January 29, 2020. ↵
- Heart Disease in Canada. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html. Updated on February 10, 2017. Accessed on January 25, 2020 ↵
