Heart disease: What is it - and what does the future hold with improving treatments?

What exactly is heart disease and who gets it?

Heart disease is one of the leading causes of death in Ireland, accounting for about one in four deaths here in 2022.

Coronary heart disease (CHD) – also known as ischaemic heart disease – occurs when there is a blockage of blood flow due to the build-up of fatty substances in the arteries (ie atherosclerosis). When the blockage is severe enough to prevent blood supply, a heart attack occurs.

Dr Angie Brown, consultant cardiologist and medical director of the Irish Heart Foundation (IHF), says there was an increase in deaths from cardiovascular disease in 2022. “While the average age of men treated for ischaemic heart disease has been 61 years for the last five years, the average age for women has gone from 69 to 67 in the last two years,” she explains.

The main factors which lead to damage to the arteries are smoking, high cholesterol, high blood pressure, diabetes and obesity, although hereditary factors can also play a part. An audit of heart attacks in Ireland from 2017 to 2022 found that when male smokers have heart attacks they do so on average at the age of 56, compared to 65 for non-smoking males. Female smokers have heart attacks on average at the age of 60, compared to 70 for non-smoking females.

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The audit also found that two-thirds of people under the age of 40 who experienced heart attacks were smokers. The rate of heart disease also increases for women during/after the menopause, as the drop in oestrogen levels results in a rise in LDL cholesterol.

What are the symptoms of heart disease?

The commonest symptom of coronary heart disease is chest pain, tightness or pressure, otherwise known as angina. Typically described as a dull, heavy discomfort, angina pain can sometimes be mistaken for heartburn or acid indigestion. Also, women can experience angina as nausea, abdominal pain or a stabbing pain rather than chest pain.

In 2022, a group of musicians in Ireland led an information campaign called Counter Attack to raise awareness of the signs and symptoms of heart disease. At that time, Jadzia Kaminska, whose husband Dave Donohoe had died of a heart attack at the age of 53, called for more public awareness of the symptoms of heart disease, which include indigestion. “I would like pharmacists to tell people who regularly buy indigestion tablets that they should go see their GP,” she said.

Other symptoms of heart disease are shortness of breath, sweating, nausea, lightheadedness or extreme unexplained tiredness. The sudden onset of severe persistent pain in the arms, neck, jaw, shoulder or back could also signify a heart attack and is a medical emergency if it doesn’t go away within a few minutes.

How is heart disease diagnosed?

An electrocardiogram (ECG), which takes a moving picture of the heart, blood tests and angiograms (an injection of dye into the coronary arteries which will show blocked or narrow blood vessels), are the standard ways to diagnose heart disease. A 2022 study by West of Ireland heart charity Croí found the average wait for an ECG by public patients in most Irish hospitals is about six months, compared to one month for private patients.

Dr Brown says many GP practices now perform ECGs and patients attending a cardiologist will also have an ECG. However, she acknowledges some delays remain in the system. “There may still be a delay in getting an ECG for a routine screening in someone who doesn’t have any symptoms,” she says.

What treatments are available – and have they changed over time?

Once diagnosed, heart disease can be successfully treated but not cured for many people. Medications can help partially reopen blocked coronary blood vessels. Medications to reduce cholesterol in your blood and to lower blood pressure may also be prescribed. Blood-thinning drugs such as aspirin are used to prevent clots.

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Many people with severe blockages in their arteries are now treated by inserting stents at the blocked site to keep them open. Some stents are coated with drugs to prevent clot formation. For those with multiple blockages, coronary bypass surgery is recommended.

What can I do to lower my risk of heart disease?

Eighty per cent of heart disease is deemed to be preventable by long-term health-promoting behaviours. You can lower your risk of getting a heart attack by eating a healthy balanced diet, staying physically fit and active, quitting smoking and reducing your consumption of alcohol. Limiting salt intake to five to six grammes a day (one level teaspoon) while maintaining a healthy weight is also recommended.

Even if you already have CHD, these changes can reduce your risk of having another heart attack. However, so-called recreational drugs such as cocaine and amphetamines can have life-threatening consequences for the heart, and have no safe limits. Binge drinking is also best avoided.

High blood pressure and high cholesterol are deemed to be more hidden risk factors of heart disease. Two to three adults over 50 have high blood pressure, half of whom don’t know it. Prof Vincent Maher, consultant cardiologist at Tallaght University Hospital, was quoted in a recent article in The Irish Times that early identification of these factors is very important. “I’d like to see blood pressure and cholesterol levels checked in all transition year students. If high levels are detected, blood pressure and cholesterol levels can be managed by lifestyle changes and sometimes medication, and monitored every six months,” he said. A blood pressure level over 140/90 is considered high, yet has no symptoms.

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The Irish Heart Foundation recommends those over 30 should have their blood pressure checked every five years and if it is borderline high to have it checked out more often.

What does the future hold for people at risk of heart disease?

Dr Brown says people with CHD have varied experiences. “Patients with symptoms who get timely and appropriate treatment and whose risk factors are managed may notice very little impact on their lives,” she says.

However, patients with severe disease may suffer ongoing symptoms and damage to their heart which causes heart failure. “Heart failure is a common chronic and debilitating condition that does impact patients’ lives. However, there has been huge improvement in treating heart failure with new drugs and special types of pacemakers.”

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The IHF is calling for the Department of Health to develop a new cardiovascular strategy, as the previous one – Changing Cardiovascular Health: Cardiovascular Health Policy 2010-2019 – expired four years ago. In response, the Department of Health says the National Review of Specialist Cardiac Services – which recommendations new configurations for a national adult cardiac service – is due for publication very soon.

Cardiac rehabilitation programmes also help those who have had a heart attack to manage risk factors and exercise safely while offering psychological support to address anxiety and/or depression. The IHF has support groups and a Heart Connect Service that provides professional support. (support@irishheart.ie or Tel: (01) 668 5001).

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