Cardiovascular disease
This is not one illness but a family of conditions sharing a single stage: the heart and the arteries.
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Medicines commonly prescribed for Cardiovascular disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 40 mg/tabletsActive substance: atorvastatinManufacturer: Kern Pharma S.L.Prescription requiredDosage form: TABLET, 40 mgActive substance: atorvastatinManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 40 mgActive substance: atorvastatinManufacturer: Laboratorio Stada S.L.Prescription required
This is not one illness but a family of conditions sharing a single stage: the heart and the arteries. It takes in angina and heart attack, stroke, disease of the leg arteries and disease of the aorta. All of them rest on the same process in the vessel wall and are fed by the same set of habits and metabolic problems. That is why someone with narrowed heart arteries should also be asked about their legs and their head: the changes usually spread through the whole arterial tree at once, and merely surface as complaints in different places at different times.
One process, different organs
Atherosclerosis lies underneath it all. Cholesterol is laid down in the wall of an artery — most often where the flow splits and swirls — inflammatory cells gather around it, and a plaque slowly grows. For years it gets in nobody's way: the vessel has room to spare. Trouble arrives by two routes.
The first is slow. The plaque narrows the artery to the point where blood is still enough at rest but no longer enough under load. That is where the pressing chest pain on the stairs comes from, and the calf pain that forces a stop after two hundred metres.
The second is sudden and far more dangerous. The cap of the plaque tears, blood meets what is inside it, and within minutes a clot grows on the spot and shuts the artery completely. This is how heart attacks and most strokes happen. Hence a feature that confuses many people: the catastrophe often strikes someone who the day before climbed five flights without getting out of breath. How stable a plaque is matters more than how big it is.
There is a third route, a quiet one. Years of raised blood pressure and high blood sugar wreck the smallest vessels — in the kidneys, in the retina, deep in the brain. Not a single dramatic episode occurs, yet eyesight, memory and kidney function slowly decline.
The four main forms
- Coronary heart disease. The arteries of the heart itself are affected. It shows up as angina — heaviness or burning behind the breastbone on exertion, in cold air, after a heavy meal — as a heart attack, and in time as heart failure, when the weakened muscle pumps less well and breathlessness and swelling appear.
- Stroke and transient ischaemic attack. A patch of brain is left without blood because of a clot or, less often, a bleed. A transient attack looks the same, but the symptoms clear on their own within minutes or hours. That is not a lucky escape, it is a warning: the risk of a full stroke is highest over the following days, and it has to be investigated at once, even if the person already feels fine.
- Peripheral arterial disease. The arteries of the legs narrow. The first sign is pain in the calf or thigh on walking that settles after standing still for a couple of minutes. Later the hair falls from the lower legs, the foot turns cold and pale, and night pain in the toes appears along with ulcers that fail to heal for months.
- Disease of the aorta. The body's largest vessel can widen — that is an aneurysm — or split along its layers. An aneurysm stays silent for years and is often found by chance on an abdominal ultrasound, yet if it ruptures the time available is measured in minutes.
When to call an ambulance rather than wait for morning
These signs are not watched at home and not sat out.
- Pressing or burning chest pain lasting more than a few minutes, especially spreading to the left arm, neck, jaw or back, with cold sweat, nausea and sudden weakness. In women, in older people and in those with diabetes a heart attack more often comes without the classic pain: only breathlessness, faintness, an unexplained sense of being wrung out.
- The face has dropped on one side, an arm has gone weak, speech has become slurred — even if it all passed off within five minutes. Sudden blindness in one eye, double vision, loss of balance and an inability to understand what is being said belong here too.
- A sudden severe headache unlike any before, particularly with vomiting and drowsiness.
- Tearing pain in the chest or between the shoulder blades that travels down the back — this is how a dissection of the aorta announces itself.
- A leg or arm has suddenly turned pale, cold, numb and painful — a clot has closed the artery, and the time available to restore the blood flow is counted in hours.
In both heart attack and stroke, treatment works better the sooner the person reaches hospital: dissolving the clot and pulling it out both act within a narrow window. Waiting to see whether it passes off by itself costs more here than anywhere.
What actually shifts the risk
There are many contributors, and the more of them come together the more they amplify each other — the risk does not add up, it multiplies.
- Blood pressure. The heaviest of the factors you can change. For years raised pressure damages the artery wall and overloads the heart while being almost unnoticeable: most people get no headache from it, and go on considering themselves healthy.
- Smoking. Damages the inner lining of the vessels and makes the blood prone to clotting. Waterpipe, vape and heated tobacco belong in the same column, as does spending time regularly in a smoky room.
- Cholesterol. Low-density lipoproteins are the very material a plaque is built from. The level depends not only on food but on what was inherited.
- Diabetes and prediabetes. High blood sugar spoils the vessels and dulls pain into the bargain, so a heart attack in someone with diabetes can pass almost unnoticed.
- Chronic kidney disease. Travels hand in hand with heart disease: each one makes the other worse.
- Weight and waist size. What is dangerous is less the weight itself than the fat around the abdomen, which interferes actively in the metabolism.
- Sitting still. Drags blood pressure, weight and blood sugar along with it all at once.
- Age, sex, family history. Men meet the disease earlier; women catch up after the menopause. Early disease in close relatives — men before 55, women before 65 — is a weighty signal and worth mentioning to the doctor.
- Alcohol. Raises blood pressure and weight; no safe amount that would protect the heart has been found.
- Sleep. Snoring with pauses in breathing is a common reason for blood pressure that responds poorly to medication.
Causes that rarely come to mind
Sometimes the disease arrives early and habits do not explain it. These situations are worth knowing: in every one of them there is something to be done.
- Familial hypercholesterolaemia. An inherited disorder of cholesterol handling: the level is high from birth and the heart attack comes at forty or earlier. Suspect it when relatives had early heart attacks, when cholesterol is very high in a slim person eating ordinary food, when there are firm thickenings over the Achilles tendons, or a pale ring around the edge of the iris at a young age.
- Chronic inflammation. Rheumatoid arthritis, psoriasis, lupus, inflammatory bowel disease and untreated HIV infection speed up atherosclerosis in their own right.
- Complications of pregnancy. Pre-eclampsia, gestational diabetes and premature birth raise the risk for decades afterwards — something a woman is usually never told.
- Cancer treatment. Some chemotherapy drugs and radiotherapy to the chest damage the heart and vessels years after recovery.
- Cocaine and amphetamines. Cause spasm and heart attack in young people whose arteries are undamaged.
- Inherited weakness of connective tissue, Marfan syndrome for example, is a cause of aortic dissection at a young age.
What pays off most
- Stopping smoking. No drug delivers a gain of that size, and it shows within the first year, whatever the age at which the person stops.
- Movement. The benchmark is around 150 minutes of moderate activity a week: brisk walking, cycling, swimming. Better to start with whatever is manageable and add gradually; half an hour of walking a day yields more than one heroic run a month.
- Food. Vegetables, pulses, whole grains, fish, nuts and vegetable oils instead of processed meat, pastries and sugary drinks. Salt up to 5 grams a day — and most of it comes not from the salt cellar but from bread, cured meats and ready-made sauces.
- Weight. Losing 5–10 per cent noticeably improves blood pressure and blood sugar; there is no need to return all the way to the weight of one's twenties.
- Alcohol. The less the better; giving it up entirely proves easier than counting every day.
- Checking blood pressure, cholesterol and blood sugar regularly after forty, and earlier with a family history or excess weight. All three can be off for years without giving any sign, and the only way to find out is to measure.
When medication is needed
Lifestyle does not cover everything. If the overall risk is high, or the disease has already declared itself, drugs are added to it, and the decision is made on the whole picture at once rather than on a single figure in a test result.
Usually several groups are involved: cholesterol-lowering agents, statins first among them; blood pressure medicines; antiplatelet drugs after a heart attack, a stroke or a stent; anticoagulants in atrial fibrillation, which on its own sharply raises the risk of stroke. Choosing them and combining them is the doctor's job: a regimen borrowed from an acquaintance or from somebody else's prescription is more dangerous here than anywhere else.
Two warnings. These medicines are not taken as a course — they work while they are being taken, and stopping returns the risk to where it was. And if side effects appear, tell the doctor: there is almost always a substitute within the same group, whereas quietly stopping leaves a person unprotected at the worst possible moment.
Online consultation
At an online appointment the doctor takes your situation apart piece by piece: gathers the risk factors, looks over tests already done and your blood pressure readings, judges how far what you describe resembles angina, and says which investigations are worth arranging in the near future. The same appointment covers what your cholesterol and blood sugar figures mean in your particular case, and produces a clear plan for food, activity and taking the medicines you have been prescribed. An online appointment is not for an acute situation: chest pain or signs of a stroke need an ambulance, not a message.
This material is for information only and does not replace medical advice.
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Online doctors for Cardiovascular disease
Discuss your symptoms and possible next steps for Cardiovascular disease with a doctor online.
