What is Cardiovascular Disease (CVD): Symptoms & Causes

Cardiovascular disease (CVD) is a complex condition that can arise from a mix of factors, and having multiple risk factors significantly boosts your chances of developing it. Alarmingly, CVD remains the top cause of global deaths, claiming 18.6 million lives annually. Cardiovascular disease poses a significant and growing global health concern. Accurate identification and risk stratification of individuals at risk are crucial. This review delves into the concept of risk, exploring traditional and novel risk factors, clinical scoring systems, and the application of risk assessment in informing treatment decisions.

A multitude of cardiovascular risk factors have been identified, with traditional factors like ageing serving as potent predictors of adverse outcomes. Hypertension and dyslipidaemia are primary targets for therapeutic intervention. Additionally, various novel biomarkers have been discovered, including inflammatory and genetic markers, which offer further insights into cardiovascular risk.

Types of Cardiovascular Diseases

• Coronary Heart Disease: Coronary heart disease is a condition characterised by the buildup of plaque in the arteries that supply blood to the heart, increasing the risk of a heart attack or ischaemic stroke. A fatty buildup called atheroma can block your heart's arteries, reducing blood flow to your heart, which can be harmful.
• Stroke: A stroke is a very serious condition that occurs when the brain doesn't get the blood it needs, causing damage to the brain cells. A stroke can be identified using the FAST acronym: facial weakness, arm weakness, speech difficulties, and time to call for emergency services if symptoms occur.
• Peripheral Arterial Diseases: Peripheral arterial disease is a condition in which the arteries that carry blood to the legs and arms become damaged. This leads to a buildup of plaque and fatty deposits, which can cause a blockage or narrowing of the arteries. This reduction in blood flow can lead to a range of symptoms, including leg pain, cramping, weakness, and numbness, as well as increasing the risk of heart attack, stroke, and other cardiovascular diseases.
• Aortic Disease: Aortic diseases encompass a range of conditions impacting the aorta, the primary artery responsible for transporting oxygenated blood from the heart to the rest of the body. A common and potentially dangerous condition is aortic aneurysm, characterised by a weakening of the aortic wall, causing it to balloon outward. While typically symptom-free, this aneurysm poses a significant threat, as it may suddenly rupture, resulting in catastrophic bleeding and potentially fatal consequences.

Symptoms of Cardiovascular Diseases

Chest Pain or Discomfort (Angina)

A sensation of constriction or compression in the chest, characterised by feelings of tightness, pressure, or weight, which may radiate or spread to adjacent areas, including:

• One or both arms (from shoulder to wrist)
• Upper back or shoulders
• Neck or throat
• Jaw or teeth
• Stomach or abdomen

This discomfort may be described as a dull ache, a sharp pain, or a squeezing sensation and can vary in intensity from mild to severe.

Shortness of Breath

Experiencing difficulty breathing or feeling winded, even when engaging in simple activities or at rest. This sensation may be characterised by:

• Feeling like you can't catch your breath or get enough air
• Needing to gasp for breath or breathe more rapidly than usual
• Feeling like your lungs are burning or starving for oxygen
• Being unable to take deep breaths or feeling like your breathing is shallow
• Feeling anxious or panicked due to difficulty breathing

Fatigue

Persistent exhaustion or lethargy, even after resting or engaging in light physical activity, is due to the heart's reduced ability to circulate oxygen and nutrients to the body's tissues. This fatigue may manifest as:

• Unrelenting tiredness or weariness that doesn't subside with rest
• Lack of energy or motivation to perform daily tasks or activities
• Feeling drained, depleted, or weak
• Reduced endurance or stamina during physical activities
• Mental fogginess, forgetfulness, or difficulty concentrating due to inadequate blood flow to the brain

Causes of Cardiovascular Diseases

• High Blood Pressure: Hypertension, or high blood pressure, is a prevalent condition that often goes unnoticed due to its lack of symptoms. However, being aware of your high blood pressure can help prevent potentially life-threatening complications, such as heart attacks and strokes. Blood pressure has two numbers: systolic (higher) measures pressure when your heart beats, and diastolic (lower) measures pressure between beats.
• High Cholesterol: High cholesterol means excess cholesterol in your blood, increasing the risk of heart attack and stroke. Cholesterol is carried by lipoproteins in the blood. There are two main types: LDL ("bad" cholesterol), which builds up in arteries, and HDL ("good" cholesterol), which removes excess cholesterol and takes it to the liver.
• Smoking: Smoking is extremely detrimental to your heart health, significantly increasing your risk of developing severe heart and circulatory diseases, including coronary heart disease, heart attacks, strokes, and peripheral artery disease, which can lead to devastating consequences, such as heart failure, disability, and even premature death.
• Obesity: Excess weight, particularly around the waist, can lead to the accumulation of fatty material in your arteries, causing atherosclerosis. This increases your risk of developing high blood pressure, high cholesterol, and type 2 diabetes, all of which are risk factors for heart disease. If the arteries that supply blood to your heart become damaged and clogged, it can result in a heart attack.
• Physical Activity: A lack of physical activity or a sedentary lifestyle can lead to a range of serious health issues, including heart and circulatory diseases such as heart attacks, strokes, high blood pressure, and high cholesterol, which can ultimately result in premature death or disability if not addressed through regular exercise and a healthy lifestyle.

Cardiovascular Risk Factors

To understand risk, we need to look at many different factors that can affect heart health. While we have identified many of these factors, new ones are still being discovered. This raises questions about how useful these new factors are, how easily they can be used in medical practice, and whether they can help guide treatment.

Unmodifiable Risk Factors

Age: The strongest predictor of adverse cardiovascular outcomes

Gender: An important factor, with differences in risk and treatment efficacy

Family history: Premature family history, including parents and siblings, is significant

Ethnicity: Higher prevalence of cardiovascular disease in South Asian and Black populations

• Age-Related Considerations

• Age dominates cardiovascular risk prediction models
• Difficult to separate the ageing process from concurrent age-related disease
• Conventional clinical measures may underestimate age's impact
• Age increases co-morbidity and affects behavioural risk factors

• Gender Differences

• Cardiovascular disease is the leading cause of death in women
• Incidence rates in women are comparable to those of men 10 years younger
• Hypoestrogenaemia is a risk factor, especially post-menopause
• Gender influences the prevalence and strength of other risk factors

• Family History and Ethnicity

• Family history reflects shared factors beyond genetics
• Ethnicity is a recognised risk factor with biological and behavioural components
• Incorporated into clinical risk prediction models
• Impacts drug choice and medication adhere

Modifiable risk factors

Modifiable risk factors offer opportunities for targeted interventions to reduce cardiovascular disease risk. Key factors include:

Blood Pressure (BP)

• Strongly associated with cardiovascular disease
• Antihypertensive therapy has clear benefits
• BP lowering is crucial for event reduction
• Within-individual variability necessitates repeated measurements

Lipid Abnormalities

• Cholesterol and triglyceride issues constitute a significant population-attributable risk
• Statins are the primary treatment for reducing LDL-C
• Residual risk remains despite treatment
• Other lipid abnormalities (high triglycerides, low HDL-C) are associated with type 2 diabetes and metabolic syndrome

Diabetes Mellitus

• A growing concern, with patients considered high-risk regardless of other factors
• Progressive, with increasing glycaemic levels correlated with vascular complications
• Impaired glucose tolerance also conveys an increased risk
• Treatment reduces microvascular and macrovascular complications (less so for type 2 diabetes)

Other Metabolic Syndrome Risk Factors

• Frequently coexist with diabetes, aggravating arterial wall injury
• Treatment brings additional benefits

Behavioural Risk Factor

• Smoking: A significant risk factor with a dose-response relationship, exacerbating the impact of other risk factors like lipids and diabetes. Effective interventions include psychological approaches and anti-smoking medications.
• Obesity: A global public health concern with severe cardiovascular consequences due to multiple pathophysiological changes. Diet modification is the primary intervention, with pharmacotherapy options like orlistat limited to specific cases.
• Physical Inactivity: A significant risk factor, with regular exercise essential for maintaining cardiovascular health.
• High Dietary Salt Intake: Excessive salt consumption increases cardiovascular risk, emphasising the need for a balanced diet.
• Excess Alcohol Consumption: Drinking too much alcohol can harm cardiovascular health, highlighting the importance of moderation

Conclusion

Cardiovascular disease (CVD) is a complex condition caused by a mix of factors, resulting in 18.6 million global deaths annually. Key risk factors include age, gender, family history, ethnicity, high blood pressure, high cholesterol, smoking, obesity, physical inactivity, and dietary factors. Identifying and managing these risk factors through lifestyle changes and interventions can help prevent CVD. Accurate risk assessment and stratification are crucial for informing treatment decisions and reducing CVD risk.