Cardiovascular Disease

Cardiovascular disease, the world’s leading cause of death, is an umbrella term referring to conditions that affect the cardiovascular system – the heart (“cardio”) and blood vessels (“vascular”) – which transports oxygen-rich blood around the body and removes waste products.

Common cardiovascular diseases include:

• Coronary heart (or coronary artery) disease: the coronary arteries, which supply the heart itself, become narrowed or blocked, reducing blood flow. This can cause a heart attack (sudden lack of blood to the heart muscle) or heart failure (the heart can’t pump efficiently).

Narrowing of the coronary arteries and other blood vessels is a result of atherosclerosis – build-up of cholesterol and other fatty substances (sometimes called “plaque”) from the blood. This may also contribute to:

• Stroke: blood supply to part of the brain is blocked or reduced.
• Peripheral artery disease: blockage of arteries supplying the arms and legs.

• Arrhythmia: irregular heart rhythm, causing an abnormally fast or slow heartbeat.^1,2,3,4,5

The following raise your risk for developing cardiovascular disease:

• Poorly controlled high blood sugar can damage the blood vessels.
• Hypertension (high blood pressure) can damage arteries and weaken the heart muscle.
• High cholesterol. Cholesterol is a key component of cells, but too much can cause atherosclerosis.
• Chemicals in tobacco smoke cause inflammation and swelling of the blood vessel lining.
• Sedentary lifestyle raises risk for blood vessel blockages.
• Obesity raises risk for type 2 diabetes and hypertension, which in turn raise risk for heart disease.
• Unhealthy diet contributes to other risk factors such as diabetes, hypertension and high cholesterol.
• Family history of cardiovascular disease, especially if a parent or sibling has one of these conditions.^3,6

Tell your doctor if you experience any symptoms associated with these cardiovascular conditions:

• Angina: chest pain or pressure during exercise.
• Heart attack: pain or discomfort in the chest, arm, back, neck or jaw; heartburn or nausea; extreme fatigue; dizziness; breathlessness; cold sweat; pale skin.
• Stroke: sudden weakness or numbness in face, arm or leg, often on one side; confusion; trouble speaking; vision loss; dizziness; co-ordination loss; severe headache; fainting or unconsciousness.
• Heart failure: breathlessness; fatigue; swollen feet, legs, abdomen or neck veins.
• Arrhythmia: fluttering sensation in chest (palpitations).

If you suspect heart attack or stroke, get emergency assistance. South Africa medical emergency numbers: 10177; 112 (cell phone).

Underlying cardiovascular disease may go unnoticed until a major cardiac event like a heart attack occurs.^2,3,6

Your doctor will review your medical and family history for cardiovascular disease risk factors.

Diagnostic tests may include:

• Blood tests to check for abnormal levels of blood sugar, cholesterol and fats.
• Electrocardiogram (EKG/ECG) to measure electrical signals in the heart.
• Stress test on a treadmill to gauge heart function during exercise.
• Imaging testsg. chest X-ray, CT (Computed Tomography) scan, MRI (Magnetic Resonance Imaging,) echocardiography – these check for tissue damage, insufficient blood supply and atherosclerosis.
• Coronary angiography and cardiac catheterisation: used when cardiovascular disease is clearly indicated, to detect blockages. A dye is injected into the heart and coronary arteries, and a thin tube is guided to the heart via a blood vessel.³

Treatment depends on the type of cardiovascular disease. It may include:

• Lifestyle changes centred on heart-healthy eating and exercise.
• You may be prescribed several medicines to address different cardiovascular issues. For example:
• Aspirin to lower blood clotting risk.
• Statins to lower blood cholesterol.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-2 receptor blockers (ARBs) to widen the blood vessels, improving blood flow and reducing blood pressure.
• Newer classes of diabetes drugs, namely glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SLGT2), are helpful for weight loss.

• Surgery, for example:
• Balloon angioplasty: a small balloon-like device is threaded through a blocked artery to open it. A stent, a tiny mesh coil, is usually placed to keep the artery open.
• Coronary artery bypass: a section of healthy blood vessel is used to bypass a blocked coronary artery.

• Cardiac rehabilitation: a recovery programme after a major cardiovascular event or It typically includes physical therapy, guidance on medication adherence and lifestyle, and psychological counselling.^2,3,7,8,9

Good lifestyle management helps lower the risk for cardiovascular conditions, and for further damage if you have been diagnosed. These positive actions also protect against other conditions like diabetes and kidney disease at the same time:

• Follow a heart-healthy diet rich in fruit, vegetables and lean protein, and low in processed foods, sugar and salt. Tips:
• Swap refined carbs (white bread and pasta, sugary cereals) for whole grain alternatives.
• Steam, boil, grill or air-fry with a little vegetable oil instead of pan-frying.
• Replace high-salt condiments with herbs, spices and citrus.
• Regular exercise. Gradually work up to minimum 150 minutes weekly of cardio (exercise that raises your pulse rate) plus bi-weekly strength training (e.g. lifting weights). Tips:
• Walk whenever possible: take the stairs; stride to the corner store.
• Do household chores like mopping or gardening vigorously.
• Don’t smoke. One year post-quitting, your coronary heart disease risk is half that of a smoker’s.
• Drink less. Excessive alcohol raises blood pressure.
• Take medications exactly as prescribed so they work effectively.
• Check in regularly with your doctors for monitoring and guidance.
• Don’t neglect your mental health. A cardiovascular disease diagnosis may feel initially overwhelming, so find a therapist if you’re feeling low or anxious. Get support from friends and family, and consider joining a patient support group or online community. The Heart and Stroke Foundation of South Africa https://www.heartfoundation.co.za/ is a great place to start. ^1,3,12,13,14