What is Cardiovascular Disease (CVD)?
Cardiovascular disease (defined as diseases of the heart and blood vessels) is one of the leading cause of death in the UK and worldwide. In the UK, 1 in 3 deaths is attributable to cardiovascular disease. CVD includes conditions such as angina, heart attacks, heart failure, stroke and blood pressure. The incidence of CVD is higher in men than women before the menopause. After menopause, this association no longer exists, and the incidence as well as the rate of progression of CVD is similar in both sexes. CVD increase with age and predominantly affects people over the age of 50 years. However, if there is a strong family history of heart attacks or strokes, the age of onset can be earlier and may be seen in patients in their thirties and forties.
What is Coronary Artery Disease (CAD)?
The major contributor to cardiovascular disease is coronary artery disease (CAD). This occurs when cholesterol and other substances are deposited in the arteries of the heart resulting in plaques that narrow the coronary arteries. This disease process is known as atherosclerosis in the medical literature. The narrowed arteries result in less oxygen-rich blood being delivered to the heart muscle, during periods of physical or mental stress, culminating in chest pain (angina pectoris). If the plaque ruptures with ensuing clot formation on top that completely blocks the artery, then a myocardial infarction (heart attack) occurs. Myocardial infarction with the devastating complication of sudden death can sometimes be the first presentation of patients with underlying CAD, which can often be asymptomatic.
Atherosclerotic plaques can also develop in the arteries of the neck that supply blood to the brain. If fragments of these plaques break off or if clot forms on top and subsequently disperse to the brain, blocking the small arteries of the brain, then a stroke or minor stroke can occur.
Risk Factors for Cardiovascular Disease and Prevention
The causes of cardiovascular disease are multifactorial but there are a number of risk factors that predispose to atherosclerosis which include: age, hypertension (high blood pressure), smoking, high cholesterol, diabetes mellitus, obesity, a sedentary lifestyle, poor diet and a family history of premature cardiovascular disease.
Patients often present after having an event (heart attack or stroke). It is therefore important to identify those patients with risk factors before their event, to initiate advice, lifestyle changes and treatment. There is a sufficient scientific evidence to demonstrate that early intervention in high risk individuals, can result in a significant reduction in future heart attacks and strokes, and improve the health of the population.
The likelihood of having a heart attack or stroke can be determined from risk assessment models, clinical assessment, risk factors and symptoms. There are limitations using risk assessment models. These include an underestimation of risk in younger patients and over estimation in older patients.
Diagnosing Cardiovascular Disease
Cardiovascular risk assessment can be further refined by using blood tests, the electrocardiogram (ECG) and further diagnostic tests. These tests include exercise stress testing, calcium scoring (a test used to determine the quantity of calcium in the arteries of the heart, which correlates with the amount of atherosclerosis), CT coronary angiography (a non-invasive method of visualising the coronary arteries), carotid artery imaging (plaque build-up in the arteries of the neck), and the use of other specialised imaging tests. Patients found to have a very high cholesterol level can be offered genetic testing. If a gene is identified that is responsible for producing high cholesterol levels, then cascade screening can be offered to other family members.
Aim of the Cardiovascular Disease Risk Assessment Programme
The Cardiovascular Disease Risk Assessment Programme is aimed at reducing the impact of cardiovascular disease and related disabilities, by early diagnosis and preventative actions. The programme offers comprehensive, personalised and individualised treatment to meet patients’ expectations. Our multidisciplinary team consists of a mixture of experienced specialists in the fields of cardiology, cardiac imaging and radiology.