Cardiovascular Disease

Condition:

Heart disease and disease of the cardiovascular system.

Definition:

The cardiovascular system consists of the heart and the arteries which carry oxygen rich blood to the tissues of the body, and the veins which carry blood back from the tissues to be circulated through the lungs to discharge CO2, carbon dioxide, and absorb fresh oxygen.

The basic problem is usually a disease of the arteries called atherosclerosis which is a build up of fatty tissues in the walls of the arteries, like water pipes furring up, and makes them more likely to become blocked by a blood clot.

This may occur in the brain resulting in a stroke, or in the arteries of the legs, called peripheral arterial disease, or in one or more of the arteries of the heart.

In the heart this may cause pain on exertion or at rest called angina or if the blockage is severe a myocardial infarction (heart attack), and because the heart muscle is damaged this may lead to heart failure which is a long term health problem.

Cause and scope for prevention:

The causes of atherosclerosis or heart disease are now relatively well known:

· Smoking

· An imbalance between energy intake and output resulting in obesity

· Changes in the blood chemistry with increased glucose, lipids and cholesterol and these are sometimes diagnosed as hypercholesterolaemia, metabolic syndrome, or hyperlipidaemia

· Lack of exercise 

Diagnosis:

Usually the person presents with chest pain and diagnosis is by imaging, sometimes with direct visualisation of the arteries.

Standard medical therapy:

Drug treatment sometimes with the insertion of a stent—a small tube pushed through the narrowed blood vessel. It is important to recognise that standard medical therapy for people who have had a heart attack now includes referral to an exercise programme, often called cardiac rehabilitation.

Benefit of exercise therapy:   

Exercise directly affects the process of atherosclerosis and therefore stops the condition getting worse. The Academy of Medical Royal Colleges report on Exercise—The Miracle Cure, states:

“All studies show clear improvements in cardiovascular health with moderate exercise. There are similar beneficial effects for sufferers of angina. 27 Overall, exercise reduces cardiac mortality by 31%.”

In addition exercise: 

· Helps the person feel better and reduces depression 

· Increases fitness and ability, closing the fitness gap 

· Reduces the risk of other conditions such as dementia

There is a small risk associated with increasing exercise levels but the Faculty of Sport and Exercise Medicine Guidelines on the balance of risks and benefits of activity for people with Cardiac Chest Pain states that:

“The balance of evidence suggests that the long-term benefits of increasing levels of regular physical activity far outweigh the temporary slightly increased risk of adverse events when those with ischaemic heart disease. This risk increases with advancing age and exercise intensity, but overall remains very low.

People should be counselled individually to gradually increase physical activity, taking into account severity of symptoms, fear of cardiac chest pain and red flag symptoms.”

Key references:

Exercise Benefits Coronary Heart Disease.

The role of cardiac rehabilitation in   patients with heart disease.

Key organisation:

British Heart Foundation.