Cardiovascular disease: Reducing risk and improving heart function

Cardiovascular disease symptoms and definitions

Cardiovascular disease is an umbrella term for various conditions affecting aspects of the entire cardiovascular system. The process leading to cardiovascular disease can take years to develop before symptoms are typically observed. The most types of cardiovascular diseases in Australia and common symptoms of cardiovascular disease include:

High blood pressure

High blood pressure, also known as hypertension, is an elevation in blood pressure due to the heart having to pump harder and the blood vessels becoming less elastic. Symptoms include mild headaches, a flushed appearance to the face, shortness of breath, nose bleeds, and visible blood vessels in the white parts of the eye.

Heart attack

Also called myocardial infarction, a heart attack occurs suddenly, and is an emergency requiring urgent attention. It occurs when the heart is starved of blood, due to a blocked artery, and can lead to death.

Symptoms tend to be, especially for men, chest pain or discomfort, neck or upper back pain, or arms, nausea or vomiting, indigestion, upper body discomfort, dizziness, shortness of breath and extreme fatigue.

Some people may have no symptoms, while others may have:

• Pain in the jaw, throat, or neck
• Pain in the abdomen or back
• Angina (heavy, dull or sharp chest pain or discomfort)
• Nausea, vomiting, fatigue, shortness of breath
• Or the same symptoms as men

Call 000 for an ambulance if any of these symptoms occur. It is better to be safe than sorry.

Congestive heart failure

Heart failure occurs when the heart muscles become so weak they cannot adequately pump enough blood to nourish cells. The most common type can occur due to ‘stiff’ heart muscles, called heart failure preserved ejection fraction (HFpEF), preventing the heart from relaxing properly. Hypertrophic cardiomyopathy is related to a genetic mutation that when ‘expressed’ (switched on) can cause the walls of the heart to stiffen, and thicken, limiting how much blood the ventricle can take in and pump out.

Symptoms of congestive heart failure include shortness of breath, swelling of the feet, ankles and legs, neck veins or abdomen, leg cramps, and fatigue. Heart failure can lead to cardiac arrest, with a person showing sudden loss of responsiveness and no normal breathing.

Atrial fibrillation

Atrial fibrillation is where the heart can ‘flutter’ and race, and if unmedicated, can pose a risk of suffering a stroke. Symptoms can occur over hours, or days, and can be recurrent or permanent. Symptoms include heart palpitations or the sense of the heart racing, shortness of breath, dizziness, feeling weak or fatigued, and chest pain.

Acute coronary syndrome

Acute coronary syndrome is an umbrella term for all situations where blocked blood flow affects the heart, which often leads to a heart attack.

Stroke

A stroke occurs when a blood clot blocks parts of the brain, the leading cause of disability worldwide. A helpful way to remember stroke symptoms is the acronym F.A.S.T.:

• F – Face drooping, or numb, ask the person to smile
• A – Arm weakness, or numb, ask the person to raise both arms
• S – Speech difficulty, slurred, unable to speak, hard to understand, jumbled words – ask them to repeat a sentence, like ‘the sky is blue’
• T – Time to call 000 – if the person shows any of these symptoms, even if they recover, get them to a hospital immediately – time is of the essence

Peripheral artery disease

Also called peripheral vascular disease, occurs when the narrowing of the arteries restricts blood flow to parts of the body other than the heart or brain, often to the periphery such as feet, toes, and legs. Symptoms therefore involve coldness, numbness or cramps in the legs or feet, colour changes on the legs, slow growth of toenails, and sores on the legs or feet that won’t heal.

Atherosclerosis

Atherosclerosis is the most common cause of all of the above conditions, and results from a combination of the build-up of fatty plaques on the walls of arteries, and the hardening of the arteries. Those with mild atherosclerosis tend to have no symptoms. Symptoms normally become apparent once the arteries are quite blocked, and include chest pain or angina (pain upon exercise), pain, numbness, cramping or weakness in arms or legs, and high blood pressure. Left untreated, atherosclerosis can lead to a stroke.

Pericarditis and myocarditis

Pericarditis and myocarditis is inflammation of the muscle wall of the heart (myocardium) or the fluid filled sac surrounding the heart (pericardium) caused by a range of factors such as viruses (COVID-19), infection, vaccination, environmental toxins, chemotherapy, or radiation.

Symptoms of myocarditis include chest pain/pressure, shortness of breath, feeling lightheaded, fluid retention in extremities, and heart palpitations. Symptoms of pericarditis include sharp, stabbing pain worsened by coughing, swallowing or taking deep breaths, pain the back, beck or left shoulder, fatigue, dry cough, abnormal heart rhythm, and swelling in the feet or legs.

Cardiovascular disease causes

Atherosclerosis is the primary cause of cardiovascular diseases and can occur over decades, maybe even starting as early as childhood in some people. It is generally characterised by the progressive build up of fatty deposits, cholesterol, cellular debris, fibrin (a clotting factor in the blood), calcium and other substances forming a plaque. As plaque builds up, it thickens the wall of the blood vessel which narrows the inside of the vessel and reduces blood flow, the amount of oxygen and nutrient distribution to the body. This affects the periphery first and small vessels of the fingers, toes, kidneys, heart, brain, eyes and other organs.

Plaque that has formed inside vessels can pose a risk by pieces breaking off and blocking smaller vessels, and plaque in narrow arteries can lead to blood clots (thrombus), also cutting off blood supply. A blocked artery to the heart is called a heart attack, and to the brain is called a stroke, and when arteries to the extremities like the legs are blocked it can cause tissue death (gangrene).

Cardiovascular disease and inflammation

In most cases, the underlying cause of cardiovascular disease is associated with systemic inflammation. The immune system initiates an inflammatory process in the body that doesn’t resolve and therefore becomes chronic. This inflammatory response can affect the function of the inner lining of your heart and blood vessels, making it increasingly more difficult for the heart to circulate the blood, and for oxygen and nutrients to move between the blood and the cells.

Over time, the blood vessels lose their elasticity, become thicker, and atherosclerotic plaques begin to form in the walls of the arteries.  Free radicals build up in the cells and interfere with metabolism and cellular energy function, and this in turn begins to affect how different organs and tissues work leading to progressive cardiovascular and cardiometabolic dysfunction.

What are the risk factors for cardiovascular disease?

Risk factors of cardiovascular disease include:

• Smoking affects blood flow by increasing the stickiness of the blood cells and reduces the blood’s ability to carry oxygen. Impaired blood flow increases the likelihood of blockages, which is why smokers have double the risk of a heart attack than a non-smoker
• Unhealthy diet / poor nutrition can leave the blood vessels without the building blocks to maintain health, elasticity and repair
• Chronic stress can affect all aspects of health, can increase inflammation and heart rate, and contribute to worsening other risk factors
• Dysregulation of blood sugar can damage blood vessels and cause the cells to become resistant to insulin, leading to type 2 diabetes
• Dysregulation of cholesterol such as high LDL cholesterol (in particular lipoprotein(a))and low HDL, which can oxidise and contribute to plaque build up
• Diabetes (Type 1 and Type 2) – diabetics are twice as likely to develop cardiovascular disease
• High blood pressure which can overload the heart and blood vessels, and speed up atherosclerosis
• Sedentary lifestyle can contribute negatively to all aspects of health, and increase other risk factors of cardiovascular disease
• Being overweight or obese can contribute to risk factors and other health problems
• Aging – more 25% of people over 75 have cardiovascular disease
• Gender – men are slightly more at risk, however, women are often underdiagnosed. After menopause, the risk for women is almost the same as for men
• Family history – there is an additional risk if you have a close family member such as a grandparent, parent or sibling with cardiovascular disease
• Ethnicity – Aboriginal and Torres Strait Islander people are at higher risk
• Environmental factors, such as environmental toxins, heavy metals, and biotoxins

Autoimmune disease and cardiovascular disease

A recent epidemiological study shows individuals with autoimmune disease have increased risk of developing cardiovascular disease. It is likely that increased levels of inflammation and damage due to altered immune responses and autoantibody attack may contribute to cardiovascular damage.

New research in 2021 and 2019 has found microbiome changes due to a diet high in red meat may be associated with higher levels of molecules trimethylamine N-oxide and phenylacetylglutamine, which have also been associated with cardiovascular disease.

Cardiovascular disease treatment – the conventional approach

Conventional medicine promotes the prevention of cardiovascular disease through education, heart health checks which are covered by Medicare and promotion of regular check ups with your GP.

Many programs and initiatives by the Heart Foundation, the Stroke Foundation, the National Health and Medical Research Council, and the Medical Research Future Fund are supporting research into the prevention of cardiovascular diseases.

At present, if you have an existing cardiovascular condition, your GP or cardiologist may recommend losing weight, quitting smoking and healthy eating, alongside pharmaceutical medicines that are usually prescribed long term.

Surgical and non-surgical procedures may be required, depending on the severity and type of your condition. Surgery includes open heart surgery, septal myectomy, valve replacements, or cardiac implantable devices to stimulate or regulate heart rhythm. In severe conditions, heart transplant surgery may be required.

Your GP / cardiologist may prescribe medications for:

• Managing blood pressure – angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers, or thiazide diuretics
• Lowering cholesterol – lipid modifying statins, and maybe also ezetimibe, bile acid binding resins, nicotinic acid and fibrates
• Antiplatelet agents for coronary heart disease e.g. aspirin, clopidogrel, prasugrel, ticagrelor, anticoagulants; warfarin, ACEI, ARB, beta blockers, statins, aldosterone antagonists, or short acting nitrates
• Stroke – blood pressure lowering drugs such as ACEI, with or without a diuretic, anticoagulants such as long-term low dose aspirin, cholesterol-lowering drugs, and diabetes management
• Chronic heart failure – ACEI, beta-blockers, aspirin, statins, ACEI or ARB, diuretics, aldosterone antagonists, digoxin, angiotensin II receptor antagonists, polyunsaturated fatty acids, direct sinus node inhibitors, iron, and other drugs
• Metabolic conditions – metformin, insulin

Many of these medications are life-saving, however all pharmaceutical medications have side effects, e.g. long term aspirin can cause damage to the lining of the stomach, which can cause gastric ulcers, it can alter the microbiome make up and diversity impacting all aspects of health. For this reason, many people are looking for natural ways to improve their cardiovascular health using the cardiovascular disease functional medicine approach, to reduce their risk factors, offset some of the adverse effects of their necessary medication and be generally healthier and feel well.

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