Causes and Management of CVD
Published on: March 20, 2025
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Thakssa Jeyabalan

Bachelors Of Science Pharmacology student at University Of Portsmouth

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Salma Amer

MBChB Medicine and Surgery University of Manchester, BSc Science University of St. Andrews

Introduction

Cardiovascular disease (CVD) affects the heart and/or blood vessels. CVD usually occurs due to the build up of fatty deposits within the arteries, which causes atherosclerosis and an increased risk of blood clots. It is also associated with damage to arteries in the brain, heart, kidney and eyes. There are four different types of CVD: coronary heart disease, strokes and transient ischemic attacks (TIAs), peripheral arterial disease and aortic disease.

Causes of CVD

Modifiable risk factors

Unhealthy diet 

Having an unhealthy diet can be a major risk factor for CVD. Diets high in fat, particularly those with a higher ratio of saturated fats to unsaturated fats, are linked to an increased risk of heart disease. Additionally, excessive intake of foods high in salt, sugar, and cholesterol is a significant contributor to CVD.2

Physical inactivity 

Engaging in a sedentary lifestyle is linked to heart disease and weight gain. Excess weight can then progress to obesity, which contributes to heart disease.2

Tobacco use

Chemicals found in cigarettes make the walls of the arteries ‘sticky’. This then causes fatty material to stick to the walls and clogs the arteries, which then reduces the space for blood to flow properly. Smoking increases the risk of blood clots, increases heart rate and reduces the amount of oxygen delivered to the rest of the body.3

Excessive alcohol consumption 

Alcohol consumption is known to increase blood pressure and overtime this puts a strain on the heart muscle and eventually leads to CVD. Furthermore, if one has an arrhythmia, alcohol consumption may further increase the risk.4

High blood pressure (Hypertension)

High blood pressure causes the arteries to lose their elasticity and can become narrow. Fatty material can then build up and damage the artery lining predisposing to a heart attack.5

High cholesterol levels 

High cholesterol levels can increase the risk of heart attack and stroke as blood can’t flow through the arteries easily due to the buildup of plaque.  Insufficient blood flow deprives the heart of nutrients and oxygen that are required for function.6

Non-modifiable risk factors 

Age 

CVD is an age dependent disease and usually affects people aged over 50 years. The older the person gets, the greater the risk of developing CVD. 

Gender 

Statistically, it is known that men are at a higher risk of CVD than women. Men often develop CVD ten years earlier than women.

Genetics and family history 

A family history of CVD is associated with an increased risk of early and lifetime CVD.

Ethnicity 

South Asian or Sub-saharan African origin are known to have an increased risk of developing CVD during their lifetime, whereas people from South American or Chinese origin have a lower risk compared to European origin.7

Management of CVD

Prevention strategies 

Lifestyle modifications 

In order to manage and prevent CVD development, a healthy diet is necessary. This includes incorporating more fruits and vegetables, cutting down on carbohydrates and increasing the intake of unsaturated fats than saturated fats. Regular physical exercise can also decrease the effects of CVD in addition to smoking cessation and decreased alcohol intake.8

Medical interventions 

If blood pressure is consistently above 140/90 mmHg in individuals under 80 years old, they are at risk of high blood pressure. To manage this, it’s recommended to reduce salt intake to less than 6g per day. For those under 55 years of age with type 2 diabetes, an ACE inhibitor or angiotensin-2 receptor blocker is typically offered. However, for individuals aged 55 or older, particularly those of African or Caribbean descent without type 2 diabetes, a calcium channel blocker is usually prescribed. Additionally, beta blockers can help lower blood pressure by slowing the heart rate and reducing the force of each heartbeat.9

Medications used to lower cholesterol are statins. They reduce the amount of cholesterol the body makes and usually are required to take one tablet a day. Statins may need to be taken for life. Other medications used if statins don’t work are ezetimibe, fibrates, bile acid and bempedoic acid.9

Medical and surgical treatments 

Medications 

Antiplatelet agents 

Antiplatelet therapy decreases platelet accumulation and inhibits thrombus formation within the arterial circulation. There are four types of antiplatelet drugs available including aspirin, clopidogrel, dipyridamole and glycoprotein. The main type of drugs used is aspirin and this irreversibly inhibits cyclo-oxygenase and blocks the production of thromboxane.10

Beta blockers

Beta blockers reduce the heart rate and decrease strain on the heart. They tey help prevent angina symptoms and minimise the damage during a heart attack. Beta blockers used in heart disease include metoprolol and bisoprolol.11

ACE inhibitors 

ACE inhibitors are commonly used to treat high blood pressure. Some examples of ACE inhibitors are ramipril and lisinopril. ACE inhibitors reduce the amount of a hormone called angiotensin-2 which causes blood vessels to narrow. They improve the flow of blood around the body and during the treatment regular blood tests are done to check that the kidneys are not adversly affected.12

Surgical interventions

Angioplasty and stent placement

Coronary angioplasty is used to widen blocked or narrowed coronary arteries. In an angioplasty a balloon is used to stretch open the blocked artery. In modern angioplasty a short wire mesh tube is used called a stent and the stent is then left in place to allow blood to flow more freely. After the surgery, the blood flow to the coronary arteries is improved and there are signs of reduced symptoms.13

Coronary artery bypass grafting (CABG)

CABG diverts blood around the clogged parts of the major arteries and it improves blood flow and oxygen supply to the heart. The process involves taking a blood vessel from another part of the body and attaching it to the coronary artery above and below the narrowed area. After the surgery a follow up appointment is done 6-8 weeks after the operation.14

Heart valve repair or replacement 

An aortic valve replacement is an open heart surgery that is used to treat problems within the heart’s aortic valve. An aortic valve replacement involves removing a faulty or damaged valve and replacing it with a new valve made from synthetic materials. The operation usually lasts around 4 hours and may take 2 to 3 months to fully recover.15

Pacemakers and defibrillators

The pacemaker is placed under the skin near the collarbone on the left side of the chest. The generatore is attached to a wire that leads to the heart through a blood vessel. A defibrillator sends an electrical shock to the heart and reboots it to get pumping again. It helps return the heart to a normal rhythm.16 

Conclusion

In conclusion, an unhealthy diet, excessive amounts of alcohol, smoking, sedentary lifestyle and other lifestyle and genetic causes are risk factors for CVD. The risk of CVD can be reduced by making various lifestyle changes and medications. Regular monitoring and follow up appointments are required.

References

  1. Aortic valve replacement. (2017, October 20). Nhs.Uk. Available from: https://www.nhs.uk/conditions/aortic-valve-replacement/
  2. Cardiovascular disease. (2017, October 17). Nhs.Uk. Available from: https://www.nhs.uk/conditions/cardiovascular-disease/
  3. CKS is only available in the UK. (n.d.-a). [CorporatePage]. NICE. Retrieved 21 July 2024, Available from: https://www.nice.org.uk/cks-uk-only
  4. CKS is only available in the UK. (n.d.-b). [CorporatePage]. NICE. Retrieved 21 July 2024, Available from: https://www.nice.org.uk/cks-uk-only
  5. Coronary angioplasty and stent insertion. (2017, October 24). Nhs.Uk. Available from: https://www.nhs.uk/conditions/coronary-angioplasty/
  6. Coronary artery bypass graft (Cabg). (2017, October 24). Nhs.Uk. Available from: https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/
  7. Coronary heart disease—Treatment. (2017, October 23). Nhs.Uk. Available from: https://www.nhs.uk/conditions/coronary-heart-disease/treatment/
  8. Effects of alcohol on your heart. (n.d.). Retrieved 21 July 2024, Available from: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/effects-of-alcohol-on-your-heart
  9. Heart disease—Symptoms and causes. (n.d.). Mayo Clinic. Retrieved 21 July 2024, Available from: https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118
  10. High blood pressure. (n.d.). British Heart Foundation. Retrieved 21 July 2024, Available from: https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure
  11. High blood pressure (Hypertension)—Treatment. (2017, October 23). Nhs.Uk. Available from: https://www.nhs.uk/conditions/high-blood-pressure-hypertension/treatment/
  12. High cholesterol—Medicines for high cholesterol. (2019, May 28). Nhs.Uk. Available from: https://www.nhs.uk/conditions/high-cholesterol/medicines-for-high-cholesterol/
  13. Hyperlipidemia (High cholesterol): Levels, causes, symptoms & diagnosis. (n.d.). Cleveland Clinic. Retrieved 21 July 2024, Available from: https://my.clevelandclinic.org/health/diseases/21656-hyperlipidemia
  14. Lifestyle modifications for cvd. (n.d.). Bing. Retrieved 21 July 2024, Available from: https://www.bing.com/search?q=lifestyle+modifications+for+cvd&qs=n&form=QBRE&sp=-1&lq=0&pq=lifestyle+modifications+for+cvd&sc=11-31&sk=&cvid=F9E45F45F69043E0A01449BB42E2C29A&ghsh=0&ghacc=0&ghpl=
  15. Pacemaker implantation. (2017, October 20). Nhs.Uk. Available from: https://www.nhs.uk/conditions/pacemaker-implantation/
  16. Smoking. (n.d.). British Heart Foundation. Retrieved 21 July 2024, Available from: https://www.bhf.org.uk/informationsupport/risk-factors/smoking
  17. The Healthy Heart: Preventing, detecting, and treating coronary artery disease. (2009, June 9). Harvard Health. Available from: https://www.health.harvard.edu/heart-health/the-healthy-heart-preventing-detecting-and-treating-coronary-artery-disease
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Thakssa Jeyabalan

Bachelors Of Science Pharmacology student at University Of Portsmouth

Thakssa is an undergraduate pharmacology student with strong background knowledge in drug designs, pharmacokinetics, pharmacodynamics and the regulatory aspects of drug development. Through writing lab reports at university she has developed the ability to think critically to identify trends and interpret data and she has excellent scientific writing skills.

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