CARDIOVASCULAR DISEASE

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Program for those [with existing CVD] [no existing CVD]

Cardiovascular disease - "heart attack", angina, stroke and peripheral vascular disease - is by far the most common disease process affecting our community. More than 40% of people will die from it.

PRIMARY PREVENTION

A healthy lifestyle is an important strategy for the whole community - it revolves around a good diet, avoiding saturated fats, taking regular exercise, reducing weight and not smoking.

At St Agnes we are able to provide a computerised assessment of an individual's risk of having a heart attack or stroke within the next 5 years. The assessment takes into account all relevant risks, including age, gender, family history, other illness, smoking, exercise, blood pressure, cholesterol level and weight. The program can show you how addressing the various risk factors will alter the subsequent risk. The program is called the CVRA assessment - ask your doctor if an assessment can be done for you (a recent cholesterol profile is required).

Much research has been done on how to reduce the risk for people who have already suffered from some form of cardiovascular disease, from having further episodes. This is called secondary prevention.

ST AGNES CARDIOVASCULAR PROGRAM

People with established cardiovascular disease are at high risk of having further episodes of related illnesses, such as heart attack or stroke, and developing complications of their existing illness e.g. heart failure.

There is overwhelming evidence that aggressive treatment of risk factors in such people will greatly reduce  the progression of their disease and the likelihood of further episodes or complications. Indeed, vigorous treatment may result in the reduction of existing vascular disease. Some factors such as age, gender and family history cannot be altered - however the following factors can, and should be treated :

SMOKING is the worst thing that you can do - no-one with cardiovascular disease should smoke.

CHOLESTEROL. Regardless of pre-existing cholesterol levels, reducing your cholesterol will reduce the risk of disease progression. Patients with coronary artery disease who lower their LDL cholesterol, reduce their risk of another cardiovascular event by 25% to 30% over the next 5 years.
Recent studies show that patients who commence a statin cholesterol lowering medication at the time of an acute "heart attack" have a 16% reduction in coronary events and a 50% reduction in stroke over the next 16 weeks.

CHOLESTEROL GOALS
Total Cholesterol                 Less than 4 mm
LDL (low density,"bad") Cholesterol     Less than 2 mm - ideally 1.8 mm or less
HDL (high density, "good") Cholesterol         More than 1.0 mm
Triglycerides                       Less than 1.5 mm

LDL cholesterol can be lowered by diet and medication - particularly "statins".
HDL may be improved by exercise.
Consideration should be given to all patients being on a statin from the time of diagnosis.

BLOOD PRESSURE. Lowering blood pressure reduces the risk of cardiovascular events - the greater the reduction the greater the benefit. Lower blood pressure goals are particularly important for patients with coronary artery disease, diabetes, heart failure, left ventricular enlargement or kidney or eye damage ( nephropathy or retinopathy) - "high risk" patients.
    Blood Pressure Goals
        BP                        140/90 or less
        High Risk group    135/85 or less

WEIGHT CONTROL - maintaining an ideal body weight.
   Weight Goal      Body Mass Index (BMI) of less than 27 - ideal 25

EXERCISE  Regular, moderate exercise improves outcomes. Walking for 20 minutes at least 4 or 5 times per week is recommended.

ALCOHOL  No more than 2 standard alcohol drinks per day should be consumed.

DIABETES should be checked for annually.

OTHER MEASURES TO CONSIDER

ANTI-PLATELET MEDICATION. Low dose aspirin or other anti-platelet medication to "thin the blood" should be considered in most patients.

ACE INHIBITORS (a group of medications used to treat blood pressure and heart failure) have been shown to reduce the risk of heart attack in patients with cardiovascular disease by at least 20% - this is independent of their blood pressure lowering effect. Consideration should be given to patients taking an ACE medication if they have cardiovascular disease - this is particularly the case if they have diabetes, hypertension or left ventricular enlargement.

An annual INFLUENZA vaccination is recommended.

Aggressive treatment of the risk factors described above, and the latest scientific evidence to support that treatment, is the basis of the St Agnes Cardiovascular Program - if you have cardiovascular disease discuss the benefits of becoming involved in our program with your doctor.

A copy of the St Agnes Cardiovascular Program information can be downloaded by clicking : DOWNLOAD

More information about the management of cholesterol problems is found on the CHOLESTEROL page.