Cardiovascular disease

Coronary heart disease

The heart is a muscular pump. Like all muscles, it needs oxygen for aerobic respiration so that it can contract. The coronary arteries supply blood, and therefore oxygen, to the heart muscle.

The coronary arteries may become blocked by a build-up of fatty material, caused by certain kinds of 'bad' cholesterol. As the fatty material increases, one or more coronary arteries narrow, and can become blocked.

Diagram comparing a healthy artery in the heart vs a blocked artery

If a blockage builds up, the amount of oxygen reaching the heart muscle is reduced. A person will develop chest pain, and if left untreated, a heart attack is the result. Heart attacks result in damage to, or death of the heart muscle. Part of the heart muscle, or the whole heart, will die.

Ways of treating cardiovascular disease

Drugs and surgery can help to control coronary heart disease.

Statins

Statins are drugs that help to lower cholesterol in the blood. They do this by lowering its production in the liver.

Statins are prescribed for people with heart disease or who have a high risk of developing it. They need to be taken long-term. Cholesterol levels will rise again if a person stops taking them.

Some studies have raised concerns regarding the side effects of statin use, while others believe they can bring additional positive benefits.

Statins are not suitable for everyone - they should not be prescribed for people with liver disease, or pregnant or breastfeeding women.

Some patients taking statins experience side effects such as headaches and memory loss. There have been reports of statins being linked with type 2 diabetes and liver damage.

Other people argue that statins should be used more widely. They may protect against other conditions such as Alzheimer's disease, but further research is needed.

Stents

Coronary arteries that are blocked or have become narrow can be stretched open and have a stent inserted to restore and maintain blood flow.

The stent is inserted into a coronary artery in a catheter.

Diagram illustrating how stents work inside arteries

Stents can be used in instances where drugs are less effective, and offer a longer term solution. Stents are made from metal alloys and do not lead to an immune response in the patient.

Around 75,000 operations are carried out each year. Risk factors depend on the patient's:

  • age
  • general health
  • whether they have had a heart attack

The operation is safe as it does not involve surgery, but there is a risk of bleeding, heart attack or stroke.

Heart transplants

A heart transplant is required in cases of heart failure. Coronary heart disease can lead to heart failure. The heart fails to pump sufficient blood and organs are starved of oxygen. There are different degrees of severity of heart failure.

A donor heart is transplanted. In rare cases, a heart is transplanted along with lungs.

A consultant assesses the patient's condition. If other treatments are not managing the heart condition, a transplant may be recommended. The patient will be put on a waiting list. A transplant puts major strain on the body, and the benefits and risks will be evaluated, including whether the patient's condition is sufficiently severe and other health factors.

There is a shortage of donor hearts in the UK. Only around 200 transplants are carried out each year in a small number of hospitals.

Artificial hearts are plastic devices used occasionally to keep patients alive whilst waiting for a heart transplant. They can also be used to allow a patient's heart to rest to help it recover.

An illustration of an artificial heartAn artificial heart

After the transplant, the patient will:

  • need time to heal, recover and build up strength
  • have to take drugs called immunosuppressant drugs for the rest of their life - this prevents the person's immune system from rejecting the donor heart
  • have an increased risk of infection because of these drugs