Cardiovascular Disease

 important facts

Cardiovascular disease is the leading cause of death worldwide: more people die from it each year than from any other cause.

In 2016, an estimated 17.9 million people died from cardiovascular disease, accounting for 31% of all deaths worldwide. Among them, 85% died of heart disease and stroke.

More than three-quarters of cardiovascular disease deaths occur in low- and middle-income countries.

Of the 17 million deaths under the age of 70 due to non-communicable diseases, 82% occur in low- and middle-income countries, and 37% are caused by cardiovascular diseases.

Most cardiovascular diseases can be prevented through population-wide strategies that address risk factors such as tobacco use, unhealthy diets and obesity, physical inactivity and harmful use of alcohol.

People with cardiovascular disease or those at high risk (due to the presence of one or more risk factors, such as hypertension, diabetes, hyperlipidemia or pre-existing conditions) require early detection and management with counseling and appropriate medications.

What is cardiovascular disease?

Cardiovascular disease is a group of heart and blood vessel disorders including:

  • Coronary heart disease – disease of the blood vessels that supply the heart muscle
  • Cerebrovascular disease – disease of the blood vessels supplying the brain
  • Peripheral arterial vascular disease – disease of the blood vessels that supply blood to the arms and legs
  • Rheumatic heart disease – damage to the heart muscle and heart valves caused by rheumatic fever caused by strep bacteria
  • Congenital heart disease – structural malformation of the heart present at birth
  • Deep vein thrombosis and pulmonary embolism – A blood clot develops in a leg vein, which can break off and travel to the heart and lungs.

Heart attacks and strokes are often emergencies caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason this occurs is because a layer of fat builds up on the lining of the blood vessels that supply blood to the heart or brain. Strokes can also be caused by bleeding from blood vessels or blood clots in the brain.

Heart attacks and strokes are often caused by the presence of multiple risk factors, such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol, high blood pressure, diabetes and hyperlipidemia.

What are the risk factors for developing cardiovascular disease?

The most important behavioral risk factors for heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioral risk factors may manifest in individuals as increases in blood pressure, blood glucose, and lipids, as well as overweight and obesity. These "indirect risk factors" can be measured in primary care settings and indicate an increased risk of heart attack, stroke, heart failure and other complications.

Stopping tobacco use, reducing dietary salt, consuming fruits and vegetables, engaging in regular physical activity, and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. In addition, medications for diabetes, high blood pressure, and high blood lipids may be needed to reduce cardiovascular risk and prevent heart attacks and strokes. Some health policies can create an enabling environment where healthy choices are affordable and accessible. These policies are essential to encourage people to adopt and maintain healthy behaviors.

There are also underlying determinants, or “causes of causes,” of cardiovascular disease. They embody the major forces driving social, economic and cultural change – globalization, urbanization and population ageing. Other determinants of cardiovascular disease include poverty, stress, and genetic factors.

What are the common symptoms of cardiovascular disease?

Symptoms of heart disease and stroke

The underlying vascular disease is often asymptomatic. A heart attack or stroke may be the first warning of an underlying condition. Symptoms of a heart attack include:

  • Pain or discomfort in the middle of the chest;
  • Pain or discomfort in your arm, left shoulder, elbow, jaw, or back.

In addition, patients may experience difficulty breathing or shortness of breath; nausea or vomiting; dizziness or fainting; cold sweats; and pale complexion. Women are more likely to experience shortness of breath, nausea, vomiting, and back or jaw pain.

The most common symptom of a stroke is sudden weakness in the face, arm, or leg, usually on one side of the body. Other symptoms include, sudden onset of:

  • Numbness in the face, arms, or legs, especially on one side of the body;
  • Confusion, difficulty speaking or understanding;
  • Difficulty recognizing objects with one or both eyes;
  • Difficulty walking, dizziness, loss of balance or coordination;
  • Severe headache without cause;
  • Fainting or losing consciousness.

People who develop these symptoms should seek medical attention immediately.

What is rheumatic heart disease?

Rheumatic heart disease is caused by inflammation and scarring caused by rheumatic fever that damages the heart valves and heart muscle. Rheumatic fever is caused by an abnormal reaction of the body to a streptococcal infection, and the first symptoms in children are usually a sore throat or tonsillitis.

Rheumatic fever primarily affects children in developing countries, especially those where poverty is widespread. Globally, almost 2% of deaths from cardiovascular disease are related to rheumatic heart disease.

Rheumatic heart disease symptoms

Symptoms of rheumatic heart disease include: shortness of breath, fatigue, irregular heartbeat, chest pain, and fainting.

Symptoms of rheumatic fever include: fever, joint pain and swelling, nausea, stomach cramps, and vomiting.

Why is cardiovascular disease a development issue in low- and middle-income countries?

At least three-quarters of deaths from cardiovascular disease occur in low- and middle-income countries.

Relative to high-income countries, people in low- and middle-income countries do not enjoy the benefits of comprehensive primary health care programs for early detection and treatment of those exposed to risk factors.

In low- and middle-income countries, people living with cardiovascular disease and other non-communicable diseases do not have easy access to effective and equitable health care that meets their needs. As a result, many people in low- and middle-income countries die from cardiovascular disease and other non-communicable diseases at a young age, often while they are still in their prime.

The poorest people in low- and middle-income countries are most affected. At the household level, there is growing evidence that cardiovascular disease and other non-communicable diseases push people into poverty through catastrophic health expenditures and high out-of-pocket costs.

At the macroeconomic level, cardiovascular diseases place a heavy burden on the economies of low- and middle-income countries.

How to reduce the burden of cardiovascular disease?

WHO has identified “best buys” or highly cost-effective interventions to prevent and control cardiovascular disease that are feasible even in low-resource settings. This includes two types of intervention: population-wide and individual, both of which are recommended to be used in combination to reduce cardiovascular disease, the greatest disease burden.

Population-wide interventions available to reduce cardiovascular disease include:

  • comprehensive tobacco control policy;
  • introduce taxes to reduce intake of foods high in fat, sugar and salt;
  • paving walking and biking trails to increase physical activity;
  • Strategies to reduce harmful use of alcohol;
  • Provide healthy school meals to children.

Preventing first heart attacks and strokes at the individual level requires targeting individual health care interventions to people at intermediate and high overall risk for cardiovascular disease, or to individual risk factors such as diabetes, hypertension, and hypercholesterolemia. Personnel aspects that exceed treatment recommendation thresholds. The former (total risk integrated approach) is more cost-effective than the latter and has the potential to substantially reduce cardiovascular events. This approach has feasibility in primary care settings in low-resource settings, including implementation by non physician health workers.

To carry out secondary prevention of cardiovascular disease for people who already suffer from diabetes and other diseases, it is necessary to adopt the following treatment methods:

  • aspirin
  • beta-blockers
  • angiotensin-converting enzyme inhibitor
  • steroids

The benefits of these interventions are mostly unique, but when combined with smoking cessation, nearly 75% of recurrent vascular events can be prevented. Currently, there is a major shortcoming in the implementation of these interventions, especially at the primary health care level.

Additionally, expensive surgical procedures are sometimes required to treat cardiovascular disease. This includes:

  • coronary artery bypass grafting
  • Balloon angioplasty (a small ball-shaped device passed through an artery to clear a blockage)
  • Valve repair and replacement
  • heart transplant
  • artificial heart surgery

Medical devices are needed to treat certain cardiovascular diseases. Such devices include pacemakers, artificial heart valves and patches used to repair heart defects.

WHO response

Under the leadership of WHO, all Member States (194 countries) agreed in 2013 on a global mechanism to reduce the burden of preventable noncommunicable diseases, including the Prevention and Control of Noncommunicable Diseases 2013–2020. Global Action Plan. The plan aims to reduce premature deaths from noncommunicable diseases by 25% by 2025 through the implementation of nine voluntary global targets.

Goal 6 of the Global NCD Action Plan calls for reducing the global prevalence of elevated blood pressure by 25%. Elevated blood pressure is one of the major risk factors for cardiovascular disease. In 2014, the global prevalence of elevated blood pressure (defined as systolic and/or diastolic blood pressure ≥140/90 mmHg) among adults aged 18 years and older was approximately 22%.

Reducing the incidence of hypertension through the implementation of population-wide policies to reduce behavioral risk factors such as harmful use of alcohol, physical inactivity, overweight, obesity and high salt intake is key to achieving this goal. A total risk approach to early detection and cost-effective management of hypertension is needed to prevent heart attacks, strokes and other complications.

The eight targets of the Global Action Plan for Noncommunicable Diseases state that at least 50% of eligible people should receive medication and counseling (including blood sugar control) to prevent heart attacks and strokes. Preventing heart attacks and strokes through a total cardiovascular risk approach is more cost-effective than treatment decisions based solely on individual risk factors and should be part of a package of essential benefits to achieve universal health coverage. Achieving this will require strengthening key components of health systems, including health financing to ensure access to basic health technologies and essential medicines for noncommunicable diseases.

Countries will begin setting national targets in 2015 and measure progress against the 2010 baseline data released in the Global NCD Status Report 2014. The United Nations General Assembly will convene the third high-level meeting on noncommunicable diseases in 2018 to assess national progress towards achieving voluntary global targets by 2025.













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