Take time out of your busy day and make a Donation to an amazing cause. Shed some light on Heart Awareness
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Take time out of your busy day and make a Donation to an amazing cause. Shed some light on Heart Awareness
The healthcare system has made good progress over the past 50 years in diagnosing, treating and managing cardiovascular disease (CVD). However, it remains Australia’s biggest killer and atherosclerotic cardiovascular disease (ASCVD), or atherosclerosis, is a leading cause of death and disability, worldwide.
Cardiovascular disease is an umbrella term that includes a range of heart conditions including high blood pressure, heart attacks, angina, coronary heart disease, congenital heart disease, heart failure, arrhythmias, stroke, high cholesterol and atherosclerosis.
Atherosclerosis often has no symptoms and can cause sudden heart attacks that occur without warning. It is therefore important to be proactive and look after your heart health from an early age.
Knowing your family history and checking your risk can be an easy way to monitor your heart and address any concerns or problems with your general practitioner (GP) as early as possible.
In Australia, Heart Health checks are available through your GP, and are currently reimbursed via Medicare from age 45 (or 30 for First Nations people).1
These include testing cholesterol, blood pressure, blood sugar as well as discussing other lifestyle factors.
Atherosclerosis, which is also known as coronary artery disease, coronary heart disease, cardiovascular disease or heart disease, is a common condition that occurs when plaques form on the inside of arteries. There is also a component of inflammation that contributes to a narrowing of the arteries.3 Plaque is formed slowly over time by cholesterol, fat, blood cells and other substances collecting on the inside wall of the arteries. This results in a narrowing of the arteries which slows blood from flowing freely through the vessels. The reason or cause for this build-up is not known but it is thought to be due to damage to the inner lining of the artery.
Arteries are the main carriers of oxygenated blood supplying organs in the body and build ups can occur in various places throughout the body causing organ-specific artery disease.4
These plaques build up silently and, in many cases, people show no symptoms until a plaque causes a blockage in an artery around the heart leading to a heart event such as angina or heart attack. In some cases, a plaque can block blood flow to the brain causing a stroke. Plaque rupture and clotting can also cause ischaemic stroke and vessel blockage (occlusion).5
Whilst we are not entirely sure why plaques form on the inside of arteries, it is thought that some medical conditions, your genetics and/or lifestyle can all increase the risk of developing atherosclerosis, these may include:2
Lipids, which include low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides, are one of the most important factors contributing to the risk of a cardiovascular event. LDL-C (‘bad’ cholesterol) makes up most of the cholesterol in a person’s body and is the form of cholesterol which builds up on the walls of blood vessels. This build up (known as plaques) is made up of various lipids and can also include calcium.
It is important for people who are at low, moderate or high risk of CVD to regularly have their cholesterol levels checked by their doctor using a blood test called a lipid panel or lipid profile. Results will likely include ‘total cholesterol’ as well as HDL-C (‘good’ cholesterol), LDL-C, triglycerides, and other measurements.
Your doctor is best placed to help you determine your risk and make recommendations on tests, strategies and treatments to help you manage your cholesterol.
Healthy cholesterol levels
The National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand clinical guidelines6 suggest that people who have experienced a heart event should aim for an LDL-C target of less than 1.4mmol/L. The target is different for those who have had a stroke. The Australian Stroke Foundation guidelines indicate that LDL-C levels should be below 1.8 mmol/L to prevent secondary strokes.7
In short, the lower your LDL-C, the better the outcome regardless of whether you are at risk or have had a previous heart event/stroke.8
If you are concerned about your cholesterol levels and heart risk, speak to your doctor.
How often should I have my cholesterol levels checked?
There are several treatment options available, and your doctor will discuss what is right for you. Some patients will start with preventative measures to address their diet and lifestyle before medication is required. Those who have experienced a previous cardiovascular event may need a different course of treatment.
Statins are medicines that lower cholesterol by inhibiting the liver enzyme HMG-CoA reductase, which is essential for cholesterol production. This reduces the amount of cholesterol your body produces. Statin tablets, taken once a day, can be prescribed to people with high cholesterol who are at high risk of heart disease or stroke. Statin tablets are also commonly prescribed for people with various forms of cardiovascular disease – including those who have had a heart attack in the past – regardless of their cholesterol levels.
Statins are generally safe and have been successfully used to treat high cholesterol for many years, however, muscle pain is a commonly reported side effect, although serious muscle problems are rare.10 If you are taking a statin and experience any muscle pain or weakness, report it to your doctor. There are other side-effects, so it is recommended to read through the Consumer Medicine Information included with your prescription before taking any medication.
There are other medicines that can help to lower cholesterol for people who cannot take statins. Your doctor is the best person to talk to determine which medication is right for you.
Ezetimibe is a once-a-day tablet taken in addition to statins for people with high cholesterol who cannot reach their LDL-C targets with statins alone. Ezetimibe is a cholesterol absorption inhibitor; it works by reducing cholesterol absorption from the small intestine. This means less cholesterol is delivered and stored in your liver and more of it is cleared from the blood, thus lowering your cholesterol levels.
Clinical studies have shown that ezetimibe is generally well tolerated, and side effects are usually mild and transient. Some of the more common side effects include abdominal pain; flatulence; diarrhoea; fatigue; headache; and myalgia (muscle pain). To check for other side-effects, you should refer to the Consumer Medicine Information included with your prescription.
PCSK9 inhibitors are a new class of medicine which are generally prescribed for people with high cholesterol who are not responding to other medications. PCSK9 inhibitors are administered by injection every 2 – 4 weeks for evolocumab and alirocumab and every 6 months for the newer PCSK9 inhibitor, inclisiran. This method of administration might be helpful for patients having difficulty taking tablets every day. Doctors will generally prescribe these medications for people with familial hypercholesterolaemia; atherosclerotic cardiovascular disease; and at high risk for a cardiovascular event.
PCSK9 inhibitors work by increasing the amount of cholesterol that is removed from your blood. Clinical studies have shown that the most common side effects of PCSK9 inhibitors include: injection site reactions; upper respiratory tract signs and symptoms; and pruritus (itchiness). Again, it is recommended to read the Consumer Medicine Information to learn more about other side-effects.
Eicosapentaenoic acid (EPA) is type of omega-3 fatty acid, obtained from the oil of fish. The drug, icosapent ethyl, which is only available on prescription, is a highly purified, pharmaceutical grade EPA that comes in capsule form and is taken twice a day. The exact mechanism of action for how this drug reduces the risk of cardiovascular disease is not fully understood, but it is thought to work by reducing inflammation, blood clotting and the narrowing and hardening of arteries, as well as stabilising artery walls and reducing triglycerides.
Some of the side effects of this medication include gout, constipation, burping, rash, pain in muscles, bones or joints increased risk of atrial fibrillation (irregular heartbeat and bleeding, and swelling of your hands, arms, legs, and feet. Check the Consumer Medicine Information for more details.
Regardless of the medication you are prescribed, it is important to remember that heart disease is a lifelong condition that needs to be continually managed, even if you do not experience any symptoms. If you have been diagnosed with high cholesterol or ASCVD, you will likely need to take several medications and make lifestyle adjustments into the future to help keep your heart well. It is important to keep taking your medication unless directed otherwise by your healthcare professional.
You are the most critical person in your health journey so educating and empowering yourself with information and asking questions of your healthcare team is the best way to achieve what is right for you. When seeking information or advice, ensure the sources are trustworthy, especially if they from the internet, and discuss your thoughts and findings with your healthcare team.
Participating in decisions about your treatment:
A heart-healthy lifestyle may help you to achieve and maintain the right cholesterol levels for you. These changes could include:
Bulding consistency with healthy lifestyle practices require time and effort, but the long-term benefits are worth it. Work in consultation with your healthcare professional and support teams to set goals that are achievable and meet your own expectations.
Symptoms of a cardiac event, like angina, heart attack and stroke, are serious and it is important to be familiar with them so you can recognise the signs and act quickly when necessary.
Chest pain (also called angina), cold sweats, dizziness, extreme tiredness, heart palpitations (feeling that your heart is racing), shortness of breath, nausea and weakness are all symptoms that should not be ignored.2
Do not wait if you think you may be having a heart attack or stroke. Call 000 for an ambulance or go immediately to your nearest hospital.
