Cardiovascular disease

Cardiovascular disease is a group of conditions affecting the heart and the blood vessels that carry blood around your body. The most common form in Canada is ischemic heart disease, where fatty deposits narrow the arteries that feed the heart muscle. Day to day it can show up as pressure in the chest on a hill or a staircase, breathlessness doing ordinary things, or tiredness that rest does not clear.

What cardiovascular disease is, and what it is not

Cardiovascular disease is not the same thing as a heart attack. It is the ongoing condition of the heart and blood vessels, while a heart attack is a sudden event that can happen because of it. The usual driver is plaque, a fatty material that builds up inside artery walls over years and leaves less room for blood and oxygen to get through. The same build up in other blood vessels can affect the brain, the kidneys and the legs, which is why heart, stroke and circulation problems often turn up in the same person.

It is also not something you would always feel, and not only a condition of men. Plaque can build for years without causing symptoms, which is why blood pressure, cholesterol and blood sugar are checked at routine visits. In Canada, diagnosed ischemic heart disease is more common in men, at 10% of men aged 20 and older compared with 7% of women, but women are affected in very large numbers. In women the symptoms are more often described as vague chest discomfort, throat tightness, unusual fatigue or nausea rather than classic chest pain.

Signs and symptoms

• Chest pressure, tightness or burning, often brought on by activity or stress
• Shortness of breath doing things that used to feel easy
• Discomfort spreading to the jaw, neck, shoulders, arms or back
• Unusual tiredness that does not go away with rest
• Swelling in the ankles, feet or legs
• A racing, fluttering or unusually slow heartbeat
• Feeling lightheaded, dizzy or close to fainting

Symptoms differ a great deal from one person to the next, and many people have none at all until something changes suddenly. What counts as a warning sign for you may be quite different from what a friend describes.

What raises the risk

Some risk factors cannot be changed:

• Getting older
• Being male
• A family history of early heart disease
• Ancestry, since South Asian, Indigenous, African and Hispanic communities in Canada are diagnosed more often and at younger ages

Others can often be worked on, usually with support from a health care team:

• Smoking, vaping nicotine, and exposure to second-hand smoke
• High blood pressure
• High cholesterol
• Diabetes and high blood sugar
• Low physical activity, and eating patterns high in salt, sugar and saturated fat
• Living with obesity, and heavy alcohol use

How cardiovascular disease is diagnosed in Canada

A family doctor or nurse practitioner usually starts with your history and a physical exam, a blood pressure reading, and blood tests for cholesterol and blood sugar. An electrocardiogram, or ECG, which records the electrical signals of the heart, is common. From there you may be referred for an exercise stress test, an echocardiogram, which is an ultrasound picture of the heart, a CT coronary angiogram, or a cardiac catheterization, where a thin tube is threaded up to the heart through an artery. In most provinces a referral from primary care is what gets you in to see a cardiologist.

Treatment and day-to-day management

Clinical research for Cardiovascular disease is enrolling. See the current studies ↓

Care in Canada is aimed at lowering the pressure and the blood fats that damage arteries, easing symptoms, and keeping you doing the things that matter to you. Depending on which vessels are involved and what else you live with, a health care team may discuss:

• Blood pressure lowering medicines, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide or thiazide-like diuretics
• Lipid lowering medicines, including statins, ezetimibe, PCSK9 inhibitors and inclisiran
• Medicines that make the blood less likely to clot, known as antiplatelets and anticoagulants
• Procedures such as percutaneous coronary intervention, which is angioplasty with a stent, and coronary artery bypass surgery
• Cardiac rehabilitation, a supervised program combining exercise, education, nutrition counselling and stop-smoking support

The mix that fits one person will not fit another. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.

When to talk to a doctor

• Call 911 if you have chest pain, pressure or discomfort lasting more than a few minutes, or that goes away and comes back, especially with sweating, nausea or shortness of breath. Do not drive yourself to hospital.
• Call 911 for sudden face drooping, arm weakness or trouble speaking. These are signs of stroke.
• Book an appointment soon if you become short of breath doing everyday tasks, if your ankles start to swell, or if you notice a new irregular heartbeat.

Why clinical research matters for cardiovascular disease

Many people still have heart attacks, chest pain or heart failure while already taking standard treatment, and there is no settled way to work out who is at risk before symptoms begin. That gap is what cardiovascular research is trying to close. Studies now recruiting are looking at newer blood fat targets such as lipoprotein(a) and triglyceride rich particles, anti-inflammatory drug classes, factor XI anticoagulants, and the use of SGLT2 inhibitors and GLP-1 receptor agonists in people who already have heart disease. Others are testing imaging and blood markers for earlier detection, and different ways of delivering cardiac rehabilitation, including virtual and home-based programs.

Clinical studies are how any of that gets tested. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any point without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Heart & Stroke
• Public Health Agency of Canada: heart diseases and conditions
• Canadian Cardiovascular Society
• Hypertension Canada