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What is the burden of cardiovascular disease?

An estimated 17.3 million people die of cardiovascular diseases every
year.  80% of the deaths occur in low- and middle-income
countries. 

What causes cardiovascular disease?

There are many risk factors that contribute to the development of
cardiovascular disease.  Some people are born with conditions
that predispose them to heart disease and stroke, but most people who
develop cardiovascular disease do so because of a combination of
factors such as poor diet, lack of physical activity and smoking, to
name just three.  The more risk factors you expose yourself to,
the higher the chance of developing cardiovascular disease.

Many of the risk factors for cardiovascular disease cause problems because
they lead to atherosclerosis. 

Atherosclerosis is the narrowing and thickening of arteries. Atherosclerosis develops
for years without  causing symptoms.  It can happen in any part of the body.  Around
the heart, it is known as coronary artery disease, in the legs it is
known as peripheral arterial disease.

The narrowing and thickening of the arteries is due to the deposition of
fatty material, cholesterol and other substances in the walls of
blood vessels. The deposits are known as plaques. The rupture of a
plaque can lead to stroke or a heart attack.

What is cholesterol?

Cholesterol is a waxy, fat-like substance used by the body to build cell walls
and for making several essential hormones. Your liver produces
cholesterol and you absorb it from the animal fats you
eat. 

Cholesterol is carried through the blood by particles called
lipoproteins. There are two types: low-density lipoproteins (LDL) and
high-density lipoproteins (HDL). The former carries the cholesterol
around the body in the blood and the latter transports cholesterol
out of the blood into the liver.

When cholesterol is too high, or the levels of the two types are out of
balance (dyslipidaemia), the cholesterol can clog the arteries
affecting the flow of the blood.

What are triglycerides?

Triglycerides are fats found in the blood that are important for muscle energy. 
They travel through the blood in lipoproteins. As triglyceride levels
rise, HDL cholesterol levels fall. High levels of of triglyceride
increase the risk for heart disease. In rare cases, very high levels
can lead to pancreatitis. Conditions that may cause high
triglycerides include obesity, poorly controlled diabetes, drinking
too much alcohol, hypothryroidism, and kidney disease.

What is the connection between high blood pressure (hypertension) and
heart disease? 

Blood moving through your arteries pushes against the arterial walls; this
force is measured as blood pressure.

High blood pressure (hypertension) occurs when very small arteries (arterioles) tighten. 
Your heart has to work harder to pump blood through the smaller space
and the pressure inside the vessels grows.  The constant excess
pressure on the artery walls weakens them making them more
susceptible to atherosclerosis.

How is coronary heart disease diagnosed?

There are a number of ways to diagnose coronary heart disease. Your
physician will probably use a number to make a definitive
diagnosis. 

A coronary angiogram uses a dye inserted into your arteries and an
x-ray to see how the blood flows through your heart. The picture
taken, the angiogram, will show any atherosclerosis.

Another test is an electrocardiogram.  This test records the electrical
activity of your heart.  An electrocardiogram measures the rate
and regularity of heartbeats, the size and position of the heart
chambers, the presence of any damage to the heart, and the effects of
drugs or devices used to regulate the heart. It is a non-invasive
procedure.
 
How are smoking and heart disease linked?

Smoking damages the lining of blood vessels, increases fatty deposits in the
arteries, increases blood clotting,adversely affects blood lipid levels, and promotes coronary artery
spasm. Nicotine accelerates the heart rate and raises blood pressure.

Does diet play a part in the development of heart disease?

Diet plays a significant role in protecting or predisposing people to heart disease. Diets
high in animal fat, low in fresh vegetables and fruit, and high in alcohol have been shown to increase the risk of heart disease.

Adopting a diet low in fat and salt has a protective effect over the long
term. This means whole grains, fruits, and vegetables.
  
Aren’t women protected from heart disease because of estrogen?

Estrogen does help raise good HDL cholesterol so protecting women, but once
through the menopause as many women as men are affected by heart
disease: but if a woman suffers from diabetes or has raised levels of
triglycerides that cancels out the positive effect of estrogen.


How do the symptoms of heart attack differ between men and women?

The symptoms of heart attack in a man are intense chest pain, pain in the
left arm or jaw and difficulty breathing. 

A woman may have some of the same symptoms, but her pain may be more
diffuse, spreading to the shoulders, neck, arms, abdomen and even her
back. A woman may experience pain more like indigestion. The pain may
not be consistent. There may not be pain but unexplained anxiety,
nausea, dizziness, palpitations and cold sweat. A woman’s heart
attack may have been preceded by unexplained fatigue.

Women also tend to have more severe first heart attacks that more
frequently lead to death, compared to men.
  
Is heart disease hereditary?

Heart disease can run in some families. But even if you inherit the risks
factors that predispose you to heart disease, such as high blood
cholesterol, high blood pressure, diabetes, or being overweight,
there are measures you can take that will help you avoid developing
cardiovascular disease.