How to Prevent Cardiovascular Diseases

Including heart disease, stroke, transient ischaemic attack and peripheral arterial disease

The cause of most cardiovascular disease is a build-up of atheroma - a fatty deposit within the inside lining of arteries. Lifestyle factors that reduce the risk of forming atheroma include: not smoking, choosing healthy foods, a low salt intake, regular physical activity, keeping your weight and waist size down, and drinking alcohol in moderation. Your blood pressure and cholesterol level are also important. All people aged over 40 should have a cardiovascular risk assessment - usually available at your GP surgery. If you have a high risk of developing a cardiovascular disease, treatment to reduce high blood pressure and/or cholesterol may be advised.

What is cardiovascular disease?

Cardiovascular diseases are diseases of the heart (cardiac muscle) or blood vessels (vasculature). However, in practice, when doctors use the term cardiovascular disease they usually mean diseases of the heart or blood vessels that are caused by atheroma.

The rest of this leaflet briefly discusses atheroma, the diseases atheroma can cause, and ways of preventing a build-up of atheroma and preventing the diseases it causes.

What is atheroma (atherosclerosis)?

Patches of atheroma are like small fatty lumps that develop within the inside lining of arteries (blood vessels). Atheroma is also known as atherosclerosis and hardening of the arteries. Patches of atheroma are often called plaques.

A patch of atheroma makes an artery narrower. This can reduce the blood flow through the artery. In time, patches of atheroma can become larger and thicker.

Sometimes, a patch of atheroma may develop a tiny crack on the inside surface of the blood vessel. This may trigger a blood clot (thrombosis) to form over the patch of atheroma, which may completely block the blood flow. Depending on the artery affected, a blood clot that forms on a patch of atheroma can cause a heart attack, a stroke, or other serious problems.

What are the cardiovascular diseases caused by atheroma?

Heart disease

The term heart disease (or coronary heart disease) is used for conditions caused by narrowing of the coronary (heart) arteries by atheroma. The problems this can cause include angina, heart attack, and heart failure.

Heart disease is common in the UK in people aged over 50.

Note: it can be confusing, as there are other heart conditions such as heart valve problems, congenital heart problems, etc. However, these are not usually included when we talk about 'heart disease'.

Cerebrovascular disease - stroke and transient ischaemic attack (TIA)

Cerebrovascular disease means a disease of the arteries in the brain (cerebrum). The problems this can cause include a stroke and a transient ischaemic attack (TIA). A stroke means that part of the brain is suddenly damaged. The common cause of a stroke is due to an artery in the brain, which becomes blocked by a blood clot (thrombus). The blood clot usually forms over some atheroma. A TIA is a disorder caused by temporary lack of blood supply to a part of the brain.

Peripheral arterial disease

Peripheral arterial disease is narrowing (due to atheroma) that affects arteries other than arteries in the heart or brain. The arteries that take blood to the legs are the most commonly affected. 

If you can prevent a build-up of atheroma in the arteries, you are less likely to develop the above diseases. If you already have one of the above diseases, you may prevent or delay it from getting worse if you prevent further build-up of atheroma.

Lifestyle risk factors that can be prevented or changed:

• Smoking.
• Lack of physical activity.
• Obesity.
• An unhealthy diet and eating too much salt.
• Excess alcohol.

Treatable or partly treatable risk factors:

• Hypertension (high blood pressure).
• High cholesterol blood level.
• High triglyceride (fat) blood level.
• Diabetes.
• Kidney diseases causing diminished kidney function.

Fixed risk factors - ones that you cannot alter:

• A strong family history. This means if you have a father or brother who developed heart disease or a stroke before they were 55, or in a mother or sister before they were 65.
• Being male.
• Severe baldness in men at the top of the head.
• An early menopause in women.
• Age. The older you become, the more likely you are to develop atheroma.
• Ethnic group. For example, people who live in the UK with ancestry from India, Pakistan, Bangladesh, or Sri Lanka have an increased risk.

However, if you have a fixed risk factor, you may want to make extra effort to tackle any lifestyle risk factors that can be changed.

Note: some risk factors are more risky than others. For example, smoking probably causes a greater risk to health than obesity does. Also, risk factors interact. So, if you have two or more risk factors, your health risk is much more increased than if you just have one. For example, an Oxford study found that men aged 50 who smoke, have high cholesterol and have high blood pressure, die, on average, 10 years earlier than men who do not have these risk factors.

Research is looking at some other factors that may be risk factors. For example, high blood levels of fibrinogen, C-reactive protein, apolipoprotein B, and homocysteine are being investigated as possible risk factors.

Known risk factors that can be prevented, changed or treated are now discussed further.

Lifestyle risk factors that can be prevented and/or changed

Smoking

Lifetime smoking roughly doubles your risk of developing heart disease. The chemicals in tobacco get into the bloodstream from the lungs and damage the arteries and other parts of the body. Your risk of having a stroke, and developing other diseases such as lung cancer are also increased. Stopping smoking is often the single most effective thing that a person can do to reduce their health risk. The increased risk falls rapidly after stopping smoking (although it takes a few years before the excess risk reduces completely). If you smoke and are having difficulty in stopping, then see your practice nurse for help and advice.

Lack of physical activity - a sedentary lifestyle

People who are physically active have a lower risk of developing cardiovascular diseases compared with inactive people. To gain health benefits you should do at least 30 minutes of moderate physical activity, on most days (at least five days per week).

30 minutes in a day is probably the minimum to gain health benefits. However, you do not have to do this all at once. For example, cycling to work and back 15 minutes each way adds up to the total of 30 minutes.

Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. For example: brisk walking, jogging, swimming, cycling, etc. However, research studies do suggest that the more vigorous the exercise, the better for health - particularly for preventing heart disease.

On most days. You cannot store up the benefits of physical activity. You need to do it regularly.

Being overweight

If you are overweight, you are more likely to develop cardiovascular diseases, diabetes, or certain cancers. The increased health risk of obesity is most marked when the excess fat is mainly in the abdomen rather than on the hips and thighs. As a rule, a waist measurement of 102 cm or above for men (92 cm for Asian men) and 88 cm or above for women (78 cm for Asian women) is a significant health risk.

Alcohol

Drinking a small or moderate amount of alcohol probably reduces the risk of developing cardiovascular diseases (38% compared with teetotallers in one study). That is, 1-2 units per day - which is up to 14 units per week. Drinking more than 15 units per week does not reduce the risk, and drinking more than the recommended upper limits can be harmful. That is, men should drink no more than 21 units per week (and no more than four units in any one day). Women should drink no more than 14 units per week (and no more than three units in any one day). One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.

Diet

Eating healthily helps to control obesity, and lower your cholesterol level. Both of these help to reduce your health risk. Also, there is some evidence that eating oily fish (herring, sardines, mackerel, salmon, kippers, pilchards, fresh tuna, etc) helps to protect against heart disease. It is probably the omega-3 fatty acids in the fish oil that help to reduce the build-up of atheroma. Also, fruit and vegetables, as well as being low in fat, also contain antioxidants and vitamins which may help to prevent atheroma from building up. Briefly, a healthy diet means:

• AT LEAST five portions, ideally more, of a variety of fruit and vegetables per day.
• THE BULK OF MOST MEALS should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.
• NOT MUCH fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low-fat, mono- or poly-unsaturated spreads. One study conducted at Harvard University found that replacing saturated fats with poly-unsaturated fats is an effective way of lowering your risk of heart attacks and other serious problems from heart disease.
• INCLUDE 2-3 portions of fish per week, at least one of which should be oily (such as herring, mackerel, sardines, kippers, salmon, or fresh tuna).
• LIMIT SALT to no more than 6 g a day (and less for children). See below for details.
• If you eat meat, it is best to eat lean meat, or poultry such as chicken.
• If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.

Salt

Adults should eat no more than 5 g of salt a day. This is about a teaspoon of salt. Even a modest reduction in intake can make quite a big difference. The current average daily intake of salt in the UK is 9 g per day. About three quarters of the salt we eat is already in the foods we buy. Simply checking food labels and choosing foods with lower salt options can make a big difference. A tip: sodium is usually listed on the food label. Multiplying the sodium content by 2.5 will give the salt content. Also, try not to add salt to food at the table.