What is cardiovascular disease?
Cardiovascular disease is a term used by doctors to refer to a collection of diseases such as:
- Transient ischaemic attack
- Myocardial infarction or heart attacks
This group of diseases is common in the population and minimising your risk of them is an important part of looking after your health.
Why is cardiovascular disease a problem?
Cardiovascular disease is the most common cause of dying and so minimising the chance of it occurring is very important:
- The life time risk of developing coronary heart disease after the age of 40 is 32% for women
- This is lower than for men of the same age due to the protective effects of oestrogen
- After the menopause the risk in women catches up with the risk in men and so reducing your risk is now increasingly important
What are cardiovascular risk factors?
Risk factors are aspects of your health, lifestyle or family history that make you more or less likely to get cardiovascular disease. They are important because some of them can be modified by changing the way you live, what you eat, how active you are and also by taking medication. These are some examples of cardiovascular risk factors:
- cholesterol (or cholesterol/HDL ratio)
- high blood pressure, particularly if you need medication to control it
- having diabetes
- family history of coronary heart disease in a close relative (first degree) under the age of 60
- high Body Mass Index (BMI), particularly if your BMI is over 30
- having Rheumatoid Arthritis
- having Chronic Kidney Disease
- having Atrial Fibrillation
Explanation of modifiable and non-modifiable risk factors.
Why does oestrogen protect me from this risk?
This is a difficult question to answer. The effect of oestrogen in cardiovascular risk is currently being researched to help improve our understanding of this area of medicine. We know that the risk of cardiovascular disease increases in women as they go through the menopause and that this change of risk is most noticeable in the 10 years after the time of the menopause. We also know that this risk is related to the level of oestrogen in the body and the change of risk occurs as the levels of oestrogen start to fall.
Oestrogen has a direct effect on your blood vessels making the smooth muscle in the wall of the vessels more easily stretched. This means that the blood vessels can dilate or open up more easily, which helps to protect them from damage and keeps your blood pressure at a lower level.
What is QRISK®2?
This is a risk calculator, which estimates your risk of cardiovascular risk based on the information you input. It then produces a risk score for developing cardiovascular disease over the next 10 years. It is only an estimate and how accurate it is depends entirely on how honestly you answer the questions. If you didn’t know the answers to the questions the computer adds in the average score for someone of your age. This makes it less accurate but it is still a valuable guide.
The score it gives is only a risk score and does not mean that cardiovascular disease will happen. An example of this is:
A QRISK®2 score of 20% means that in a crowd of 100 people like you, on average 20 people will get cardiovascular disease over the next 10 years. Or put another way, you have a ‘one in five’ chance of getting cardiovascular disease over the next 10 years.
We know that risk calculators like this give useful information that is better than your doctor making a clinical judgement alone. This is the reason that NICE (National Institute for Clinical Excellence) updated their advice in 2014 to include the QRISK®2 score The advice from your GP is however very important when it comes to reducing this risk and managing any aspects of your health that can be changed to help reduced this risk.
Why can’t I use QRISK®2?
If you are over the age of 84 or you have previously had a heart attack, a stroke or a transient ischaemic attack or currently have angina you cannot use the QRISK®2 score. This is because in these situations your risk score is likely to be greater than 20% so the scoring system does not give extra information to guide treatment. The advice written below is still relevant to you but the score itself does not influence what that advice would be.
Smoking is a very strong risk factor for cardiovascular disease and it is very important for your health that you stop smoking. It may not be possible to stop smoking straight away but even a reduction in the number of cigarettes or tobacco you smoke will have a positive effect on your health.
Facts about smoking:
- the main cause of preventable morbidity and premature death in England, leading to an estimated annual average of 86,500 deaths between 1998 and 2002 (Twigg et al. 2004).
- it increases the risk of cancer, respiratory diseases, coronary heart and other circulatory diseases, stomach and duodenal ulcers, osteoporosis, cataracts, age-related macular degeneration and gum disease
There are support services available through your GP or via the NHS Stop Smoking Services. The help available includes:
- support groups
- behavioural counselling as an individual or as part of a group
- medication to help reduce the craving a desire to smoke.
Weight control: diet & exercise
Obesity (BMI >30 kg/m2) is a strong risk factor for cardiovascular disease and if your BMI >25 kg/m2 you will benefit from reducing your weight. This becomes increasingly important now that you have reached the menopause because the change in your hormone levels alters the way your metabolism works and how your body stores fat. You are now more likely to store fat around your internal organs and over your abdomen. Unfortunately obesity and this change of fat distribution contributes to the risk of:
- diabetes and insulin resistance
- cardiovascular disease
- abnormal cholesterol levels
- endometrial, breast and colon cancer
- sexual dysfunction
- urinary incontinence
- musculoskeletal disorders like osteoarthritis
but reducing your weight will have a positive impact on all these conditions. Even a small reduction in weight will have a positive effect and may make you feel much healthier.
When trying to lose weight it is important to set realistic goals and not to aim to lose weight any quicker than 0.5–1 kg (1–2 lb) a week. You may lose weight quicker than this to start with but a slow steady reduction in weight is much more likely to result in a long-term reduction in weight.
One of the most important things that you can do to reduce your risk of cardiovascular disease is to modify your lifestyle to make your diet as healthy as possible. All people who have cardiovascular disease or are at increased risk of cardiovascular disease benefit from a diet in which fat makes up less than 30% of the total energy consumed. As the NHS recommendation is for 2000 calories a day, no more than 600 calories should come from fat.
You should consider:
- replacing saturated and mono-unsaturated fat intake with olive oil, rapeseed oil or spreads based on these oils. (the easiest way to achieve this is to minimise the intake of animal based fat)
- basing meals on starchy foods such as potatoes, bread, rice and pasta
- choosing wholegrain varieties of starchy food
- eating plenty of fibre-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread, and brown rice and pasta.
- reducing the intake of sugar and food products containing refined sugars including fructose
- eating at least 5 portions of fruit and vegetables per day
- eating at least 2 portions of fish per week, including a portion of oily fish
- eating at least 4 to 5 portions of unsalted nuts, seeds and legumes per week.
- always eating breakfast
- try to monitor the size of the portions you are eating to ensure you are not over eating
Further information and advice on healthy cooking methods can be found at NHS Choices.
It is also very important that you increase the amount of exercise you get. The NICE recommendations are that every week you should:
- do at least 150 minutes of moderate intensity aerobic activity or
- 75 minutes of vigorous intensity aerobic activity or a mix of moderate and vigorous aerobic activity
- do muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)
This may be possible by:
- making enjoyable activities – such as walking, cycling, swimming, aerobics and gardening – part of everyday life.
- minimising sedentary activities, such as sitting for long periods watching television, at a computer or playing video games.
- building activity into the working day – for example, take the stairs instead of the lift, take a walk at lunchtime.
Further information and advice on Physical activity guidelines for adults can be found at NHS Choices.
Increased alcohol consumption increases the risk of cardiovascular disease. It also has a negative impact on other aspects of your general health and can make menopausal symptoms such as hot flushes, night sweats and sleep disturbance worse.
You should not regularly drink more than 2-3 units of alcohol per day. As you have indicated that you drink more than this amount you should consider reducing this by
- Drinking alcohol less frequently
- Avoiding alcohol on certain days of the week
- Avoiding binge drinking, where you consume 4 or more units of alcohol in a day
Treatment of blood pressure
High blood pressure (hypertension) is one of the most important preventable causes of premature morbidity and mortality in the UK. It is a major risk factor for:
- ischaemic and haemorrhagic stroke
- myocardial infarction
- heart failure
- chronic kidney disease
- cognitive decline
- and premature death.
If your BP is >140/90 mmHg your GP may recommend starting medication to lower your blood pressure.
Treatment of elevated cholesterol
We would recommend making an appointment with your GP for a blood test so we can check your cholesterol and triglyceride concentrations. As you are at increased risk of cardiovascular disease it is important we do these tests and consider further investigations before we make a final recommendation for you.
The current NICE guidelines are that you should consider starting on a medication called a statin which lowers your cholesterol. You may choose to consider the lifestyle modification advice above before you consider these drugs. It is important you discuss this with you GP as there are possible side effects from these drugs and some people are unable to tolerate them.