The Truth About Coronary Heart Disease CHD

8/9/2019 The Truth About Coronary Heart Disease CHD

1/11

Coronary Heart Disease

Causes, Risks, Effects, Preventative initiatives

Case Study: Merseyside

21 January 2014

Featured on: joepfernando.co.uk

JOEP FERNANDO
http://joepfernando.co.uk/


2/11

WHAT IS CARDIOVASCULAR DISEASE? (CVD)

Cardiovascular disease includes all the diseases of the heart and circulation including coronary

heart disease (angina and heart attack), heart failure, congenital heart disease and stroke.

Also known as heart and circulatory disease.

~British Heart Foundation

THE CAUSES OF CVD

Atherosclerosis and Coronary Thrombosis

This is the build up of fatty

deposits within the coronary

artery wall, forming an atheroma.

This leads to the narrowing of

the coronary artery, meaning the

red blood cells cannot through

the artery at a fast enough rate,

thus depriving stye cardiac

muscle of glucose and oxygen.

This then leads on to an Angina

(tightening of the chest).

If an atheroma breaks away from

the artery wall, it could cause a

blood clot to form, which would

block the coronary artery andthus the blood supply to the

cardiac muscle (heart). A heart

attack is the product of this, or more specifically, Coronary Thrombosis, or myocardial infarction (Tissue death

due to lack of local oxygen as there is a lack of the muscles oxygen supply). In the image above, we see an

atherosclerotic plaque which comprises of lipids (fatty deposits), as well as some calcium and cellular debris.

Stents can be used as a treatment, as they widen the diameter of the lumen of the artery to allow the red

blood cells to pass through without any obstruction from atheromas.

CARDIOVASCULAR DISEASE


3/11

There are also two types of factors that lead to increased risk of having CVD. They are categorised into:

Changeable/ Modifiable Risk factors:

-Hypertension (high blood pressure). Likely to cause Coronary heart disease as High blood pressure

puts additional force on the artery walls, which can damage the artery walls. The injured arteries are

likely to become hardened as scar tissue forms in the artery, reducing its elasticity.

-Abnormal Blood levels, whereby there is a high level of cholesterol in the blood. High levels of Low

density Lipoproteins (which transport cholesterol from the liver to the blood add to the total level of

cholesterol in the blood). Whereas low levels of high density lipoproteins don't reduce the amount of

cholesterol in the blood when the levels are too high, as they are considered to be a good type of

cholesterol.

-Smoking and Tobacco intake increases risk of CVD as the carbon monoxide produced damages the

endothelium of the arteries, leading to atheromas as white blood cells are attracted to repair damage.

The carbon monoxide also binds with the haemoglobin irreversibly (as Hb has a higher affinity for CO

compared to O2), meaning less oxygen is pumped to respiring cells and tissues. This also forces the

cardiac muscle to respire aerobically (without oxygen) when deprived of oxygen. This leads to Angina

and CHD. The risk is significantly increased for heavy smokers and if the subject started smoking from

a young age, as the heart was deprived of oxygen for a longer period of time, compared to a person

who recently picked up smoking.

-Physical inactivity leads to CVD, as it leads to obesity and high blood pressure (hypertension as

mentioned above). It is said that exercise manages to increase levels of High density lipoproteins

(good cholesterol), and may even reduce levels of Low Density Lipoproteins (bad cholesterol which

increases the total levels of cholesterol in the blood).

-Type 2 Diabetes makes you twice as likely to have CVD than someone who doesn't have type 2

diabetes. This is due to people with type 2 diabetes often having a High blood pressure, Abnormal

cholesterol and triglicerides level (fats) , obesity, poorly controlled blood sugars.

-A diet high in saturated fat is said to increase the risk of heart disease and stroke, however new

research has questioned this; in the BMJ (British medical journal), Dr Aseem Malhotra has stated that

the advice to avoid saturated fats has paradoxically increased the risk of obesity and heart disease

as fats have been replaced with sugars for taste. This has also lead to a rise in cases of Type 2

diabetes. There are two main types of LDLs involved here. The one associated with Saturated fat

intake - Large buoyant (type A) LDL particles is not the LDL linked with Cardio vascular disease. The

CARDIOVASCULAR DISEASE


4/11

second type of cholesterol - smaller, denser (type B) is linked with CVD, and this is not present in

saturated fats.

-Stress is considered to be a contributing risk factor to heart disease although it is not completely

understood. Emotional stress, behaviour habits, socioeconomic status are all said to be main causes

of stress. Researchers have identified many reasons why stress may affect the heart; they raise the

heart rate and blood pressure, and thus the hearts need for oxygen,as well as angina. During stress

hormones are also released by the nervous system as well as the amount of clotting factors being

released in the blood.

Unchangeable/ Non Modifiable Risk factors:

-As a person gets older, the risk of CVD doubles each decade after the age of 55, as our hearts

capacity and power decreases. The hearts wall may thicken, arteries may stiffen and harden, reducing

elasticity..

-If there is family history of CVD, the risk is increased due to hereditary factors.

-Males are at greater risk of heart disease, whereas pre menopausal women are protected due to their

sex hormones produced. However, after menopause, their risk increases to become similar to a males

risk.

-Ethnic origin is also a factor as among some racial and ethnic groups people are more at risk of

developing severe high blood pressure (African-Americans), who also have a higher risk of CVD

compared to whites.


5/11

Impacts of CHD/ CVD on Lifestyle

Psychosocial Effects of living with CHD

-Anxiety regarding their wellbeing and how diagnosis will affect their lifestyle

-A patient feels guilty for lifestyle choices which they believe has lead to their condition of CHD.

-People with CHD may socially isolate themselves as a result of depression as a possible side effect

from the medication.

-Depression may lead to the patient becoming less motivated and lead less functional roles in life.

Physical changes that have to be made

-Taking prescribed medications (eg):

-Beta Blockers (reduce Angina, Blood

pressure, and slows heart rate)

-Changes in Diet

-Picking up exercise (aerobic and Cardiovascular((?))

-Stopping with old smoking habits

-Surgical route:

-Angioplasty: placing a stent in an artery to increase

the size of an arteries lumen (previously mentioned).


6/11

Case study: Merseyside

Merseyside is a county in North West England, with a population of 1.38 million. It borders Lancashire (to the

north east), Greater manchester (to the east) and Cheshire (to the south and south west).

What is the current situation with CHD in Merseyside?

-Merseyside is part of the North West Public Health Observatory (NWPHO), which means it has to

produce a public information report on tackling CHD. It attempts to do this by bringing together local

and national information resources, to enhance links between the environment, lifestyle and health.

-The report will also look into details such as Key socio-economic factors, as well as key behavioural

risk factors for CHD.

The report focuses on key causes and high risk factors of CHD, such as smoking and then considers and actsupon methods suggested to reduce levels of smoking. The report mentions: smoking cessation services,

helplines, school programmes, and media campaigns. It then goes into more detail, talking about how each

point should be implemented and developed. For example, to expand upon the cessation services, the report

mentions that there should be primary care advice, as well as specialist clinics and one to one sessions.

The full list of initiatives:

-Initiatives to reduce smoking


7/11

-Initiatives to reduce the prevalence of CHD risk factors in the population (diet, physical activity for all

age ranges including incentives for employees o cycle/ walk to work, and including all age ranges inthis - from children to the elderly being involved in physical activity)

-Reducing Obesity (Diet, physical activity, behavioural therapy)

-Key environmental factors (Air pollution, Passive smoking, Water quality, poverty- material ,

employment and job security)

-Initiatives to reduce Social

Inequalities (behavioural

factors,material,psychosocial)

-Prevention of CHD

(methods and plans of

action):


8/11


9/11

Deaths in Merseyside and Cheshire (combined) (From a report)


10/11

UK CVD costs in 2006. (source: Brussels EU CV Disease Statistics)

Total cost: 30.699 Billion Pounds

Breakdown of figures:

Informal Care: 8.3 billion pounds

Production loss: 8.3 billion pounds

Healthcare: 14.1 billion pounds

Informal Care production loss healthcare


11/11

Heart Of Mersey

-Established in 2003, independent organisation funded by the NHS and

local authorities across sub region of Cheshire and Merseyside.

-Managing programmes that focus on the conditions that actively

contribute to poor health, such as poor diet, tobacco, physical activity.

-Strong local voice for regulatory activity and policy, up to internationallevels to promote an environment with healthier choices.

-Their upstream population based approach is cost effective and is more effective in reducing CHD levels as it

has a greater impact than medical interventions or individually based approaches.

Aims of Heart of Mersey organisation

-To promote a healthier environment whereby premature death and disability form CVD/CHD

is reduced.

-Health inequalities are addressed in different social areas/ religious groups

-Promoting or continuing to do research

-Advice and Advocacy services and to undertake campaigning.

Its partner enterprises:

-HM Partnerships was founded in 2008

-European Healthy Stadia Network founded in 2012

Documents

The Truth About Coronary Heart Disease CHD