I'm now going to tell you about approaches to control, combat, and treat cardiovascular disease or CVD. Much has been done over the last 50 years to improve the outcomes of patients with CVD. However, you have already seen that the scale of CVD means that it remains one of the most pressing disease concerns globally. I will discuss three main types of interventions; individual lifestyle interventions, public health prevention, and medical and surgical treatments. From a public health perspective, the most important way to reduce CVD is through the reduction of the underlying risk factors. Since as you heard, up to 90 percent of CVD may be preventable. Smoking is a major risk factor for heart disease. Smoking restricts blood vessels, forcing the heart to work harder, while raise levels of carbon monoxide reduce the oxygen supply in the blood. For smokers, quitting is key for reducing the risk of CVD. An unhealthy diet is another major risk factor. Many patients who present with heart conditions or risk factors for heart disease will be encouraged to make dietary improvements. Such a diet would be rich in plant-based foods, including fruit and vegetables, whole grains and legumes, and with reduced sugar, salt, saturated and trans fats. Such changes in diet can have beneficial effects on blood pressure and blood lipids. Other ways to reduce the risk of CVD include reducing alcohol, and taking up or increasing exercise. Air pollution is another risk factor for CVD. But avoiding high levels of air pollution can be difficult at an individual level, as it very much depends on where you live, and the amount of traffic in your area. So when it comes to pollution, population level controls are necessary, such as implementation of the ultra lower emissions zone in London. So let's now move on to some of the population level interventions we can use to tackle CVD. Smoking bans have been implemented in many areas around the world, and have been shown to reduce smoking rates. Smoking bans work by making it more difficult for people to smoke in public areas, as smoking affects not only the smokers risk of CVD and other diseases, but also the risk of those around them, smoking bans are a key public health measure. Restrictions on unhealthy food for example, reducing their availability in hospitals and schools and introducing advertising controls and taxes can also help reduce CVD risks. Here governments can play a key role. Also introduction of statutory food labeling with for example, a simple traffic light system for fats, salts and sugars, can help people make informed choices about what they eat. Finally, industry has a key part to play, to make available healthier products. Alongside public health measures and individualized style choices, there are a number of medical interventions used to lower CVD risk, for those with a history of CVD, as well as those with no history of the disease, but with relevant risk factors. Drugs may be prescribed for people who are unable to modify their CVD risk through lifestyle changes alone. Statins are one of the most prescribed drugs in the world, and they've had a big impact on the treatment and management of CVD. Statins are a lipid lowering class of drugs, that are widely prescribed for people with or at risk of CVD, and who have raised levels of blood cholesterol. Drugs to treat hypertension are also widely prescribed to reduce the risk of future CVD. Other drugs have been used successfully in CVD treatment. For example, those used to dissolve blood clots in people suffering from an acute stroke, or drugs to reduce risk among patients who have had a heart attack, so-called secondary prevention such as Beta blockers and Aspirin. Surgical and direct medical interventions are also important. Treatments include, removal of blood clots and insertion of stance to hold open blocked arteries and restore blood flow. In severe cases, open-heart surgery may be undertaken. For example, bypass surgery is used to circumvent blocked arteries by taking a blood vessel from another part of the body to bypass the blockage. Devices are also available to treat abnormal heart rhythms. A pacemaker can be implanted which sends electrical signals when it detects if the heartbeat is irregular, has missed a beat, or is beating too slowly or too fast. There is also a device called an implantable cardioverter defibrillator, an ICD which sends bigger electrical pulses when it detects a life-threatening arrhythmia or the heart has stopped. These are just some of the treatments and interventions we can use to reduce the CVD burden. But you can see that with a disease is prevalent and complexes CVD, it is necessary to have a multifaceted response, incorporating lifestyle interventions, public health prevention, and medical and surgical treatments.
