Cardiovascular Disease

Original Editor - Rachael Lowe

Top Contributors - Catriona O'Brien, Evan Thomas, Oyemi Sillo and Kim Jackson

Introduction

Cardiovascular disease (CVD) refers to a group of conditions involving the heart, blood vessels, or the sequelae of poor blood supply due to a diseased vascular supply. Over 82% of the mortality burden is caused by ischaemic or coronary heart disease (IHD), stroke (both haemorrhagic and ischaemic), hypertensive heart disease or congestive heart failure (CHF). Over the past decade, CVD has become the single largest cause of death worldwide, representing nearly 30% of all deaths and about 50% of NCD deaths. In 2016, CVD caused an estimated 17.9 million deaths, representing 31% of all deaths worldwide[1]. Behavioural risk factors such as physical inactivity, tobacco use and unhealthy diet explain nearly 80% of the CVD burden [2] .

What are cardiovascular diseases?

CVDs include a wide range of conditions, such as the following:

  • Coronary Heart Disease (CHD)
  • Cerebrovascular Disease
  • Peripheral Arterial Disease
  • Rheumatic Heart Disease
  • Congenital Heart Disease
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism

85% of CVD deaths are due to heart attacks and strokes[1]. These are generally acute events caused by blockage, preventing blood flow to the heart or brain. The most common cause for these blockages is due to a process called atherosclerosis.

Who is at risk?

Modifiable risk factors[3] of CVD include

  • unhealthy diet
  • physical inactivity
  • smoking
  • increased consumption of alcohol

Individuals with such behaviours may present with increased blood pressure, lipids and glucose levels, as well as being overweight or obese.

Non-Modifiable risk factors[3] include

  • Family history
  • Age
  • Gender - men at greater risk than pre-menopausal women; post menopausal women are at similar risk as men
  • Ethnicity
  • Socioeconomic status

Symptoms of CVD

Often the first warning of an underlying cardiovascular disease is a heart attack or stroke.

Symptoms of a heart attack may include:

  • pain or discomfort in centre of chest
  • pain or discomfort in arms, left shoulder, elbows, jaw, or back.
  • Shortness of breath
  • Nausea or vomiting
  • Light-headedness
  • Pallor
  • Cold sweat

Symptoms of a stroke may include the following:.

  • unilateral weakness of face, arms or legs
  • confusion, difficulty speaking or understanding speech
  • dizziness
  • difficulty seeing with one or both eyes
  • headache
  • fainting

How Physiotherapists Can Help

Cardiac rehab programmes have been shown to be very effective, with physiotherapists playing a key role in these programmes.They have been shown to reduce length of hospital stay as well as number of cardiovascular related admissions, cardiac mortality and improved quality of life[4]. Cardiac rehab classes include exercise, education and support.

Physical activity performed at an intensity of >40% of maximal aerobic capacity has shown the greatest benefits in reducing the development or progressing of CVD.[5] For every one metabolic equivalent (MET) increase in aerobic fitness there is a reduction of 8-17% in premature death.[6] Aerobic exercise increases people’s cardiac output, maximum heart rate, endurance, and arterial blood flow. It may also enhance their blood lipid profiles. For people who already have cardiovascular disease, prescribed aerobic exercise programs by physiotherapists can reduce their risk long-term. Aerobic conditioning activities such as running, rowing and walking along with resistance strength training exercises have been shown to be inversely associated with the risk of
coronary heart disease[7].

Resources

References

  1. 1.0 1.1 https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
  2. Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum
  3. 3.0 3.1 https://www.world-heart-federation.org/resources/risk-factors/
  4. British Association for Cardiovascular Prevention and Rehabilitation. The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation 2nd Edition. London : British Association for Cardiovascular Prevention and Rehabilitation;2012.
  5. Farrell SW, Kampert JB, Kohl HW 3rd, et al. Influences of cardiorespiratory fitness levels and other predictors on cardiovascular disease mortality in men. Med Sci Sports Exer 1998;30:899905.
  6. Kavanagh T, Mertens DJ, Hamm LF, et al . Prediction of Long-Term Prognosis in 12169 Men Referred for Cardiac Rehabilitation. Circulation 2002;106:666-671.
  7. Dr Marilyn Moffat, President of the WCPT. How physical therapists fight non-communicable disease throughout the lifespan. 2011