Cardiovascular diseases

Cardiovascular diseases (CVDs) are disorders affecting the heart and blood vessels. They are the leading causes of death globally. Heart attacks and strokes are acute events, primarily caused by a blockage preventing blood from flowing to the heart or brain. In 2022, an estimated 19.8 million people died from CVDs, or 32% of all deaths worldwide. A significant majority, 85%, are due to heart attacks and strokes. Over three quarters of CVD deaths occur in low- and middle-income countries.

The WHO Eastern Mediterranean Region faces a substantial burden from these conditions, with cardiovascular diseases causing around 31% of all deaths. Key behavioural risk factors for CVDs include an unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. Environmental risk factors, such as air pollution, also play a significant role. Reducing risk factors helps decrease the risk of cardiovascular disease. There are also several underlying determinants of CVDs. These reflect the major forces driving social, economic and cultural change: globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors. The Region has the highest prevalence of hypertension among the WHO regions, at 38%, with approximately 50% of them undiagnosed. Among those aware about their condition (diagnosed), only 39% received treatment, making only 16% able to control their condition. Physical inactivity in the Region is a concern, with about 50% of women and over one third of men not meeting sufficient physical activity levels.

Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first sign of underlying disease. Symptoms of a heart attack include pain or discomfort in the centre of the chest or in the arms, the left shoulder, elbows, jaw or back.

The person may experience difficulty in breathing or shortness of breath; nausea or vomiting; light-headedness or faintness; a cold sweat; and turning pale. Women are more likely than men to have shortness of breath, nausea, vomiting, and back or jaw pain.

The most common symptom of a stroke is sudden weakness of the face, arm or leg, most often on one side of the body. Other symptoms include sudden onset of:

• numbness of the face, arm, or leg, especially on one side of the body;
• confusion, difficulty speaking or understanding speech;
• difficulty seeing with one or both eyes;
• difficulty walking, dizziness and/or loss of balance or coordination;
• severe headache with no known cause; and/or
• fainting or unconsciousness.

People experiencing these symptoms should seek medical care immediately.

Rheumatic heart disease

Rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities. People who live in overcrowded and poor living conditions are at greatest risk.

Rheumatic heart disease is serious but preventable. It starts as a sore throat or skin infections caused by a bacterium called Streptococcus pyogenes (group A streptococcus), which passes easily from person to person in the same way as other upper respiratory tract infections.

Streptococcal infection can cause the immune system to react against the tissues of the body, including inflaming and scarring the heart valves. This is called rheumatic fever. Rheumatic heart disease results from that inflammation and scarring.

Symptoms of rheumatic heart disease include shortness of breath, fatigue, irregular heartbeats, chest pain and fainting. Symptoms of rheumatic fever (which can cause rheumatic heart disease if not treated) include fever, pain and swelling of the joints, nausea, stomach cramps and vomiting.

WHO supports governments to prevent, manage and monitor CVDs by developing global strategies to reduce the incidence, morbidity and mortality of these diseases. These strategies include reducing risk factors, developing standards of care, enhancing health system capacity to care for patients with CVD, and monitoring disease patterns and trends to inform national and global actions.

The risk factors for CVD include behaviours such as tobacco use, an unhealthy diet, harmful use of alcohol and inadequate physical activity. They also include physiological factors, including high blood pressure (hypertension), high blood cholesterol and high blood sugar or glucose, which are linked to underlying social determinants and drivers such as ageing, income and urbanization.

Preventing CVDs can be achieved by quitting tobacco use, reducing salt intake, eating more fruits and vegetables, engaging in physical activity and avoiding harmful use alcohol. Health policies that make healthy choices affordable and accessible are crucial for promoting healthy behaviours. Beyond prevention, early identification of those at high risk of CVDs and providing appropriate treatment can prevent premature deaths. Access to NCD medications and basic health-care technologies in all primary health-care facilities is vital for ensuring patients receive treatment and counselling.