Cardiovascular disease

	Cardiovascular diseases (problems affecting the heart and blood vessels) are the leading cause of illness and death for both men and women in the United States. About 44% of the deaths in this country are attributable to cardiovascular disease. The majority stem from atherosclerosis.
	Before menopause, women tend to have lower blood pressure and fewer heart attacks than do men of equivalent age. (Female hormones exert a protective effect against heart attacks). After menopause, the rates among women are higher than those of men and increase with advancing age.
	The American Heart Association estimates that 69 million Americans have one or more forms of cardiovascular disease. The table below indicates the prevalence and mortality of the most common types.

Prevalence of cardiovascular disease (1993) estimates

Condition		Prevalence*	Mortality
High blood pressure	63,640,000	32,790
Heart attack and angina	6,230,000	489,340
Stroke	3,020,000	145,340
Rheumatic heart disease	1,320,000	6,000
Congenital heart disease	930,000	5,700

*Some individuals have more than one of the listed conditions.
Reproduced with permission. 1993 Heart & stroke facts statistics. © American Heart Association.
From Cournacchia HJ, Barrett S: Consumer health, St. Louis, 1993, Mosby.

HEART ATTACK–SIGNALS AND ACTION
	Know the warning signals of a heart attack.
	•	Uncomfortable pressure, fullness, squeezing or pain in the center of your chest, 			lasting 2 minutes or more.
	•	Pain may spread to shoulders, neck, or arms.
	•	Severe pain, dizziness, fainting, sweating, nausea, or shortness of breath may also 			occur.
	•	Not all these signals, however, are always present. Don’t wait. Get help immediately.

	Know what to do in case of an emergency.
	•	If you are having chest discomfort that lasts for 2 minutes or more, call the 			emergency rescue service.
	•	If you can get to a hospital faster by car, have someone drive you.
	•	Find out which hospitals in your area offer 24-hour emergency cardiac care.
	•	Select in advance the facility nearest your home and office and tell your family and 			friends to call this facility in an emergency.
	•	Keep a list of emergency rescue service numbers next to your telephone and in a 			prominent place in your pocket, wallet, or purse.

RISK FACTORS OF HEART DISEASE
Major risk factors that cannot be changed
	Heredity--It appears that a tendency toward heart disease or atherosclerosis is heredity.
	Male sex--Men have a greater risk of heart attack than women. Even after menopause, 			when women’s death rate increases, it never reaches that of men.
	Race--Black Americans have moderate hypertension twice as often as whites and 			severe hypertension three times as often.
	Age--Fifty-five percent of all heart attack victims are age 65 or older, of those who die, 			more than four out of five are over 65.

Major risk factors that can be changed
	Cigarette smoking--The heart attack death rate among people who do not smoke cigarettes is considerably lower than for people who smoke. For those who have given up the habit, the death rate eventually declines almost to that of people who have never smoked. Don’t smoke cigarettes.
	High blood pressure--A major risk factor of stroke and heart attack, high blood pressure usually has no specific symptoms but can be detected by a simple, painless test. A person with mild elevations of blood pressure often begins treatment with a program of weight reduction, if overweight, and salt (sodium) restriction before drugs are recommended.
	Blood cholesterol levels--Too much cholesterol can cause buildups on the walls of arteries, narrowing the passageway through which blood flows, and leading to heart attack and stroke. A doctor can measure the amount of cholesterol in the blood by a simple test. Since the body gets cholesterol both through diet and by manufacturing it, a diet low in saturated fat and cholesterol will help lower the level of blood cholesterol if it is too high. Medications also are available to maintain cholesterol levels within the normal range.

Other contributing risk factors
	Diabetes--Diabetes appears most frequently during middle age, more often in people who are overweight. In its mild form, diabetes can escape detection for many years, but it can sharply increase a person’s risk of heart attack, making control of other risk factors even more important. A doctor can detect diabetes and prescribe changes in eating habits, weight-control and exercise programs, and drugs, if necessary, to keep it in check.
	Obesity--In most cases, obesity simply results form eating too much and exercising too little. It places a heavy burden on your heart. In addition, obesity is associated with coronary heart disease primarily because of its influence on blood pressure, blood cholesterol, and precipitating diabetes. To reduce weight, doctors usually recommend a program that combines exercise with a low-calorie diet.
	Lack of exercise--Lack of exercise has not been clearly established as a risk factor for heart attack. But when combined with overeating, lack of exercise may lead to excess weight, which is clearly a contributing factor. A doctor should be consulted for the physical activities that best suit the age and physical condition of the individual.
	Stress--It’s practically impossible to define and measure a person’s emotional stress level. Moreover, each of us reacts differently to it. All human beings feel stress--life without it would be dull, indeed. But excessive stress over a long period may create health problems in some people. Most doctors agree that reduction of emotional stress will benefit the health of the average individual.

HYPERTENSION
	A blood pressure of 120/80 is considered normal. Hypertension can be classified as follows:
	mild hypertension =
		diastolic pressure between 90 and 104
	moderate hypertension =
		diastolic pressure between 105 and 115
	severe hypertension =
		diastolic pressure above 115
	isolated systolic hypertension =
		diastolic below 90
		but systolic above 160
	The goal of treatment is diastolic pressure below 90 and systolic below 140.

CHOLESTEROL LEVELS

NCEP* classification of serum cholesterol levels (mg/dl)

	Total cholesterol
Under 200		Desirable
200-239		Borderline high-risk
240 or more		High risk

	LDL cholesterol
Under 130		Desirable
130-159		Borderline high-risk
160 or more		High risk

*National Blood, Lung, and Heart Institute’s National Cholesterol Education Program.

STROKE

	A stroke occurs when an artery to the brain bursts or becomes clogged by a blood clot or other particle. Deprived of oxygen, nerve cells in the affected area of the brain cannot function and die within minutes, resulting in loss of function in the parts of the body that are controlled by these cells.

Risk factors of stroke
	Some of the factors that increase the risk of stroke are congenital, whereas others result from the hazards of life. Some of these factors can be minimized by the individual and with a doctor’s help. Other factors cannot be changed.

Risk factors that cannot be changed
	Age--The incidence of stroke is strongly related to age. In fact, the incidence of stroke more than doubles in each successive decade for people over 55 years old.
	Sex--The risk of stroke is greater in men than in women. However, in women who take oral contraceptives the risk of stroke is slightly increased. Women who are also heavy smokers may aggravate this risk further.
	Race--The risk of death and disability from stroke is much greater among black Americans than among white Americans. This may be a result of the greater prevalence of high blood pressure among blacks.
	Diabetes mellitus--Although diabetes is treatable, the fact that a person has diabetes still makes it much more likely that a stroke will occur.
	Prior stroke--The risk of stroke for a person who has already suffered a stroke is many times that of a person who has never had a stroke.
	Heredity--The risk of stroke is greater in people who have a family history of stroke.
	Asymptotic carotid bruit--As an indication of existing atherosclerosis, a bruit is an abnormal sound heard when a stethoscope is placed over an artery (in this case, the carotid artery, which is in the neck). Carotid bruit clearly indicates an increased stroke risk, although a bruit mainly indicates that atherosclerosis is present and doesn’t necessarily mean the carotid artery with the bruit will become clogged and a stroke will result.

Risk factors that can be changed
	High blood pressure--The control of high blood pressure will reduce the risk of stroke.
	High red blood cell count--A marked increase, as well as a moderate elevation, in the red blood cell count may be a risk factor of stroke.
	Heart disease--A diseased heart increases the risk of stroke in two ways: as a failing pump and as a source of emboli, clots that form in the heart and could travel to the arteries leading to the brain and cause a blockage. Good management of heart disease reduces the risk of stroke.

Warning signals of stroke
	Know the warning signals of stroke.
	•	Sudden, temporary weakness or numbness of the face, arm, and leg on one side of the body.
	•	Temporary loss of speech or trouble talking or understanding speech.
	•	Dimness or loss of vision, particularly in only one eye.
	•	Unexplained dizziness, unsteadiness, or sudden falls.
	Many major strokes are preceded by “little strokes,” warning signals like the above, experienced days, weeks, or months before the more severe event.
	Prompt medical or surgical attention to these symptoms may prevent a fatal or disabling stroke from occurring.