What does 'cardiovascular disease' stand for?

Cardiovascular disease includes all those pathologies affecting heart and/or blood vessels. Cardiovascular disease usually occurs when one or more arterials do not receive an adequate blood supply. In a brain stroke, blood flow is reduced or interrupted to part of the brain which undergoes ischemia or death cell due to lack of oxygen. In myocardial infarction, insufficient blood flow is restricted to one of the vessels supplying blood to the muscular walls of the heart - the coronary arteries.
Other cardiovascular disease may have different causes: congenital cardiovascular malformations, for instance, occur when the heart or blood vessels have not properly developed during foetal life.

What is atherosclerosis and what role does it play in cardiovascular disease?
It occurs when fatty substances accumulate in the walls of arteries which become thick and, consequently, the blood flow becomes restricted. Fatty deposits (mainly lipids and cholesterol) of varying size (plaques) builds up in the innermost lining of arteries. This is a slow process that depends on the individual's predisposition and the level of several risk factors. Atherosclerotic plaque may either contribute to reducing vessel diameter or else rupture and cause thromboembolic events. Cerebral stroke and myocardial infarction are the major consequences of atherosclerosis.

Are men and women at equal risk for a heart attack?
No, they aren't. Gender is actually one of the risk factors. In men ages 25-74 the estimated prevalence in 2000 was 220,000 events, with a rate of 90 new cases per day. In women, just over 39,000 cases per year were estimated, with a rate of 30 new cases per day.
This difference is due to multiple reasons, the most important of which is the protective effect exerted by female hormones, the estrogens, on the heart and blood vessels. Cardiovascular risk in women remains lower than in men until menopause and, after a latency period, increases sharply. Diabetes in women cancels out the protective effect of the hormones, thus women with diabetes have almost the same risk for cardiovascular disease as men without diabetes.

Which are the main risk factors?
The risk factors for cardiovascular disease are numerous and heterogeneous. Some factors are non- modifiable, such as age, gender and familiarity (a blood relative who suffered from cardiovascular disease). Other important factors are defined as 'modifiable' to highlight the fact that can be controlled through external interventions, thus reducing the likelihood of falling ill. This category includes behavioural habits related to peculiar lifestyles, such as cigarette smoking, low level of physical activity and an unhealthy diet. An unbalanced diet can lead to obesity, diabetes and a high blood cholesterol level, which, together with high blood pressure, represent the main biological risk factors.

What prevention can do in the fight against cardiovascular disease?
Prevention, whose main aim is to keep the risk factors' level under control, is still the best weapon in the fight against cardiovascular disease, which comes suddenly and unexpectedly, thus the victim often does not receive adequate aid as the event normally occurs outside the hospital. Out of hospital mortality actually accounts for 30% of total mortality, and it is largely caused by cardiac arrest occurring within the first hour after the onset of symptoms. In terms of survival, delay in treatment should therefore be considered a real risk factor. Hence, prevention remains the best way to avoid or reduce the disease.

At what age should you start getting your cardiovascular disease risk checked?
The right age depends on the individual's family history. It is recommended that risk factors be kept under control since an early age. The essential clinical tests and measurements to perform are simple, inexpensive and within everyone's reach: blood pressure, serum cholesterol, serum HDL cholesterol, weight and height should be measured.

How many persons suffer from cardiovascular disease?
Cardiovascular disease currently accounts for 44% of total deaths, 30% of these due to myocardial infarction and 31% to stroke. In industrialized countries like Italy cardiovascular disease is the leading cause of death: every year 36 thousand persons die from acute myocardial infarction.

How can the risk of heart attack be reduced?
Prevention has some rules that should be strictly observed:
Avoid smoking: smokers suffer heart attacks three times more than non smokers and, after the event, the mortality rate among those who continue to smoke is three times higher than that of non smokers. Also passive smoking must be avoided as well: individuals regularly and frequently exposed to other people's cigarette smoke have a cardiovascular risk higher than that of non smokers. Past smokers have the same risk level as non smokers over a period of about 10-15 years after giving up.
Adopt an healthy diet: it is recommended that the relative proportion of elements rich in saturated fats (e.g. butter, cheese, bacon fat and fatty meat) should be reduced in favour of monounsaturated fats such as olive oil (which reduce the 'bad' LDL cholesterol without reducing the 'good' HDL cholesterol) and polyunsaturated fats of vegetable and fish origin. The consumption of fruit and vegetables, fish and foodstuffs rich in fibres and starches should be increased, and alcohol and salt intake reduced.
Check blood pressure: blood pressure should be kept under control and measured 'at rest', that is, after being seated for 5 minutes. In adults over the age of 30 years, the systolic blood pressure should be lower than 140 mmHg, while diastolic pressure must not exceed 90 mmHg. Ideal blood pressure is 120/80mmHg.
Make regular physical activity: regular, non aggressive physical activity is recommended: to give an example, walk every day for 30 minutes or else cycling in flat country, without over-exertion.
Avoid emotional tension and stress: one's emotional state, even if in an indirect way, can effect the cardiovascular system, especially when it is already impaired by the simultaneous presence of other risk factors that may be aggravated by stress.

I had an heart attack some time ago. What must I do to avoid recurrences?
Coronary disease regression is feasible, therefore it is important to remain vigilant and take action on several fronts. More precisely, it is advisable to really put the rules of prevention in practice. To do this, it is necessary to adopt several healthy habits (avoid smoking, reduce stress, make physical exercise, asopt an healthy diet and check risk) and strictly follow drug treatment prescribed by the physician.