How Much of Cardiovascular Disease is Self-Inflicted?
Atherosclerosis, the buildup of fatty plaques in blood vessel walls, is an inevitable outcome of aging, driven by chronic inflammation, oxidative stress, and other processes that cannot be evaded without the development of new approaches to medical biotechnology. The pace at which this becomes a fatal condition is heavily driven by lifestyle choices, however. All of the usual activities and decisions that physicians tell us to avoid will, over time, lead to a faster progression of atherosclerosis, and a greater risk of mortality due to the rupture or blockage of blood vessels. It is quite possible that many people will be saved from their own neglect by new medical therapies that emerge in the years ahead. Equally, why roll the dice on the speed of medical progress, when you can postpone that need?
As much as 90% of the risk of a heart attack, stroke, or peripheral arterial disease (PAD) can be explained by smoking, poor eating habits, lack of physical activity, abdominal obesity, high blood pressure, raised blood lipid levels, diabetes, psychosocial factors, or alcohol. These guidelines focus on atherosclerotic cardiovascular disease (CVD), which affects the arteries. As the inside of the arteries become clogged up by fatty deposits, they can no longer supply enough blood to the body. This process is the main cause of heart attacks, strokes, PAD and sudden death where arteries become completely blocked. The most important way to prevent these conditions is to adopt a healthy lifestyle throughout life, especially not smoking, and to treat risk factors.
Targets for blood lipids, blood pressure, and glycaemic control in diabetes remain as recommended in recent guidelines on dyslipidaemias, hypertension, or diabetes. The current guidelines introduce a stepwise approach to intensifying preventive treatments, while always taking into consideration potential benefit, other conditions, psychosocial factors and patient preferences. In healthy people, for example, the stepwise approach starts with recommendations for everyone: smoking cessation, adopting a healthy lifestyle, and maintaining a systolic blood pressure below 160 mmHg.
Stopping smoking is potentially the most effective of all preventive measures, with substantial reductions in heart attacks or death. The CVD risk in smokers under 50 years of age is five-fold higher than in non-smokers. Quitting must be encouraged in all smokers, and passive smoking should be avoided where possible. Regarding nutrition, a healthy diet is recommended for all individuals to prevent CVD. This should emphasise plant-based foods including whole grains, fruits, vegetables, pulses, and nuts. New recommendations include the adoption of a Mediterranean or similar diet.
In terms of body weight, it is recommended that overweight and obese people lose weight to lower blood pressure, blood lipids, and the risk of diabetes, and thereby reduce the likelihood of CVD. For the first time, the guidelines state that bariatric surgery should be considered for obese individuals at high risk of CVD when a healthy diet and exercise do not result in maintained weight loss.