State of the Heart

Cardiac Exercise Research Group

Cardiovascular disease affects everyone

 

Illnesses such as stroke, heart attack (myocardial infarction), angina pectoris, aortic aneurism and intermittent claudication ("smokers' legs") all represent diseases of the heart and arteries. These, and others, are all examples of cardiovascular disease (CVD). 450,000 Norwegians live with cardiovascular disease,1  meaning everyone knows someone affected. 

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Cardiovascular disease is a frequent cause of death, even though the latest reports from Norwegian Statistics state that less people dies from CVD than earlier2

Although mortality from CVD has decreased over the past 30 years, we see in recent years that the number of young people who get heart attacks increases. This is worrying.

In 2012, 10 700 patients in Norway had stroke as the primary diagnosis. 26 100 had heart attacks or angina pectoris as the primary diagnosis.3 The problem is not unique to Norway; the World Health Organization (WHO) estimates that every year, cardiovascular disease kills 17.3 million people globally.4

Additionally, cardiovascular disease is a leading cause of premature death. Although the prognosis today is more optimistic – for instance the mortality from stroke has declined – cardiovascular disease remains an increasing burden on health care providers. With an aging population, the demand for treatment will continue to increase. Therefore research on both the treatment and prevention of cardiovascular disease is an important investment in the future.

 Types of cardiovascular disease

There are many types of cardiovascular diseases, each with different underlying causes and risk profiles. In Norway, stroke, heart attack, high blood pressure, heart failure and angina pectoris are the most common ones. 

The Norwegian National Council on Cardiovascular Disease has a helpful summary:

A stroke is usually caused by a blood clot in a cerebral artery, but can also be due to hemorrhaging after the rupture of a blood vessel in the brain. The consequence of a stroke is that brain cells die from the lack of blood supply.

 

A heart attack, or myocardial infarction, involves the destruction of heart muscle from lack of oxygen. If the blood supply becomes inadequate, heart muscle can no longer contract and begins to die.

 

Although high blood pressure is not a disease in and of itself, it should still be treated to prevent disease. High blood pressure can damage arteries and lead to the formation of plaques. Over time, this can lead to cardiovascular disease such as heart attack, heart failure, stroke and kidney failure. As the blood pressure gets higher, the stress on the heart increases, along with the risk of developing disease.

 

During heart failure, the heart's ability to contract is reduced, so it no longer provides enough oxygen to the body. The blood supply is redirected to prioritize the most important organs, such as the brain and the heart itself. The blood supply to the liver, kidneys and skin is reduced, which can yield various medical complaints.

 

Angina pectoris generally causes chest pain, as the oxygen supply to the heart muscle becomes inadequate.

Internationally, diseases of the heart and arteries are generally subdivided into five main groups – ischemic, rheumatic, hypertensive, cerebrovascular and inflammatory cardiovascular diseases

Heart attacks, angina, and some types of heart failure are all examples of ischemic heart disease. Common to all of these is the narrowing of coronary arteries, so the blood supply to the heart is reduced. Cerebrovascular heart disease (or stroke) is when the blood supply to parts of the brain becomes inadequate. Disease caused by high blood pressure is called hypertensive heart disease. 

Rheumatic heart disease arises from rheumatic fever after untreated streptococcal infections, leading to an immune response where the immune system attacks the body's own tissue. It can particularly target heart valves and heart muscle, causing these to function poorly. The immune response to infection of the heart muscle (myocarditis), the membrane surrounding the heart (pericarditis) or the heart's inner lining (endocarditis) is called inflammatory heart disease. Although inflammation normally is an important immune response, it can damage heart tissue and prevent normal cardiac function.  

Risk factors for cardiovascular disease

  • Obesity
  • Lack of physical activity
  • Diabetes
  • Family history of cardiovascular disease
  • High cholesterol
  • High blood pressure
  • Smoking
  • Alcohol
  • Poor eating habits

 

Cardiac Exercise Research Group

Cardiovascular disease in Norway

The risk of cardiovascular disease varies by location. In Norway, it is greater in the north in both men and women.

Cardiovascular mortality (women)

Cardiovascular mortality (men)

Cardiovascular mortality relative to the national average (2008)
  Men Women
Østfold 16% 12%
Akershus -11% -11%
Oslo 0% -4%
Hedmark 11% 8%
Oppland 9% 12%
Buskerud -4% 1%
Vestfold -5% -2%
Telemark -1% 5%
Aust-Agder -9% 12%
Vest-Agder 0% -14%
Rogaland -12% -4%
Hordaland -7% -8%
Sogn og Fjordane -3% -6%
Møre og Romsdal 0% -6%
Sør-Trøndelag 2% 7%
Nord-Trøndelag 9% 0%
Nordland 9% 10%
Troms 8% 12%
Finnmark 25% 20%

Cardiovascular disease around the world

Internationally, the risk of different types of cardiovascular disease also varies by location. In total, the greatest number of people die from cardiovascular disease in Europe and Western Pacific, and ischemic and cerebrovascular cardiovascular diseases are responsible for most deaths in all regions.

Rheumatic heart disease causes the greatest number of deaths in Southeast Asia and the Western Pacific, inflammatory heart disease causes the greatest number of deaths in Europe, and hypertensive heart disease causes the greatest number of deaths in the Southeast Asia. Compared to ischemic and cerebrovascular cardiovascular disease, the total number of deaths from these types of disease is significantly lower.  

Number of deaths per region (1000 people)5
  Rheumatic Hypertensive Ischemic Cerebrovaskular Inflammatory
Europe 25 225 2195 1287 115
Eastern Mediterranean 22 96 587 292 33
Africa 11 86 374 449 56
Western Pacific  96 274 1383 2504 101
Southeast Asia 56 287 1834 1192 31
The Americas 10 185 881 437 65

See the interactive map on the World Heart Federation's website

The good news - exercise helps!

Although the risk factors for cardiovascular diseases vary, lifestyle plays an important part. Therefore, it is possible to reduce the risk through lifestyle changes. CERG's research on exercise and cardiovascular disease shows that regular physical activity is important for cardiovascular health, and for many people this leaves room for improvement.

For example, a study of patients with metabolic syndrome showed that the greatest reduction in mortality was found in people who maintained a low level of physical activity, compared to none at all. Although the reduction in mortality was even greater in people who exercised more, this is still important for motivation. You need not spend a vast number of hours exercising every week for it to benefit your health –getting out at least a little can make a big difference. 


Cardiac Exercise Research Group

Furthermore, our research shows that aerobic interval training is one of the types of exercise that yields the best results. In myocardial infarction patients, we found that a little high-intensity training had a greater effect than more time spent on low- or medium-intensity training. We found that 4x4 interval training can improve the peak oxygen uptake (a measure of fitness) effectively both in the short and longer terms. This is important because fitness has proven to be a good predictor of future cardiac health.

Cardiac Exercise Research Group

 

Ready, get set…exercise!

In conclusion, CERG recommends that you set aside some time for exercise every week. If you need help to get started, you can take a look at CERG's 7-week fitness program, which will help you get into better shape and improve your physical fitness quickly.

Sources (Note: All sources link to external sites)

  1. Norwegian National Council on Cardiovascular Disease (return to 1)
  2. Statistics Norway (return to 2)
  3. Ellekjær and Selmer – PubMed (return to 3)
  4. WHO – Cardiovascular Disease (return to 4)
  5. WHO – World Health Report 2004 (return to 5)