1. Coronary Heart Disease

This results from abnormalities that narrow the arteries supplying blood to your heart i.e the coronary arteries, hence the name “coronary heart disease”. Narrowing of these arteries may restrict or completely block the supply of blood to your heart muscle, either of which can cause heart disease.

Features of Coronary Heart Disease

1. Angina: Chest pain comes on with exertion and improves with rest. It is caused by partial blockage of an artery so that insufficient oxygen-rich blood reaches the heart when its requirements increase.

2. Myocardial Infarction: Severe chest pain occurs when part of the heart muscle dies. This usually results from total blockage of an artery so that no blood reaches the affected tissues.

3. Arrhythmia: Abnormal heart rhythm can occur as a result of damage to the heat and may be detectable as palpitations.

4. Heart Failure: This is a weakening of the pumping action of the heart and can lead to a build- up of fluid in the body with symptoms such as breathlessness and swollen ankle.


Non-Modifiable Risk Factors(can’t be changed) Modifiable Risk Factors (can be changed)
 Existing CHD  High blood cholesterol levels
 Age  Cigarette smoking
 Family history of CHD  Hypertension
 Being Male  Diabetes mellitus
 Ethnic factors  Obesity
 Poor diet
 Lack of exercise
 Abnormal blood clotting

Note: Non-modifiable risk factors can’t be changed


The risk of having a heart attack is much higher in people who already have CHD than in those without CHD, with the risk increasing nearly three times in those with angina and six times after a previous heart attack. Men are at risk of developing heart disease earlier in life than women.

Although, you cannot change non-modifiable risk factors, your level of risk from CHD ids reduced if your modifiable risk factors are improved. Thus, if you have already had a heart attack and have raised cholesterol level, you will probably have fewer further heart attack and live longer if you reduce your fat intake.

2. Stroke and Peripheral Vascular Disease

This occurs when these arteries are blocked in other parts of your circulation. For instance, if the blood supply to your brain is affected, a type of stroke may occur, whereas if the arteries supplying the lower half of your body become blocked, gangrene (Blackening and death of skin and muscle may develop(peripheral vascular disease).

3. Aortic Aneurysm

This occurs when the blockages weaken the main artery in your body, the aorta, causing a widening ordilatation (called an aneurysm) of its well, which can rupture with catastrophic consequences.

Note: The process leading to the blockage or weakening of arteries is termed ‘artherosclerosis’ sometimes called arteriosclerosis.

Causes Of High Blood Cholesterol levels or Hypercholesterolemia The term hypercholesterolemia means high blood cholesterol levels. ‘Hyperlipidaemia’ is a less specific term that refers to an increase in one or more blood fat levels. As both cholesterol and triglycerides are fats, hyperlipidaemia could be used to indicate raised blood levels of either.

High blood cholesterol levels are caused by two main types of condition:

1. Primary hypercholesterolemia : This results from inherited genetic abnormalities that lead to increased blood cholesterol levels.

2. Secondary hypercholesterolemia : This is found when a disease produces high blood cholesterol levels as a complication. Examples of such disease states include :

 Diabetes mellitus
 Obesity
 Alcohol abuse
 Hypothyroidism( under active thyroid gland)
 Kidney disease
 Drugs, for example roaccutane used to treat severe acne, thiazide diuretics used to treat fluid retention or high blood pressure, some beta-blocking drugs used to treat high blood pressure or angina.

Diagnosing Hypercholesterolemia: Sometimes there are signs that suggest that hypercholesterolemia may be present. These include xanthomas, xanthelasmas and corneal arcus.

Tendon Xanthomas: These are swellings on the tendons of muscles, typically the ‘Achilles heels’ on the back of the hands or in the elbow. They are caused by deposits of cholesterol and strongly suggest that familial hypercholesterolemia may be present

Xanthelasmas: These are cholesterol deposits in the skin around the eye.

Corneal Arcus: This is a white ring found in the outer part of the cornea of the eye. It is found at a younger age (in the 30’s and 40’s) in patients with familial hypercholesterolemia and may be picked by an optician during a routine test.

Criteria For the Diagnosis of Famlial Hypercholeseterolemia

A. Definite familial hypercholesterolemia

i. Blood cholesterol level above 6.7 mmol/l in adults Plus
ii. Tendon Xanthomas in the patient in a close relative.

B. Possible familial hypercholesterolemia

i. Blood cholesterol level above 6.7mmol/l in children or 7.5mmol/ in adults. Plus Family history of a heart attack below the age of 50 in grandparent, uncle, aunt, or cousin, or below the age of 60 years in a parent, brother or sister or

ii. Family history of blood cholesterol levels above 7.5mmol/l in a close relative.


Compiled by Pharm Odebiyi Seye

Vanguard Pharmacy Limited

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