Understanding cardiovascular disease

The most common forms include:

• Coronary artery disease (CAD): caused by narrowing or blockage of the arteries supplying blood to the heart. Can lead to angina or myocardial infarction (heart attack).
• Cerebrovascular disease: affects blood flow to the brain, increasing the risk of stroke.
• Peripheral artery disease (PAD): reduced blood flow to the limbs, especially the legs, resulting in pain, numbness, or ulcers².
• Heart failure: a condition where the heart can't pump blood effectively. It often results from previous heart attacks or long-standing hypertension.
• Arrhythmias: abnormal heart rhythms that may feel like fluttering or palpitations and can sometimes be life-threatening.
• Congenital heart defects: structural abnormalities of the heart present from birth.

Atherosclerosis plays a central role in many cardiovascular conditions. In people with type 2 diabetes, high blood sugar levels promote the buildup of plaque in arterial walls, making them more prone to rupture and clot formation. This accelerates the development of atherosclerotic cardiovascular disease (ASCVD) and ischemic heart disease, increasing the risk of heart attacks, strokes, and further cardiovascular disease³.

People with diabetes are nearly twice as likely to have heart disease or stroke compared to those without diabetes⁴. Furthermore, hypertensive and atherosclerotic cardiovascular disease is especially common in people with both high blood pressure and poor glycaemic control, contributing to their increased risk of further health complications.

In clinical practice, cardiovascular disease is often classified using ICD-10 codes for accurate diagnosis and billing. For example:

• I25.10 - atherosclerotic heart disease of native coronary artery without angina
• I11.0 - hypertensive heart disease with heart failure
• I70.2 - atherosclerosis of native arteries of the extremities

These classifications help tailor treatment plans and track outcomes over time.

Symptoms of cardiovascular disease can vary depending on the condition, but many share overlapping features, and some are exacerbated by physical inactivity. Early signs are often subtle or mistaken for other conditions, especially in people with diabetes, where nerve damage may dull pain perception.

• Chest pain or discomfort (angina), especially during physical activity
• Shortness of breath when resting or exerting
• Fatigue, even with minimal activity
• Heart palpitations (feeling like your heart is racing or skipping beats)
• Pain in the neck, jaw, throat, upper abdomen or back
• Swelling in the legs, ankles, or feet, often linked to heart failure
• Dizziness or lightheadedness, especially when standing

People living with hypertensive cardiovascular disease or arteriosclerotic cardiovascular disease may not experience noticeable symptoms until a major event, such as sudden cardiac arrest, a heart attack, or stroke, occurs.

Because symptoms can be mild or develop gradually, regular check-ups are crucial - particularly for individuals with diabetes⁵. Tests such as ECGs, cholesterol panels, blood pressure readings, and imaging (e.g., echocardiograms or coronary calcium scans) can help identify issues before complications arise.

Receiving a diagnosis of cardiovascular disease can feel daunting, but it doesn't mean the end of a full and active life. Just like those living with diabetes, many people live well with cardiovascular disease through a combination of treatment, lifestyle changes, and ongoing monitoring.

Managing cardiovascular disease involves a multi-faceted approach:

• Medication: you may be prescribed statins, antihypertensives, antiplatelets, or newer diabetes medications such as SGLT2 inhibitors or GLP-1 receptor agonists - both of which have shown cardiovascular benefits in people with type 2 diabetes⁶.
  
• Lifestyle modifications:
  • Eat a Mediterranean or DASH-style diet that is rich in vegetables, fruits, legumes, lean protein, and healthy fats⁷
  • Exercise regularly and aim for 150 minutes of moderate activity per week
  • Maintain a healthy weight
  • Quit smoking and reduce alcohol consumption
• Regular monitoring: routine blood tests, blood pressure checks, and heart monitoring are essential

You don’t have to manage cardiovascular disease alone. A strong support team may include:

• Cardiologist: leads heart-related care
• Diabetes specialist: helps control blood glucose levels, including with treatment for diabetes
• Dietitian: supports heart and diabetes-friendly meal planning
• Mental health professional: assists with anxiety, depression, and adjustment
• Primary care doctor: coordinates care and referrals

It’s common to feel overwhelmed or anxious after a diagnosis. Cardiac rehabilitation programmes, peer support groups, and therapy can help people rebuild both physical stamina and emotional wellbeing⁸

Whether you're managing type 2 diabetes, have a family history of heart disease, or simply want to protect your long-term health, there are clear steps you can take to reduce your cardiovascular risk.

Small, sustainable changes in behaviour can lead to significant health benefits.

• Eat a nutrient-rich diet
  • Prioritise high-fibre foods, whole grains, vegetables, and unsaturated fats
  • Limit saturated fat, added sugars, sodium, and processed foods
• Be physically active
  • Engage in aerobic activity (e.g., walking, swimming, cycling) - similar to managing your diabetes with exercise
  • Add resistance exercises 2-3 times per week
• Quit smoking
  • Smoking doubles the risk of heart disease and impairs circulation
  • Seek support from stop-smoking programmes and nicotine replacement therapies
• Limit alcohol
  • Excess alcohol can increase blood pressure and worsen blood sugar control
• Get enough sleep
  • Poor sleep quality is associated with higher rates of hypertension and heart disease⁹
• Manage stress
  • Chronic stress contributes to inflammation, high blood pressure, and unhealthy coping behaviours
  • Techniques like mindfulness, deep breathing, or therapy can help

For individuals with moderate to high cardiovascular risk, lifestyle changes alone may not be enough. Medications can help manage:

• Blood pressure (ACE inhibitors, ARBs, calcium channel blockers)
• Cholesterol (statins, ezetimibe, PCSK9 inhibitors)
• Blood sugar (particularly SGLT2 inhibitors and GLP-1 agonists in diabetics)
• Clot prevention (aspirin or other antiplatelet agents)

Your doctor will assess your individual cardiovascular disease risk factors and determine whether medication is appropriate for prevention or treatment.

Navigating a new diagnosis can be confusing. One of the most important things you can do is to ask questions and stay informed.

• What type of cardiovascular disease do I have?
• What caused it, and can it be reversed or controlled?
• How does my diabetes or other condition affect my heart?
• What are the treatment options, and what are their benefits and risks?
• Should I change my diet or exercise routine and, if so, how?
• How will we monitor my progress?
• What symptoms should I report immediately?
• Should my relatives also get checked?

• Bring a list of medications you take (including supplements)
• Take notes during the visit or ask to record the conversation
• Keep a symptom diary, especially if you notice changes in energy, breathing, or pain
• Ask about referrals to cardiac rehab, dietitians, or support groups

Engaging in shared decision-making improves cardiovascular health outcomes and empowers you to be an advocate for your care¹⁰.

Cardiovascular disease is a serious condition - especially when combined with type 2 diabetes, but it is treatable and often preventable. By adopting a heart-healthy lifestyle and addressing potentially modifiable risk factors, following medical advice, and staying engaged with your healthcare team, you can significantly reduce your risk and live a longer, healthier life.

Whether you're newly diagnosed or simply concerned about your risk, the best time to act is now. Through awareness, early detection, and personalised care, you have the power to protect your heart health.

Start by talking to your doctor to understand your condition and treatment plan. Follow their advice closely regarding blood pressure levels and ask questions if anything is unclear.

You should also adopt a heart-healthy lifestyle: avoid an unhealthy diet, eat well, exercise regularly, quit smoking, limit alcohol, and manage stress.

Take your prescribed medications as directed and keep up with follow-up appointments to monitor your progress. With proper care, many people manage cardiovascular disease and live active, fulfilling lives.

Cardiovascular disease usually can’t be fully cured, but it can be effectively managed. With lifestyle changes, medications, and medical care, many people control their symptoms and reduce the risk of complications. Early detection and consistent cardiovascular disease treatment can help prevent the condition from worsening and allow individuals to lead healthy, active lives.

Yes, many people around the world are living with cardiovascular disease. It’s one of the most common health conditions globally. Many individuals manage it successfully with lifestyle changes, treatment, and support. You're not alone - connecting with support groups or others facing similar challenges can provide encouragement, guidance, and a sense of community.