• Cardiovascular diseases (CVDs) are the leading cause of death globally.
• An estimated 19.8 million people died from CVDs in 2022, representing approximately 32% of all global deaths. Of these deaths, 85% were due to heart attack and strokes.
• Over three-quarters of CVD deaths take place in low- and middle-income countries.
• Out of the 18 million premature deaths (under the age of 70) due to noncommunicable diseases in 2021, at least 38% were caused by CVDs.
• Most cardiovascular diseases can be prevented by addressing behavioural and environmental risk factors such as tobacco use, unhealthy diet (including excess salt, sugar, and fats), and obesity, physical inactivity, harmful use of alcohol ,and air pollution.
• It is important to detect cardiovascular diseases as early as possible so that management with counselling and medicines can begin.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and the blood vessels. They include:

• Coronary heart disease: A disease of the blood vessels supplying the heart muscle
• Cerebrovascular disease: A disease of the blood vessels supplying the brain
• Peripheral arterial disease: A disease of blood vessels supplying the arms and legs
• Rheumatic heart disease: Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
• Congenital heart disease: Birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth
• Deep vein thrombosis and pulmonary embolism: Blood clots in the leg veins, which can dislodge and move to the heart and lungs

Heart attacks and strokes are usually acute events, and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.

The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. Amongst environmental risk factors, air pollution is an important factor. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risk factors” can be measured in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure and other complications.

Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. Health policies that create conducive environments for making healthy choices affordable and available, as well as improving air quality and reducing pollution, are essential for motivating people to adopt and sustain healthy behaviours.

There are also a number of underlying determinants of CVDs. These are a reflection of the major forces driving social, economic and cultural change, globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.

In addition, drug treatment of hypertension, diabetes and high blood lipids is necessary to reduce cardiovascular risk, and prevent heart attacks and strokes among people with these conditions.

Symptoms of heart attacks and strokes

Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first sign of underlying disease. Symptoms of a heart attack include:

• Pain or discomfort in the centre of the chest.
• Pain or discomfort in the arms, left shoulder, elbows, jaw, or back.

In addition the person may experience difficulty in breathing or shortness of breath; nausea or vomiting; light-headedness or faintness; a cold sweat; and turning pale. Women are more likely than men to have shortness of breath, nausea, vomiting, and back or jaw pain.

The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of:

• Numbness of the face, arm, or leg, especially on one side of the body
• Confusion, difficulty speaking or understanding speech
• Difficulty seeing with one or both eyes
• Difficulty walking, dizziness and/or loss of Balance or coordination
• Severe headache with no known cause
• Fainting or unconsciousness

People experiencing these symptoms should seek medical care immediately.

Rheumatic heart disease is caused by damage to the heart valves and heart muscle from the inflammation and scarring caused by rheumatic fever. Rheumatic fever is caused by an abnormal response of the body to infection with streptococcal bacteria, which usually begins as a sore throat or tonsillitis in children.

Rheumatic fever mostly affects children in developing countries, especially where poverty is widespread. Globally, about 2% of deaths from cardiovascular diseases are related to rheumatic heart disease.

Symptoms of rheumatic heart disease include: shortness of breath, fatigue, irregular heartbeats, chest pain and fainting.

Symptoms of rheumatic fever include: fever, pain and swelling of the joints, nausea, stomach cramps and vomiting.

Treatment for cardiovascular diseases depends on the specific condition, severity, and individual health profile. It typically includes:

• Lifestyle interventions: Diet, exercise, smoking cessation, and stress management.
• Pharmacological therapies: Medications to manage blood pressure, cholesterol, blood sugar, and clotting. These include antihypertensives, lipid-lowering agents (e.g., statins), antiplatelets, anticoagulants, and glucose-lowering drugs.
• Non-oral therapies: Injectable medications, intravenous treatments, and implantable devices (e.g., pacemakers, defibrillators).
• Surgical and interventional procedures: Angioplasty, stenting, bypass surgery, valve repair or replacement, and heart transplantation.
• Novel and emerging treatments: Gene therapies, regenerative medicine improve outcomes and personalize care.

Early detection and consistent management are critical to preventing complications such as heart attack, stroke, kidney failure, and sudden cardiac death.