Clinical Pharmacy: Pathophysiology & Therapeutics
Cardiovascular Diseases (CVDs)

KEY FACTS

Leading Global Cause of Death: CVDs are the leading cause of death globally.

Mortality (2022): An estimated 19.8 million people died from CVDs in 2022, representing approximately 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke.

Burden in LMICs: Over three quarters of CVD deaths take place in low- and middle-income countries.

Premature Deaths: Out of the 18 million premature deaths (under the age of 70) due to noncommunicable diseases in 2021, at least 38% were caused by CVDs.

Prevention: Most cardiovascular diseases can be prevented by addressing behavioural and environmental risk factors.

Early Detection: It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin.

OVERVIEW

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include:

Coronary Heart Disease – a disease of the blood vessels supplying the heart muscle. Cerebrovascular Disease – a disease of the blood vessels supplying the brain. Peripheral Arterial Disease – a disease of blood vessels supplying the arms and legs. Rheumatic Heart Disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria. Congenital Heart Disease – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth. Deep Vein Thrombosis and Pulmonary Embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can be caused by bleeding from a blood vessel in the brain or from blood clots.

RISK FACTORS FOR CARDIOVASCULAR DISEASE

Behavioural & Environmental Risk Factors

  • Unhealthy diet (excess salt, sugar, fats)
  • Physical inactivity
  • Tobacco use
  • Harmful use of alcohol
  • Air pollution (key environmental factor)

Intermediate Risk Factors (Measurable in Primary Care)

Effects of behavioural risks manifest as: raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity.

Risk Reduction Strategies

  • Cessation of tobacco use
  • Reduction of dietary salt
  • Increased fruit and vegetable intake
  • Regular physical activity
  • Avoiding harmful use of alcohol
  • Health policies for healthy environments and improved air quality
  • Drug treatment of hypertension, diabetes, and high blood lipids.

Underlying Determinants

Globalization, urbanization, population ageing, poverty, stress, and hereditary factors.

COMMON SYMPTOMS OF CARDIOVASCULAR DISEASES

Symptoms of a Heart Attack

  • Pain or discomfort in the centre of the chest; and/or
  • Pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.
  • Difficulty in breathing or shortness of breath;
  • Nausea or vomiting;
  • Light-headedness or faintness;
  • A cold sweat; and turning pale.
  • Note: Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.

Symptoms of a Stroke

Most common: Sudden weakness of the face, arm, or leg, most often on one side of the body.

  • Sudden numbness of the face, arm, or leg, especially on one side.
  • Confusion, difficulty speaking or understanding speech.
  • Difficulty seeing with one or both eyes.
  • Difficulty walking, dizziness, loss of balance or coordination.
  • Severe headache with no known cause.
  • Fainting or unconsciousness.

Immediate medical care is required.

RHEUMATIC HEART DISEASE

Characteristics

Caused by damage to heart valves and muscle from inflammation/scarring due to rheumatic fever. Rheumatic fever is an abnormal response to streptococcal bacteria (starts as sore throat/tonsillitis in children). Affects children in developing countries, especially in poverty. Accounts for about 2% of global CVD deaths.

Symptoms of Rheumatic Heart Disease

Shortness of breath, fatigue, irregular heartbeats, chest pain, fainting.

Symptoms of Rheumatic Fever

Fever, pain and swelling of the joints, nausea, stomach cramps, vomiting.

CVDs AS A DEVELOPMENT ISSUE IN LOW- AND MIDDLE-INCOME COUNTRIES
  • 80% of global CVD deaths occur in LMICs.
  • Lack of primary health care programmes for early detection and treatment.
  • Less access to effective, equitable health care services.
  • Late detection, death at a younger age (in productive years).
  • The poorest are most affected.
  • CVDs contribute to poverty at household level due to catastrophic health spending.
  • Heavy macroeconomic burden on LMIC economies.
REDUCING THE BURDEN OF CARDIOVASCULAR DISEASES

Key strategy: Inclusion of CVD management interventions in universal health coverage packages. Health systems often require significant investment for effective CVD management.

Evidence-Based Interventions

  • Hypertension programmes at primary care level are efficient and cost-effective, reducing CHD and stroke.
  • Access to appropriate technology and medication is crucial.

Essential Medicine List for CVD Management

  • Aspirin
  • Beta-blockers
  • Calcium channel blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Diuretics
  • Statins

Prompt management of acute events (heart attack, stroke) is vital.

Surgical & Interventional Procedures

  • Coronary artery bypass
  • Balloon angioplasty (to open blocked artery)
  • Valve repair and replacement
  • Heart transplantation
  • Artificial heart operations

Medical Devices

Pacemakers, prosthetic valves, patches for closing holes in the heart.