Overview

Vascular disease is a collection of conditions in which blood vessels or the circulatory system are malfunctioning. In 2019, the prevalence of vascular disease was estimated at 110 million globally.¹ It is possible to make lifestyle choices to reduce the risk of developing vascular disease. 

Prevention strategies include lifestyle factors such as stopping smoking, exercising, reducing stress and having a healthy diet. Maintaining healthy lifestyle choices can help to reduce the risk of developing vascular disease. Additionally, having regular health checks can assess individuals’ risk score of developing vascular disease and provide individualised strategies to decrease risk.

Making small changes in lifestyle can have a big positive effect on vascular health.

Vascular disease

Vascular disease, also known as vasculopathy refers to any condition where the blood vessels are in an abnormal condition or the circulatory system is affected. This affects the body’s ability to carry oxygen and nutrients throughout the body and remove waste from tissues. Conditions include disease of arteries, veins, capillaries, lymph vessels and blood disorders. There are many different types of vascular disease including some that can only happen in specific areas of the body. Vascular disease is a subcategory of cardiovascular disease. Some examples of types of vascular disease are:

• Peripheral artery disease
• Carotid artery issues
• Venous disease
• Blood clots
• Aortic aneurysm
• Fibromuscular dysplasia (FMD)
• Lymphoedema
• Vasculitis

There are known risk factors associated with vascular disease and a large number of these are environmental. Being aware of these risk factors and adapting lifestyle choices to avoid THEM can reduce the likelihood of developing vascular disease. 

Smoking and vascular disease

Individuals who smoke have an increased risk of having vascular disease. Cigarettes contain chemicals which cause the cells lining blood vessels to become inflamed. The inflammation of these cells causes the blood vessels to narrow. This results in reduced space in the blood vessels which impacts the ability to carry oxygen and nutrients through the body. The chemicals also cause plaque to build up in arteries, causing further narrowing. 

Any amount of smoking can cause this damage to the blood vessels, even if the individual only smokes occasionally. In some cases, quitting smoking can reverse or delay disease progression.² Secondhand smoke can also cause this damage in individuals who do not smoke.

Exercise and cardiovascular disease

Regular exercise can keep the blood circulatory system healthy and working efficiently. This is because it has a number of positive effects on the body such as reducing cholesterol levels, reducing inflammation and inducing changes in oxygen delivery. These positive effects reduced the risk of disease development i. In addition to preventing the onset of vascular disease, it has been found that regular exercise can have a positive impact on the outcomes of patients with vascular disease.³ 

Obesity can increase the risk of vascular disease as it can lead to fatty material building up in the blood vessels. Regular exercise can contribute to maintaining a healthy weight. 

Diet and cardiovascular disease

Maintaining a healthy diet can prevent developing vascular disease. This is because it can help to maintain a healthy weight and prevent fatty deposit build up. One key aspect of a healthy diet is eating at least five portions of fruit and vegetables a day which is beneficial to vascular health. Consumption of too many saturated fats can increase cholesterol levels and increase the risk of vascular disease. Examples of saturated fats are butter, meat products, cheese, chocolate and biscuits. It is important to have a reduced intake of saturated fats. Too much salt can raise blood pressure and increase the risk of vascular disease so salt intake should be limited.

The ‘Mediterranean diet’ has been shown to be more healthy than a typical ‘Western diet’ which contains high levels of salt and saturated fats.⁴ It can be extremely beneficial in preventing the development of vascular disease. The most common aspects of the Mediterranean diet are: 

• Limited red meat intake
• Limited foods with added sugars
• Having moderate portions of dairy products
• Eating vegetables, fruits, whole grains and plant-based fats everyday
• Eating fish, poultry, beans, legumes and eggs every week

Sleep and cardiovascular disease

During normal, healthy sleep, a process known as nocturnal dipping occurs. This is when blood pressure drops by around 10-20%. When an individual experiences poor sleepdue to lack of sleep or sleep disruptions, it can mean that their blood pressure does notgo down at night.⁵ Studies have found that elevated blood pressure at night is linked to overall high blood pressure. High blood pressure (hypertension) is a risk factor for vascular disease. Maintaining healthy, undisrupted sleep can reduce the risk of disease development.

Improving sleep can be difficult but there are many strategies which can improve the quality of sleep. Having a regular sleep routine can help to improve sleep. This includes having a set time to start winding down for bed and going to bed and getting up at set times every day. The time spent winding down is critical. Electronic devices such as mobile phones, tablets and computers produce blue light which disrupts sleep, so it is suggested to not use any blue light devices at least an hour before bed. Meditation, relaxation techniques, listening to music/podcasts are all good ways to relax before bed. It is important to create the right environment for sleep, such as somewhere dark and cool. 

Stress and cardiovascular disease

Stress can have a negative effect on vascular health. Psychological stress or mental stress is a risk factor for higher incidence of cardiovascular events.⁶ Chronic stress may cause individuals to have reduced vascular endothelial function (cells that line the blood vessels).⁷ When this happens, the blood vessels are unable to regulate the exchange of things such as nutrients between the blood and surrounding tissues. It is important to try and manage stress levels to prevent the development of vascular disease. There are various strategies to try to reduce stress: 

• Exercising and being active can help to clear thoughts and deal with problems in a calm manner.
• Connecting with friends and family can improve mood and they can often help with any problems that are causing stress.
• Having some time set aside to do activities or hobbies can be relaxing.
• Setting goals and challenges can boost mood.
• Avoiding unhealthy habits such as drinking alcohol and smoking can improve mood and provide a clearer headspace.
• Helping others can encourage a positive mindset.
• Looking for the positives in life can improve mood.
• Prioritising and managing workloads can make tasks more manageable.

NHS health check 

In the UK a service known as an NHS Health Check looks at heart disease amongst other conditions. It consists of assessing the risk of getting certain conditions. This is available for individuals aged 40-74 years who do not have certain pre-existing conditions (specified on their website). GPs or local councils will invite eligible individuals to these health checks every five years. In these health checks the following are assessed::

• Height and weight 
• Waist circumference
• Blood pressure 
• Cholesterol levels
• smoking habits, alcohol intake, physical activity levels and family medical history

Typically, results are provided in the health check and suggestions on how to reduce risk are discussed such as increasing exercise, improving diet and stopping smoking. 

Summary

Vascular disease is a common disease which has a large number of risk factors. Many of these risk factors are linked to lifestyle so there are many prevention strategies in order to reduce the risk of disease development. Smoking can cause narrowing of blood vessels and arteries. Stopping smoking can potentially reverse or delay disease progression. Regular exercise can reduce cholesterol levels and inflammation of cells in blood vessels. Maintaining a healthy weight and diet can reduce fatty deposits in arteries which lead to vascular disease. The Mediterranean diet has been proven beneficial. Poor sleep can cause hypertension. Methods used to improve sleep can reduce this risk. Chronic stress can cause reduced function of cells in blood vessels so it is important to manage stress. NHS health checks can assess individuals' risk and suggest prevention strategies to reduce risk levels.