Cardiovascular Disease

Cardiovascular Disease (CVD) kills 25% of all humans in Australia.

Types

• Heart attacks

• Stroke

• Aorta diseases

• Peripheral vascular diseases

Fact Sheet

• Prevention of Cardiovascular Disease

Risk Factors

• Smoking

• Overweight and obesity

• Unhealthy Diet

• Physical Inactivity

• Dyslipidemia

• Hypertension

• Diabetes Mellitus

Statistics

90% of stroke burden may be caused by modifiable risk factors.

90% of the risk for heart attacks is due to 9 modifiable risk factors.

Framingham Heart Study showed those with 5 risk factors had a 10-year risk of a first cardiovascular event of 25 to 30%.

CARDIOVASCULAR DISEASE

Leading cause of death

Four major areas

• Heart attacks

• Strokes

• Peripheral artery disease

• Aorta diseases

Major risk factors

• Age

• Smoking

• Lipids

  • High total cholesterol

  • High LDL cholesterol

  • High Triglycerides

  • Low HDL cholesterol

• High Blood Pressure

• Diabetes

• Obesity

• Psychological factors

• Diet

  • High sugar foods

  • Low consumption of fruits and vegetables

  • High consumption of meat

  • High trans fatty acids

  • Low fibre

• Exercise

  • Physical inactivity

  • Resistance training protects

• Alcohol

• Family history

• Chronic Kidney Disease

• Inflammation

  • CRP

• Metabolic syndrome

• Microalbuminuria

• Abnormal sleep, too much or too little

• Urate

Based on statistics about the increased percentage of risk, here are the top 20 risk factors for atherosclerotic cardiovascular disease:

• Smoking - Increases risk by 2-4 times

• Diabetes - Increases risk by 2-4 times

• High blood pressure - Increases risk by 2-3 times

• High LDL cholesterol - Increases risk by 1.5-2 times

• Low HDL cholesterol - Increases risk by 1.3-1.5 times

• Age - Increases risk by 1.2-1.5 times per decade

• Male gender - Increases risk by 1.5-2 times

• Family history - Increases risk by 1.5-2 times

• Obesity - Increases risk by 1.3-1.5 times

• Sedentary lifestyle - Increases risk by 1.3-1.5 times

• Metabolic syndrome - Increases risk by 2-3 times

• Chronic kidney disease - Increases risk by 3-4 times

• Sleep apnea - Increases risk by 2-3 times

• Stress - Increases risk by 2-3 times

• Rheumatoid arthritis - Increases risk by 1.5-2 times

• Obstructive sleep apnea - Increases risk by 2-3 times

• Elevated triglycerides - Increases risk by 1.5-2 times

• Elevated lipoprotein (a) levels - Increases risk by 1.5-2 times

• Chronic infection - Increases risk by 1.5-2 times

• Nonalcoholic fatty liver disease - Increases risk by 1.5-2 times

Prevention of Cardiovascular Disease

Healthy Diet

• High in fruits and vegetables such as the Mediterranean diet

• High in fibre (cereals, whole grains, beans, broccoli, cauliflower, carrot, apple, pear, nuts)

• High in Omega-3 fatty acids (salmon, mackerel, walnuts, chia seeds)

• More monounsaturated fats (avocado, olive oil) and less trans-fatty acids (processed food) and less saturated fats (red meat)

• Less sugar and lower refined carbohydrates (less added sugar, white rice, white bread, potato)

Smoking Cessation

• Cigarette smoking is still the leading cause of premature death worldwide

• Quitting is difficult. The best chance of success involves combining all of the following:

  • Setting a quit date within 2 weeks, quit abruptly on this date, gradual reduction prior is acceptable 

  • Behavioural techniques for cravings such as delaying, distraction

  • Baseline Nicotine Replacement Therapy (NRT)  such as nicotine patches and/or quick-acting options for cravings (lozenges, spray, gum, e-cigarette, inhaler)

  • Medication for cravings (Champix, Zyban) ideally for 3 to 6 months

  • Vaping is better than smoking but has its own risks

  • Remove all cigarettes from your house

  • Recruit friends and family members to help

  • Use programs like QuitLine 137848 or https://www.icanquit.com.au/

High blood pressure / Hypertension

• Defined as blood pressure greater than 130/80 mmHg for most people

• Modifiable therapies include

  • Dietary salt restriction reduces systolic blood pressure by 5 / 2.5 mmHg

  • Weight loss (about 0.5 to 2 points for every 1 kilogram of weight lost)

  • Diet high in fruit, vegetables, whole grains, fish, and nuts and low in both sugar and red meat helps (e.g. Mediterranean or DASH diet). Reduces blood pressure by 6 / 4 mmHg

  • Aerobic exercise (3 to 4 times per week) reducing by 4-6 / 3 mmHg

  • Ensuring enough dietary potassium helps a little

  • Limiting Alcohol helps. No more than 1-2 drinks daily.

• Medications help. The decision to start medication is based on overall cardiovascular risk which we can measure. Anyone with blood pressure measured at home outside of a doctor's office that is consistently above 135 / 85 mmHg should consider medication.

Physical Activity

• The recommendation is a bare minimum of 150 minutes of moderate-intensity exercise per week

  • For example, a brisk walk, for 30 minutes, 5 days per week

Weight Loss

• The aim is as close as possible to a Body Bass Index (BMI) of 20 to 25. Any weight loss helps.

High Blood Cholesterol / Dyslipidemia

• Can be hereditary and people with a strong family history should be screened early

• Complicated topic but the general idea is:

  • High LDL is bad. Target < 4

  • High HDL is good. Target > 1

• Modifiable changes include

  • A low-cholesterol diet alone doesn’t seem to help

  • The focus should be on the quality of cholesterol eaten and the ratio of good to bad 

  • Aim for more good cholesterol (more avocado, olive oil, fatty fish) 

  • Less bad cholesterol (trans-fatty acid in processed foods, and saturated meat in red meat)

  • High-fibre diet can lower LDL by 10%

  • Exercise can help to raise HDL by 10% and lower LDL by 10%

  • Eating more plants helps as they contain sterols with compete with the absorption of other cholesterol in the gut. They lower total cholesterol and LDL

  • Eating 30g of soy products a day reduced total cholesterol by 7 to 10%

  • Margarine should be cut out of your diet, but if not possible then replace it with olive oil or plant sterol enriched spread like Olive Grove.

• Medications help. First-line medications are statins. Reduce LDL cholesterol by 30 to 40%

Type 2 Diabetes

• Diabetes is a significant contributing factor to overall cardiovascular risk

• Early aggressive treatment and tight blood glucose control helps

Omega-3 Fatty Acids

• Omega-3 fatty acids are still being investigated but high levels are likely protective overall

  • One study showed about a 20% reduction in all causes of death including cardiovascular disease comparing those in the top 20% of the population with the highest Omega-3 levels versus those in the bottom 20% with the lowest Omega-3 levels

• RDI Omega-3 for women 1.1g and men 1.6g

• You can achieve the total recommended Omega-3 dose with any one of these items:

  • Salmon (350g for women, 500g for men) e.g. 2 x 250g salmon = total weekly dose

  • Mackerel (170g for women, 240g men)

  • Chia Seeds (45g for women, 60g for men)

  • Walnuts (21 for women, 30 for men)

Alcohol

• Some evidence that the consumption of regular small amounts of alcohol has lower overall cardiovascular risk (1 standard drink per day on 6 days per week seems to be the right amount)

• Binge drinking does not have the same benefit. Higher amounts of alcohol is harmful.

• Doesn’t account for other risks associated with alcohol including increased risk of cancers such as breast cancer, liver disease, mental health, sexual assault, accidents and self-harm

Aspirin

• Long-term aspirin leads for people who have not had a previous heart attack or stroke effects:

  • All-cause mortality - No impact or a very small reduction

  • Non-fatal heart attack - Sight Reduction

  • Non-fatal stroke - Likely no impact or a very small reduction

  • Colon cancer - Possible reduction 

  • The main risk is an increase of 50% for major bleeding, most of this was non-fatal