JOEP FERNANDO Coronary Heart Disease ! ! Causes, Risks, Effects, Preventative initiatives Case Study: Merseyside 21 January 2014 Featured on: joepfernando.co.uk ! CARDIOVASCULAR DISEASE 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 and thus 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 muscle’s 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 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 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. ! ! ! ! ! ! ! ! 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). ! ! ! ! ! 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 acts upon 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 -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 in this - 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): ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Also included are: -Non pharmacological interventions -eg. Mediterranean diet -Pharmacological interventions - new cholesterol lowering drugs (Statins) There have also been training and development projects in merseyside, to implement the National service Framework (NSF) fro Coronary Heart disease. The project: ! ! 1. A comprehensive, ongoing nurse education programme in CHD treatment and management. 2. Clinical support network groups, both within specialties (ie heart failure management) and across areas of provision of CHD management (ie nurses from primary, secondary and tertiary care who manage the same patients at different stages of their treatment). 3. Site visits to other areas to examine the delivery of care for patients with CHD, learn from their experiences and share information regarding effective initiatives. 4. An annual conference to share the benefits of the project both locally and nationally. ! ! ! ! ! ! ! ! ! ~NWPH.net (public health England) Deaths in Merseyside and Cheshire (combined) (From a report) ! ! ! UK CVD costs in 2006. (source: Brussels EU CV Disease Statistics) Informal Care ! 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 ! ! production loss healthcare 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 international levels 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 -Health inequalities are addressed in different social areas/ religious groups -Promoting or continuing to do research -Advice and Advocacy services and to undertake campaigning. ! ! ! ! ! ! -To promote a healthier environment whereby premature death and disability form CVD/CHD is reduced. Its partner enterprises: -HM Partnerships was founded in 2008 -European Healthy Stadia Network founded in 2012
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