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Avoid Heart Attack and Stroke PDF
Avoid Heart Attack and Stroke PDF
Heart Attacks
and Strokes
Don’t be a victim
Protect yourself
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Number of deaths from coronary heart disease
2002
GREECE
KAZAKHSTAN
MALTA MONGOLIA
DPR
GEORGIA KYRGYZSTAN KOREA
UZBEKISTAN JAPAN
AZERBAIJAN
ARMENIA
TURKEY TURKMENISTAN REP.
TAJIKISTAN KOREA
SYRIAN ARAB
C H I N A
CYPRUS
U S A MOROCCO TUNISIA REPUBLIC ISL . REP.
LEBANON AFGHANISTAN
ISRAEL IRAQ IRAN 702 925
JORDAN MARSHALL ISLANDS
KUWAIT PAKISTAN BHUTAN KIRIBATI
BAHAMAS ALGERIA LIBYAN NEPAL
ARAB BAHRAIN
CUBA
MEXICO JAMAHIRIYA QATAR NAURU
TURKS & CAICOS (UK) UAE
EGYPT TUVALU
DOMINICAN BANGLADESH
REP. SAUDI ARABIA INDIA
JAMAICA CAPE MYANMAR LAO COOK
HAITI PDR
BELIZE VERDE MAURITANIA OMAN VIET NAM
SAMOA ISLANDS
GUATEMALA ST KITTS & NEVIS ANTIGUA & BARBUDA MALI FIJI NIUE
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DOMINICA NIGER THAILAND VANUATU
EL SALVADOR ST VINCENT & GRENADINES SENEGAL ERITREA YEMEN 1 531 534
ST LUCIA GAMBIA CHAD PHILIPPINES TONGA
NICARAGUA BARBADOS SUDAN
GRENADA BURKINA CAMBODIA
GUINEA-BISSAU DJIBOUTI
COSTA RICA TRINIDAD & TOBAGO FASO
GUINEA NIGERIA
PANAMA VENEZUELA GUYANA CÔTE SRI LANKA
BENIN
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SURINAME D’IVOIRE CENTRAL AFRICAN MALDIVES BRUNEI DAR.
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LIBERIA
COLOMBIA REPUBLIC
MALAYSIA
EQUATORIAL CAMEROON SOMALIA
GUINEA UGANDA
SINGAPORE MICRONESIA,
KENYA FED. STATES OF
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DEM. REP. RWANDA
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CONGO CONGO BURUNDI
UNITED REP. PAPUA
PERU I N D O N E S I A NEW
TANZANIA
BRAZIL GUINEA SOLOMON
COMOROS ISLANDS
ANGOLA TIMOR-LESTE
MALAWI
ZAMBIA
BOLIVIA MADAGASCAR
ZIMBABWE MAURITIUS
NAMIBIA
BOTSWANA
MOZAMBIQUE
PARAGUAY
CHILE
SWAZILAND AUSTRALIA
SOUTH
AFRICA LESOTHO
URUGUAY
ARGENTINA
NEW
ZEALAND
Avoiding
Heart Attacks and Strokes
Don’t be a victim – Protect yourself
WHO Library Cataloguing-in-Publication Data
Avoiding heart attacks and strokes : don’t be a victim - protect yourself.
1.Heart arrest - prevention and control. 2.Cerebrovascular accident - prevention and control 3.Popular
works I.World Health Organization.
This booklet has been produced by WHO, World Self Medication Industry (WSMI), World Heart Federation
(WHF), and International Stroke Society (ISS). It is intended for a global audience, and cannot therefore
address the specific cultural, dietary and lifestyle situation of different countries and populations. It is
hoped that national professional associations will translate and adapt it for local use. Translations in French,
Spanish, Chinese, and Arabic are in preparation.
Printed in France
Contents
Annex. Medicines for treating and managing heart attacks and strokes 40
Explanation of terms used in this booklet 42
Contributors 44
Why you should read this booklet
You probably know someone – in your family or among your friends – who
has had a heart attack or a stroke (a brain attack). These cardiovascular
diseases – diseases of the heart and the blood vessels – are killing more and
more people around the world, striking rich and poor alike.
Those who survive a heart attack or stroke often need to take long-term
medical treatment.
If you have ever had a heart attack or stroke, or had to care for someone
who has, you will know that these diseases can seriously affect the life of
both the patient and his or her family. The effects can even reach beyond the
family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you
should read this booklet.
This booklet explains why heart attacks and strokes happen and how you
can avoid them. It tells you what you should do to avoid becoming a victim.
It gives you guidance for your children too. A lot of the damage to the blood
vessels starts at a young age. Children often need help to develop healthy
habits, like eating a balanced diet and being active.
If you are at high risk, there is advice on the signs to look out for and what
you can do to reduce your risk. If you have already had a heart attack or
stroke, there is advice on how your condition can be treated and controlled,
and how you can improve your quality of life.
Following the advice in this booklet may mean changing your habits and
routines, and that is often not easy. It helps to get lots of encouragement and
support from your friends and family, and from your health care team. This
booklet is not meant to take the place of your doctor, but by reading it, you
are taking a positive step towards better health.
4
Key messages
1. Heart attacks and strokes are major killers in all parts of the
world. But they can often be prevented.
10. Heart attacks and strokes can strike suddenly and can be
fatal if assistance is not sought immediately.
5
What you
should know
1. Understanding heart attacks and strokes
A heart attack
The heart itself gets oxygen and nutrients through blood vessels called the
coronary arteries. When the blood flow to the heart is cut off, the decrease
in the supply of oxygen and nutrients can cause lasting damage to this vital
organ. When the blockage is sudden, it is called a heart attack.
If the blockage is only partial and the blood flow to the heart is decreased, it
can cause chest pain called angina. It may not cause lasting damage to the
heart muscle, but it is a warning sign that a person could develop a major
heart attack.
7
Figure 1: A heart attack is caused by a blockage in a coronary artery
Coronary arteries
Blocked artery
Damaged muscle.
When a coronary artery
is blocked, the heart
muscle is damaged
What is a stroke?
The normal brain
The brain can only function if blood is flowing through it. Two large blood
vessels, which run along either side of the neck, bring blood from the heart
to the brain. The blood vessels branch off and get smaller and smaller, until
tiny blood vessels supply oxygen and nutrients to all parts of the brain.
A stroke
A stroke happens in the same way as a heart attack, but takes place in the
brain. If the blood flow to the brain is interrupted, the brain loses its supply
of oxygen and nutrients. This causes the damage to the brain tissue that we
call a stroke.
8
Figure 2: A stroke happens when the blood supply to the brain is interrupted
Damaged brain tissue
When the blood flow to the brain is
blocked, the brain tissue is damaged.
Figure 3: Gradual increase of fatty deposits along the inside of artery walls leads to
narrowing of the arteries.
Fatty deposits
Artery
10
2. Preventing heart attacks and strokes
Nearly two-thirds of people who have a heart attack die before they can
reach medical care. Even when stroke patients have access to modern, ad-
vanced treatment, 60% die or become disabled. So it is important to know
the warning signs and to act fast (see Sections 3 and 4).
But it is even better to prevent a heart attack or stroke from ever happen-
ing. Prevention is always better than treatment, and most heart attacks and Tobacco use, an
strokes can be prevented.
unhealthy diet, and
Research shows that a number of things make us more likely to have a heart
attack or stroke. These are called risk factors. physical inactivity
Some risk factors are linked to choices we make in the way we live. The three increase the risk of
most important lifestyle factors are: heart attacks and
• smoking and other tobacco use; strokes.
• unhealthy diet; and
• lack of physical activity.
Poor lifestyle choices can lead to three serious physical problems:
• high blood pressure (hypertension);
• high blood sugar (diabetes);
• high blood fats (hyperlipidaemia).
These are the most important risk factors for heart attacks and strokes.
Throughout large parts of the world, tobacco use is on the rise. People are
also becoming overweight in many countries as a result of being less active
and eating more food that is high in fat and sugar. More and more young
people and children are getting diabetes because they are overweight. We
owe it to our children to change these lifestyle choices.
11
Unhealthy diet
An unhealthy diet is one with:
• too much food (too many calories);
• too much fat, sugar or salt;
• not enough fruit and vegetables.
If you eat a lot of food and you are not active enough to burn it off, you
will put on weight. You could slowly become overweight or even obese.
Being overweight can lead to diabetes, high blood pressure, and high blood
fat levels. All of these physical problems increase the risk of heart attacks
and strokes. Obese people are at especially high risk if they have a lot of fat
around the waist and stomach area.
An unhealthy diet often contains too much “fast food”, which is high in fat
and sugar, and sugar-loaded soft drinks. Fast food is also very high in salt,
which increases blood pressure.
Read Section 7 to find out how to improve your diet.
Metabolic syndrome
When a person has central obesity (too much weight around the waist),
abnormal blood fat levels (e.g. high triglyceride level or low HDL cholesterol;
See section 11), high blood pressure and high blood sugar at the same time,
this is known as metabolic syndrome. People with metabolic syndrome are 13
at high risk of developing diabetes or having a heart attack or stroke, and
require careful medical attention.
Chronic stress
Feeling lonely, isolated, or anxious for a long time can combine with other
risk factors to make a person more likely to have a heart attack or stroke.
Certain medicines
Some oral contraceptives and hormone treatments can increase the risk of
heart attacks. Check with your doctor for details.
14
3. What are the signs of a heart attack and
what should you do?
Most heart attacks are sudden and intense. But sometimes a heart attack
starts slowly, with mild pain or discomfort. People often aren’t sure what is
wrong, and wait too long before getting help. A severe heart attack can stop
the heart, causing sudden death.
Heart attacks can
Major heart attack strike suddenly
A major heart attack is called a myocardial infarction. It usually starts with and can be fatal
pain or discomfort in the centre of the chest, which lasts for more than a few
if assistance
minutes or keeps coming back. The discomfort can feel like pressure, squeez-
ing, or fullness. Pain or discomfort may also be felt in the arms, the left is not sought
shoulder, elbows, jaw, or back. Other symptoms include: immediately.
• difficulty breathing or shortness of breath;
• feeling sick or vomiting;
• feeling light-headed or faint;
• breaking into a cold sweat;
• becoming pale.
Women are more likely to have shortness of breath, nausea, vomiting, and
back or jaw pain. People who have had diabetes for a long time may not feel
the chest pain as much, because diabetes can damage the nerves.
Angina
If the heart blood vessels are blocked only partially and the blood flow to the
heart is decreased but not stopped, it can cause chest pain called angina or
angina pectoris. The person may have pain or discomfort in the centre of the
chest that lasts for a few minutes. Often it is triggered by physical activity
and relieved by rest. It may also be brought on by strong emotions, stress, or 15
extreme heat or cold. The pain may spread to the arms, back, jaw, neck and
stomach. People who have angina are at high risk of having a major heart
attack.
People with angina should monitor their chest pain. The angina may be get-
ting worse if the chest pain:
• occurs more often;
• lasts longer than usual;
• is combined with shortness of breath or a fast or irregular heart beat;
• occurs with smaller amounts of exercise or stress.
16
• physical activity prescribed by doctors;
• help with taking medicines and going through medical treatment;
• support for lifestyle changes, like quitting smoking;
• health education and counselling tailored to your needs and risk factors;
• help with regaining strength and independence and improving your qual-
ity of life;
• support for going back to work.
Medicines used to treat heart attack and angina You can avoid
Medicines often used to treat heart attacks and angina include: a repeat heart
• antiplatelet agents, such as aspirin; attack by adopting
• nitrates and other medicines to relax blood vessels; a healthy life
• medicines to control blood pressure, such as calcium-channel blockers,
style and taking
and angiotensin converting enzyme inhibitors;
• diuretics to help get rid of excess water; medications.
17
4. What are the signs of stroke and what
should you do?
Major stroke
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, loss of balance or coordination;
• severe headache with no known cause;
• fainting or unconsciousness.
The effects of a stroke depend on which part of the brain is injured and how
severely it is affected. A stroke may affect just one part of the body, such
as the face, an arm or a leg. It can also completely paralyse one side of the
body. A very severe stroke can cause sudden death.
Figure 5: Different parts of the brain control different parts of the body.
Minor stroke
A minor stroke is also called a transient ischaemic attack or TIA. The features
of minor strokes may be similar to those of major strokes, but they are milder
and last only a short time, usually less than an hour. Often, the person recov-
ers without treatment. These “mini-strokes” are warning signs; most people
who have had one or more minor strokes will later have a major stroke.
Note: A person can have a major stroke without having had any minor
18 strokes.
What to do in the case of a stroke
If you see someone showing signs of a stroke, call a doctor or ambulance
right away, or take the person to the emergency room of the nearest hospi-
tal. Do this even if the symptoms are not very severe, because a stroke can
progress. You should also do this in the case of a minor stroke. If there is no
hospital or health centre near you, call a doctor immediately.
20
5. Other heart diseases
Heart failure
Heart failure occurs when the heart cannot fill up with enough blood or
pump the blood through the body with enough force. Because of the de-
creased blood flow, the body cannot function normally. Water builds up in
the body because of the weak pumping function of the heart.
The most common cause of heart failure is damage to the muscles of the
heart, as a result of previous heart attacks.
How can you lower the risk of heart defects for your baby?
• Avoid cousin (blood relative) marriages.
• Be vaccinated against rubella (German measles).
• If you are pregnant, avoid alcohol, X-rays, and any medicine that your
doctor has not prescribed or approved for you.
23
Rheumatic heart disease
Rheumatic fever is a disease that causes inflammation of the joints and the
heart. If untreated, it can lead to rheumatic heart disease, heart failure, severe
disability and even death. Rheumatic fever begins with a sore throat, caused
by bacteria called streptococci (“strep sore throat”). This is often seen in
school-age children and is easily passed from child to child.
A child with strep sore throat has a sudden sore throat and a high fever (over
38 °C or 100 °F). The back of the child’s mouth and tonsils become very red
and swollen. Painful and tender nodes or lumps develop under the skin of
the neck, which can be felt by touching.
If strep sore throat is not treated, it can develop into rheumatic fever. Rheu-
matic fever causes swelling and pain (arthritis) in large joints, such as the
knees and elbows. It also causes swelling and pain in the heart muscle and
heart valves. This can damage the heart valves so that they do not open and
close properly. The abnormal heart function or heart failure that this damage
causes is called rheumatic heart disease.
25
What you
can do
6. Stop using tobacco
Stopping tobacco
The benefits of quitting
use reduces the
Stopping tobacco use at any age results in health benefits right away. It will
chance of a heart
reduce your chances of having a heart attack or a stroke from the day you
stop! It will also reduce your chances of having other health problems, such attack or stroke
as cancer and lung disease. from the moment
There are other benefits to stopping tobacco use: you stop.
• After a few weeks, you will feel less tired and wake up feeling more
refreshed. You will have more energy. Your blood circulation will improve
within a few weeks, making walking easier.
• Your sense of taste and smell will improve, so you will be able to enjoy
food more.
• You will not smell of stale smoke, and will have fresher breath.
• You will save money.
• You will no longer be putting your family and friends in danger from
your tobacco smoke.
28
7. Improve your diet
Limit alcohol
You do not need to avoid alcohol completely. A man should not drink more
than two alcoholic drinks a day. Women should not drink more than one.
One drink, or unit, of alcohol, contains about 10 grams of alcohol. That is
about one 250-ml bottle of beer, one 100-ml glass of wine, or one 25-ml
glass of whisky.
29
Limit fatty foods
All fats are high in energy and will make you gain weight unless you burn
them off by staying active. Some fats are more likely to increase your risk of
heart attack and stroke:
• Saturated fats and trans-fats lead to “bad” cholesterol in your blood, and
increase your risk of heart disease. Try to restrict your use of these fats.
• Unsaturated fats are less risky, but they still make you gain weight. You
should eat them in moderation.
Chocolate
30
8. Stay active and control your weight
32
9. Reduce high blood pressure
33
What should I do if I have high blood pressure?
• Maintain a healthy body weight.
• Stay active.
• Eat a healthy diet that is low in salt and fat and high in fruit and vegeta-
bles.
• Do not smoke.
• Do not drink too much alcohol.
• Have your blood pressure taken regularly.
High blood
If you are doing these things and your blood pressure is still high, your doc-
pressure has no
tor can prescribe medicines. These do not cure high blood pressure, but they
symptoms, but can control it. You must take them as directed, probably for the rest of your life.
cause a sudden You should have your blood pressure checked regularly.
stroke or heart To find out more about medicines for high blood pressure, read the
Annex.
attack. Have your
blood pressure
checked regularly.
34
10. Reduce high blood sugar
People with high blood sugar levels, or diabetes, have a higher risk of heart
attacks and strokes. At least half of the people who have diabetes do not
know they have it.
Diabetes speeds up the development of atherosclerosis – the narrowing and
hardening of the arteries that causes heart attacks and strokes. Untreated dia-
betes can also lead to blindness, kidney failure, nerve damage, leg ulcers and
coma. Pregnancy is much more difficult for diabetic women and their babies
are more likely to have birth defects.
35
A doctor can diagnose diabetes by measuring the blood sugar level using a
simple blood test. If necessary, you may be asked to take a special drink with
glucose (sugar) so that your blood sugar level can be measured afterwards.
Modified from Definition, diagnosis and classification of diabetes mellitus and its complications. Report of
a WHO consultation (WHO, Geneva, 1999) and the International Diabetes Federation IGT/IFG consensus
statement (Unwin N, et al. International Diabetes Federation IGT/IFG Consensus Statement. Report of an Expert
Consensus Workshop 1-4 August 2001, Stoke Poges, UK. Diabetic Medicine 2002; 19: 708-723).
Individuals with a fasting blood sugar level between 6.1 mmol/l (110 mg/
dl) and 7.0 mmol/l (126 mg/dl) are at high risk of developing diabetes and
should improve their lifestyle to reduce the risk.
If lifestyle changes do not reduce your blood sugar levels enough, you will
need to take medicine. Many people with type II diabetes can be treated with
36 oral medicine alone. Some may need insulin injections, or sometimes both.
At the time of diagnosis, the doctor will do tests to detect any complications
from the diabetes and will advise on treatment. If you have diabetes, you
should have regular check-ups. You should also follow carefully instructions
for making lifestyle changes and taking medicine. Be sure to ask questions if
there is anything you do not understand.
You may have to measure the sugar levels in your blood or urine in between
check-ups. Your doctor will show you how to do this if it is necessary.
37
11. Reduce high blood fat levels
Blood fats, or lipids, include cholesterol and triglycerides. The body needs a
certain amount of cholesterol, but when there are too many fats in the blood
(hyperlipidaemia), fatty deposits build up in the arteries, increasing the risk
of heart attacks and strokes.
Healthy diet is
“Good” and “bad” cholesterol
Cholesterol cannot dissolve in blood, so it needs “carrier” proteins to trans-
low in fat, low in
port it around the body. The carrier proteins are called lipoproteins. There are
salt and sugar and two main kinds:
high in fruits and High density lipoprotein (HDL): When cholesterol is carried by HDL, it is
vegetables. called HDL cholesterol. This is “good” cholesterol, and reduces the risk of
heart disease and strokes.
Low density lipoprotein (LDL): When cholesterol is carried by LDL, it is called
LDL cholesterol. This is “bad” cholesterol, and increases the risks of heart at-
tacks and strokes.
38
What causes high blood fat levels?
High cholesterol levels may run in some families. But most often, high blood
fat levels are caused by an unhealthy diet and lack of physical activity. High
blood fat levels rarely produce symptoms or warning signs. When cholesterol
levels are very high, some people develop skin growths called xanthomas. To
check your blood fat levels, ask your doctor for a simple blood test.
In some cases, a high blood fat level may be associated with an undiagnosed
medical condition, like diabetes.
39
Annex. Medicines for treating and
managing heart attacks and strokes
This table shows medicines commonly used to treat heart attacks, strokes,
and the physical problems that cause them.
Warning: Most of these medicines are prescribed by doctors and must only
be used under medical care. Never take them without your doctor’s advice.
Used wrongly, these medicines can be fatal.
Allergic reactions
The most common side-effects are allergic reactions such as:
• itching, red or swollen skin;
• stomach pain and vomiting;
• diarrhoea;
• high heart rate;
• feeling giddy or dizzy.
Dry cough
Dry cough sometimes occurs with ACE inhibitors.
Bleeding
If you are using an antiplatelet agent like aspirin, or an anticoagulant like
warfarin, it can produce bleeding. Watch out for:
• blood in the urine or faeces (stool);
• bleeding from the gums when eating or brushing teeth;
• abnormal pain in the stomach area.
If you have any of these symptoms, talk to your doctor before taking another
dose of medicine. People taking warfarin need to be carefully monitored. If
you are taking warfarin, you should follow closely your doctor’s recommen-
dations, which will include regular blood tests.
abdomen: the part of the body between the carotid endarterectomy: a surgical proce-
chest and the hips. dure to remove the thickened and hardened
parts inner walls of the artery that supplies
angina: chest pain caused by a reduction in
blood to the brain.
blood flow to the heart muscle.
cholesterol: a waxy substance that can be
angioplasty: a procedure to open up blocked
produced by the liver, or absorbed from certain
blood vessels, particularly coronary arteries.
animal foods, such as dairy products, meat,
Often performed with either a balloon or a
animal fats and egg yolks. It can be found in
wire mesh (stent, see also stenting).
the blood stream.
antibiotic: a drug used to treat bacterial high density lipoprotein (HDL) choles-
infections. terol: so-called ‘good’ cholesterol, which
arteriogram: an imaging procedure in which protects against heart attacks and strokes.
contrast medium (dye) is injected into the low density lipoprotein (LDL) choles-
blood vessels, which are then X-rayed, to find terol: so-called ‘bad’ cholesterol, which can
out whether they are blocked or narrowed. increase the risk of heart attacks and strokes.
coronary arteriogram: an arteriogram per- coma: a state in which a person is not con-
formed on the heart blood vessels (coronary scious, usually due to serious illness or injury.
arteries) to see if they are narrowed or not.
computerized tomography (CT): an imaging
atrial fibrillation: a type of irregular heart- procedure, in which X-rays are used to produce
beat, which can be a risk factor for stroke. cross-sectional images of the body.
blood fats/lipids: fats or fat like substances coronary arteries: blood vessels on the sur-
such as cholesterol and triglyceride present in face of the heart, which feed the heart muscles.
blood.
diabetes: a chronic disease characterized by
blood pressure: the force with which blood inability of the body to produce or use insulin
pushes against the walls of arteries. properly. Associated with high levels of sugar
diastolic blood pressure: blood pressure in the blood.
when the heart is resting between contrac-
echocardiogram: a medical examination that
tions.
uses ultrasound to record the movement and
systolic blood pressure: blood pressure structure of the heart.
when the heart is contracting.
electrocardiogram: a medical examination in
blood sugar: sugar that circulates in the which electrodes are attached to the surface of
blood. the body to record electrical signals associated
body mass index (BMI): a measure of weight with the contractions of the heart.
in relation to height, calculated as weight in endocarditis, infective: an infection inside
kilograms divided by the square of height in the heart, which can damage heart valves.
metres.
exercise stress test: a medical examination
bypass surgery: a type of surgery, in which in which an electrocardiogram is performed on
blood is rerouted around a blocked artery, of- a person who is exercising, to measure the re-
ten using a segment of a healthy blood vessel sponse of the heart to physical activity and how
removed from another part of the body. much physical activity the heart can tolerate.
coronary artery bypass surgery (CABG):
fasting plasma glucose: blood sugar levels
a bypass surgery performed on coronary
when you have not had meals at least for 8
arteries to improve the supply of blood to
hours. Plasma is the yellowish liquid part of the
the heart.
blood used for the measurement of the blood
sugar levels are measured.
42
heart attack: death of part of the heart mus- saturated fat: a type of fat that can increase
cle as a result of a coronary artery becoming the risk of heart attacks and strokes. Found
blocked. in foods from animals and some plants, e.g.
coconuts. Known to increase the risk of heart
heart failure: a condition in which the heart
attacks and strokes by elevating blood fat
cannot pump enough blood to meet the needs
levels.
of the body.
stenting: a procedure to open up hardened
heart murmur: abnormal heart sounds pro-
and narrowed arteries, using a wire mesh
duced by blood flow in the heart. Often associ-
called a stent (see also angioplasty).
ated with an abnormality of the heart (such as
damaged or abnormal heart valves). strep-sore throat: infection in the throat
caused by streptococcal bacteria.
heart valves: valves between the heart cham-
bers and the large blood vessels, which control streptococci, group A: the bacteria that
blood flow by opening and closing in accord- cause strep-sore throat and rheumatic fever
ance with the heartbeat. If damaged, blood
stroke: a condition in which brain tissue is
flow within the heart will becomes erratic.
damaged as a result of interruption of the
haemoglobin: substance contained in red blood supply, usually because a blood vessel
blood cells, which carries oxygen through the bursts or is blocked by a clot.
body.
thrombolytic therapy: treatment for heart
hormone: a substance produced by various attacks and strokes, in which a drug that dis-
glands in the body with specific functions. solves blood clots is injected to recover blood
Insulin is an example of a hormone. flow in the area suffering from the lack of
blood flow into the bloodstream.
insulin: a hormone produced by the body,
which allows cells to use sugar. tonsils: two large lymph nodes located at the
back of the mouth.
magnetic resonance imaging (MRI): an
imaging technique, in which powerful electro- trans-fat: a type of fat that increases the risk
magnets are used to produce detailed pictures of heart attacks and strokes. It is generated
of the inside of the human body. when oil is processed to stay fresh longer, and
is often found in foods like stick margarines
Omega-3 fatty acids: ‘good fats’ that can
and fast foods.
protect people from heart attacks and strokes.
Fish oils are rich in omega-3 fatty acids. transient ischaemic attack: a small stroke-
DHA(docosahexanoic acid): a type of ome- like event, which resolves in a day or less
ga-3 fatty acid (‘good fat’) that can protect (minor stroke). Often a warning sign of an
blood vessels from heart attacks and strokes. impending major stroke.
EPA(eicosapentanoic acid): a type of triglyceride: a type of fat found in food and
omega-3 fatty acid (‘good fat’) that can in the body.
protect blood vessels from heart attacks and
unsaturated fat: a type of fat usually found in
strokes.
foods from plants, such as safflower, sesame,
penicillin: an antibiotic, which is usually used sunflower, canola, and olives.
to treat streptococcal infections, such as strep-
waist-to-hip ratio: ratio of waist circumfer-
sore throat and rheumatic fever.
ence and hip circumference. Can be used as an
physical activity: any kind of activity that indicator of overweight and obesity.
involves bodily movements.
xanthoma: a soft yellowish bulge of skin
physiotherapy (physical therapy): treatment containing cholesterol. High blood fats (choles-
using exercises, heat, etc. terol) can cause xanthomas.
X-ray: an imaging procedure that uses elec-
tromagnetic radiation called x-ray to obtain a
picture of inside the human body.
43
Contributors
This project was coordinated by Shanthi Mendis and David Webber.
44
Deaths from stroke
Number of deaths from stroke Top 3
2002 highest number of
deaths from stroke
200 000 and above 1000–9999
ICELAND
FINLAND 100 000–199 999 below 1000
SWEDEN
NORWAY
10 000–99 999 no data
ESTONIA
RUSSIAN
UNITED LATVIA FEDERATION
KINGDOM
DENMARK LITHUANIA
IRELAND
NETH. BELARUS
POLAND
BELGIUM GERMANY
CZECH UKRAINE
REPUBLIC SLOVAKIA
LUX. REP.
HUNGARY MOLDOVA
FRA NC E AUSTRIA ROMANIA
SWITZ. SLOVENIA BOSNIA &
HERZEGOVINA
CROATIA SERBIA &
MONTENEGRO BULGARIA
MONACO
RUSSIAN FEDERATION 517 424
ANDORRA ITALY
C A N A D A ALBANIA
PORTUGAL FYR MACEDONIA
S P A IN
GREECE
KAZAKHSTAN
MALTA MONGOLIA
DPR
GEORGIA KYRGYZSTAN KOREA
UZBEKISTAN JAPAN
AZERBAIJAN
ARMENIA
TURKEY TURKMENISTAN REP.
TAJIKISTAN KOREA
U S A CYPRUS SYRIAN ARAB 1 652 885
MOROCCO TUNISIA REPUBLIC ISL . REP.
LEBANON AFGHANISTAN
ISRAEL IRAQ IRAN C H I N A
JORDAN MARSHALL ISLANDS
KUWAIT PAKISTAN BHUTAN
BAHAMAS ALGERIA LIBYAN NEPAL
BAHRAIN KIRIBATI
CUBA ARAB GUAM
MEXICO JAMAHIRIYA QATAR NAURU
EGYPT UAE
DOMINICAN INDIA TUVALU
BANGLADESH
JAMAICA REP. SAUDI ARABIA LAO
HAITI MYANMAR COOK
BELIZE MAURITANIA PDR SAMOA ISLANDS
ANTIGUA & BARBUDA OMAN VIET NAM
GUATEMALA ST KITTS & NEVIS MALI FIJI NIUE
HONDURAS
DOMINICA CAPE VERDE NIGER 771 067 THAILAND VANUATU
EL SALVADOR SENEGAL ERITREA YEMEN
ST VINCENT & GRENADINES ST LUCIA CHAD TONGA
GAMBIA SUDAN PHILIPPINES
NICARAGUA BARBADOS
GRENADA BURKINA CAMBODIA
GUINEA-BISSAU FASO DJIBOUTI
COSTA RICA TRINIDAD & TOBAGO
GUINEA NIGERIA
PANAMA VENEZUELA GUYANA CÔTE SRI LANKA
BENIN
SIERRA LEONE ETHIOPIA
PALAU
TOGO
SURINAME D’IVOIRE CENTRAL AFRICAN MALDIVES BRUNEI DAR.
GH ANA
LIBERIA
COLOMBIA REPUBLIC
MALAYSIA
EQUATORIAL CAMEROON SOMALIA
GUINEA UGANDA
SINGAPORE MICRONESIA,
KENYA FED. STATES OF
ECUADOR GABON
SAO TOME
DEM. REP. RWANDA
& PRINCIPE SEYCHELLES
CONGO CONGO BURUNDI
UNITED REP. PAPUA
PERU I N D O N E S I A NEW
TANZANIA
BRAZIL GUINEA SOLOMON
COMOROS ISLANDS
ANGOLA TIMOR-LESTE
MALAWI
ZAMBIA MADAGASCAR
BOLIVIA MAURITIUS
ZIMBABWE
NAMIBIA
BOTSWANA
MOZAMBIQUE
PARAGUAY
CHILE AUSTRALIA
SWAZILAND
SOUTH
AFRICA LESOTHO
URUGUAY
ARGENTINA
NEW
ZEALAND
3
Tobacco use
Unhealthy diet
3
Hypertension
Diabetes
Hyperlipidaemia
Heart attacks
and Strokes
ISBN 92 4154672 7
Cardiovascular Disease Programme
CH-1211 Geneva 27, Switzerland
mendiss@who.int
Fax 00 41 22 791 4151
http://www.who.int/cardiovascular_diseases/en/