What Is Cardiovascular Disease? What Are Its Risk Factors and How Can It Be Prevented?

Cardiovascular disease, among the most important health problems, includes heart and blood vessel diseases grouped into four main categories:

• Manifesting as myocardial infarction (MI), known as heart attack, severe chest pain called angina pectoris, heart failure and coronary death: coronary heart disease (CHD)
• Manifesting as stroke and transient ischemic attack: cerebrovascular disease (brain vessel disease)
• Affecting arteries supplying the hands and feet: peripheral artery disease
• Aortic atherosclerosis and thoracic or abdominal aortic aneurysm

Referring to blockage or severe narrowing of vessels supplying the heart, coronary heart diseases are particularly important because they account for one-third of all cardiovascular diseases.

What is cardiovascular disease? Why does it matter?

Cardiovascular diseases are the number 1 cause of death worldwide and in Türkiye. According to the World Health Organization (WHO), worldwide they cause 18 million deaths annually —in other words, account for %31 of annual global deaths. Heart attack and stroke account for approximately %85 of cardiovascular (CVD) deaths. By 2030, deaths from these diseases are estimated to rise by approximately %30.

What are the causes / risk factors for cardiovascular disease?

In developing cardiovascular disease, risk factors include smoking/tobacco use, physical inactivity, obesity, unhealthy diet, diabetes, hypertension, dyslipidemia (cholesterol disorders) and a family history of cardiovascular disease. Alongside addressing risk factors, early diagnosis and timely treatment can substantially reduce these diseases.

For hyperlipidemia (high cholesterol), known risks such as smoking or hypertension and overall health guide whether medication is required.

• High LDL cholesterol,
• High triglycerides or
• Low HDL cholesterol increase adverse cardiovascular effects.

Your doctor can use the 10-Year Coronary Heart Disease Risk Estimate to calculate your coronary event (heart attack) risk over the next 10 years.

Tips for preventing cardiovascular disease

Although you cannot change certain risk factors such as family history, sex or age, important preventive steps can reduce others. Adopting a healthy lifestyle today can be the first step toward avoiding future heart problems.

Establishing a healthy lifestyle

1. Do not smoke or use tobacco

Smoking or using any tobacco is one of the most important cardiovascular risk factors. The risk is not limited to direct use but is also linked to 2nd- or 3rd-hand smoke . Tobacco contains over 7000 toxic/harmful chemicals that damage the heart and blood vessels, increase atherosclerosis (arterial narrowing), reduce vascular elasticity and can ultimately cause heart attacks.

Carbon monoxide in cigarette smoke reduces blood oxygen, forcing the heart to work harder to restore normal levels. This raises blood pressure (hypertension) and heart rate. Smoking also increases clotting risk, particularly increasing heart attack and stroke risk in women who use oral contraceptives.

Smoking 1 pack daily increases cardiovascular risk approximately 2-4-fold. Even seemingly less harmful light smoking—only 1 cigarette daily—has been proven to increase risk by nearly %50 compared with nonsmoking (see the relevant scientific study).

The relationship between e-cigarette use and cardiovascular disease has also been demonstrated in published studies. Bioactive nicotine and breakdown products in vapor may damage the cardiovascular system with long-term use.

Smokeless tobacco, other tobacco products and low-tar or low-nicotine cigarettes do not reduce cardiovascular risk. No form of smoking is safe for preventing heart disease or reducing its risk.

If you smoke, quit. If someone in your home smokes, encourage them to quit too.

Quitting smoking may be difficult, but living with a heart attack, stroke or other cardiovascular disease later is harder. If you succeed, heart disease risk begins falling soon afterward. Heart attack (coronary heart disease) risk decreases substantially after one year and approaches that of a nonsmoker within approximately 15 years.

2. Reduce alcohol

Alcohol amount is associated with cardiovascular risk. Heavy use may raise blood pressure and increase cardiomyopathy (heart muscle damage), stroke, arrhythmias and other cardiovascular risks. Excess also contributes to obesity, alcoholism, cancer, suicide and accidents.

Some studies, however, found positive cardiovascular effects with light-to-moderate drinking. Proposed protective mechanisms include beneficial effects on HDL cholesterol and clotting.

Moderate drinking is defined as approximately 2 glasses (20 gr) daily for men and 1 glass (10 gr) or less for women. Maintaining this delicate balance is difficult; alcohol consumed for presumed benefits can readily cause harm (see 12 diseases caused by alcohol). We therefore strongly advise neither nondrinkers to begin nor drinkers to increase consumption.

3. Eat healthily

The easiest and most suitable way to protect cardiovascular health is lowering cholesterol by reducing dietary saturated fat and trans fat. AHA recommends limiting saturated fat to < % 7 of daily calories and minimizing trans fats. Choose reduced-fat cheese and milk instead of full-fat versions, limit fried foods and favor meals prepared with vegetable oils.

Main saturated-fat sources:

• Red meat
• Full-fat dairy products
• Coconut and palm oils

Trans-fat sources:

• Fried foods and fast food
• Baked goods
• Packaged snacks
• Margarines
• Crackers, french fries and cookies
• Products labeled “partially hydrogenated” or “hydrogenated” contain trans fats

Excess SALT is harmful regardless of type

Dietary salt is a major determinant of blood pressure and cardiovascular risk. Even moderate reductions significantly benefit blood pressure. WHO recommends less than 5 grams per person daily to help prevent cardiovascular disease. However, a 2012 study found consumption in Türkiye was %14.8 gr. About %55 came from salt added during cooking, %32 from bread and %12 from table salt.

Salt-reduced Mediterranean Diet (DASH Diet) ranks first among major diets worldwide for cardiovascular protection.

A healthy diet includes fresh fruit and vegetables, whole grains, legumes, nuts such as hazelnuts and almonds, poultry such as chicken and turkey, and fish, but not fizzy drinks or sugary foods. Fiber-rich foods benefit health and may help lower cholesterol by about %10.

-Related topic: How much salt is too much?

4. Exercise and be physically active

Physical activity and exercise matter for health. Many studies demonstrate reduced coronary deaths and overall cardiovascular risk. People performing moderate activity on at least 4 days weekly for 30 minutes or longer have % 20-30 lower mortality risk than those insufficiently active.

NICE (National Istitute for Healthand Care Exellence) guidelines recommend assessment and preventive care for adults with or without cardiovascular disease (CVD) risk, including heart disease and stroke. The American Heart Association (AHA) and European Society of Cardiology (ESC) support these recommendations.

Recommended activity averages 150 minutes weekly of moderate aerobic exercise, cycling or brisk walking, or 75 minutes of vigorous aerobics, running or singles tennis. Vigorous activity for 1 minute provides benefits similar to 2 minutes of moderate activity.

In adults, 150 minutes of moderate activity weekly is considered to reduce ischemic heart disease risk by 30 percent and diabetes risk by 27 percent.

Gardening, cleaning, taking stairs instead of elevators, using cars less, getting off public transport 1-2 stops early and walking, or owning a dog and walking it morning and evening also benefit cardiovascular health. Rather than very exhausting exercise, increase intensity, duration and frequency for greater benefits.

Physical activity is important for energy balance (metabolic rate) and weight control. It preserves and improves the vessel lining (endothelial function), supports weight loss and maintenance, and improves abnormal blood glucose, blood pressure, lipid profiles and insulin sensitivity.

5. Aim for a healthy weight—avoid obesity!

Obesity is widespread worldwide in children as well as adults. Activity, avoiding unnecessary calories and maintaining healthy eating help achieve and preserve an ideal weight. This can be determined using body mass index (BMI) . BMI divides body weight (kg) by height in meters squared. Obesity is classified by BMI in both sexes. With BMI >25 kg/m2 (overweight and obese), higher cholesterol, hypertension, insulin resistance and susceptibility to type 2 diabetes generally increase long-term cardiovascular risk.

BMI is useful but imperfect. Someone with little muscle and much fat may have a low BMI, while muscular, physically fit women and men may have high BMI without high health risk. Waist circumference or waist-to-hip ratio may therefore better measure abdominal fat:

• Men with a waist of 102 cm or more are generally considered overweight.
• Women are generally overweight with a waist of 88 cm or more.
• A waist-to-hip ratio >0.9 is also considered a health risk.

Even modest weight loss helps. Losing only 3 to 5 percent can lower triglycerides and blood glucose and reduce diabetes risk. More weight loss can lower blood pressure and cholesterol.

5 suggestions for easier weight loss:

• Set realistic goals and stay motivated; do not waste time or energy on an unattainable weight or unsustainable diet,
• Record what you eat in a food diary, noting when and how much to identify mistakes more easily,
• Reduce portion sizes,
• Make smart food choices. If you do not want to give up favorite foods, sacrifice something else or compensate to preserve balance, perhaps with lighter meals before or afterward or exercise. Discover healthy snacks and how fruit, vegetables and whole grains keep you full longer,
• Stay physically active
• The greatest secrets of those who lose weight and maintain it are changing eating habits (%98) and increasing activity, particularly walking (% 94).

6. Get enough sleep

Adequate, good-quality sleep is essential to health. Sleep deprivation does more than cause daytime yawning; it may damage health. Obesity, hypertension, heart attack, diabetes and depression are more common with insufficient sleep.

Waking without an alarm and feeling rested suggests enough sleep. Constantly using the snooze button and struggling to get up suggests poor-quality or inadequate sleep.

Sleep should not be seen merely as an obligation: the body needs it to rest. Prioritize it for a better life. Most adults need 7-9 hours nightly. Plan sleep to achieve quality rest: for example, begin sleeping before 12 at night and wake at the same time daily. If falling asleep is difficult, keep the bedroom dark and quiet.

If you think you sleep enough but wake unrefreshed and remain tired all day, discuss assessment for sleep apnea syndrome (obstructive sleep apnea) with your doctor.

In obstructive sleep apnea, throat muscles relax and intermittently block the airway during sleep, temporarily stopping breathing. Symptoms include loud snoring, inability to breathe during sleep, repeated awakenings, waking with headache, sore throat or dry mouth, feeling tired on waking, and daytime memory or learning problems.

Obesity is a major cause, so weight loss is important. A continuous positive airway pressure (CPAP) device keeps the airway open during sleep and, alongside weight loss, substantially helps obstructive sleep apnea. CPAP is also known to reduce heart disease risk.

7. Reduce stress

No direct link between stress and coronary disease risk has been found, but indirect effects on risk factors are demonstrated. Under stress, people may overeat, start smoking or smoke more. If these behaviors persist for years, stress contributes to risks such as obesity, diabetes, hypertension and hyperlipidemia.

How can healthy habits combat stress without medication?

1. Slow down
   Plan tasks and allow enough time without rushing, minimizing unpleasant surprises and deadline pressure during important work.
2. Try postponing
   When overwork and lack of sleep become habitual, work becomes a struggle. Sometimes postponing tasks and regaining focus improves efficiency and makes them easier.
3. Stop worrying
   Even if you think you may fail, realize it is not the end of the world. Take a breath and trust that things will get back on track.
4. Smile
   Laughter benefits everyone. Do not fear laughing aloud even alone. You will feel better.
5. Make time for loved ones
   Call friends and family, talk and chat with them.
6. Be organized
   Create to-do lists to maintain focus even on difficult, important tasks. Organized planning prevents distraction and makes success less stressful.
7. Help others
   Make time for someone who needs you and help them. Helping others feels good.
8. Stay active every day
   Exercise can relieve mental and physical tension. Discover enjoyable activities and do them often.
9. Give up harmful habits
   Too much alcohol, tobacco or caffeine can raise blood pressure and increase irritability and anxiety.
10. Be open to change
    Do not hesitate to learn a skill, pursue a new goal, love others or help someone unfamiliar.

Managing cardiovascular risk factors

Have regular health screening

High blood pressure, cholesterol and blood sugar can damage the cardiovascular system. First, be aware of risks: without screening, you cannot know your situation. Regular testing shows your values and whether precautions are needed.

• Blood pressure: Routine screening generally begins in adolescence. People aged 18 to 39 without hypertension risk factors are advised to screen every 3-5 years.

If aged 40 or older, or 18 to 39 and overweight, obese or with other hypertension risks, ask for annual blood pressure monitoring. Normal pressure is considered 120/80 mm Hg or lower.

• Cholesterol levels: Adults should generally check cholesterol from age 18 at least every five years. Earlier and more frequent checks may be recommended with other risks, such as a family history of early heart disease.

• Diabetes screening: Because diabetes is an important cardiovascular risk factor, screening before disease develops is valuable. Ask when fasting glucose or hemoglobin A1C testing should check for diabetes.

With normal weight and no other type 2 diabetes risks, screening should begin at 45. If results are normal, continue at least every 3 years. ADA (American Diabetes Association) recommends screening overweight children and adolescents aged 18 and over. Depending on risks such as excess weight or family history, your doctor may recommend earlier screening.

Screening may diagnose high cholesterol, hypertension or diabetes, all cardiovascular risk factors, or reveal susceptibility. Your doctor may prescribe medication. However, lifestyle changes always remain the most important long-term means to reduce risk or susceptibility. The earlier you start and the longer you maintain them, the more successful you will be in addressing these factors and cardiovascular disease.