Cardiovascular disease

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Cardiovascular disease
SpecialtyCardiology Edit this on Wikidata

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries and veins).[1] Cardiovascular disease refers to any disease that affects the cardiovascular system (as used in MeSH C14 or International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD10), ICD-10 Chapter IX: Diseases of the circulatory system), principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease.[2] The causes of cardiovascular disease are diverse but atherosclerosis and/or hypertension are the most common.

Cardiovascular diseases remain the biggest cause of deaths worldwide, though over the last two decades, cardiovascular mortality rates have declined in many high-income countries. At the same time cardiovascular deaths and disease have increased at an astonishingly fast rate in low- and middle-income countries.[3] Although cardiovascular disease usually affects older adults, the antecedants of cardiovascular disease, notably atherosclerosis begin in early life, making primary prevention efforts necessary from childhood.[4] There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise, and avoidance of smoking.

Types of cardiovascular disease

Main article: Coronary heart disease
  • Cardiomyopathy - diseases of cardiac muscle
Main article: Cardiomyopathy
  • Hypertensive heart disease - diseases of the heart secondary to high blood pressure
Main article: Hypertensive heart disease
  • Heart failure
Main article: Heart failure
  • Cor pulmonale - a failure of the right side of the heart
Main article: Cor pulmonale
  • Cardiac dysrhythmias - abnormalities of heart rhythm
Main article: Cardiac dysrhythmias
Disability-adjusted life year for inflammatory heart diseases per 100,000 inhabitants in 2004.[5]
  no data
  less than 70
  70-140
  140-210
  210-280
  280-350
  350-420
  420-490
  490-560
  560-630
  630-700
  700-770
  more than 770
Main article: Valvular heart disease
Main article: Stroke
  • Peripheral arterial disease
Main article: Peripheral arterial disease

Risk factors

Almost all cardiovascular disease in a population can be explained in terms of a handful of risk factors: age, gender, high blood pressure, high serum cholesterol levels, tobacco smoking, excessive alcohol consumption, family history, obesity, lack of physical activity, psychosocial factors and diabetes mellitus. [2] While the individual contribution of each risk factor varies between different communities or ethnic groups the consistency of the overall contribution of these risk factors is remarkably strong. [6] Some of these risk factors, such as age, gender or family history are immutable, however many important cardiovascular risk factors are modifiable by lifestyle or drug treatment.

Age

Age is an important risk factor in developing cardiovascular diseases. It is estimated that 87 percent of people who die of coronary heart disease are 60 and older[7]. At the same time, the risk of stroke doubles every decade after age 55.[8]

Multiple explanations have been proposed to explain why age increases the risk of cardiovascular diseases. One of them is related to serum cholesterol level.[9]In most populations, the serum total cholesterol level increases as age increases. In men, this increase levels off around age 45 to 50 years. In women, the increase continues sharply until age 60 to 65 years.[9]

Aging is also associated with changes in the mechanical and structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and may subsequently lead to coronary artery disease.[10]

Gender

Men are at greater risk of heart disease than pre-menopausal women.[11] However, once past menopause, a woman’s risk is similar to a man’s.[11]

Among middle-aged people, coronary heart disease is 2 to 5 times more common in men than in women.[9] In a study done by the World Health Organization, gender contributes to approximately 40% of the variation in the sex ratios of coronary heart disease mortality.[12]Another study reports similar results that gender difference explains nearly half of the risk associated with cardiovascular diseases[9] One of the proposed explanations for the gender difference in cardiovascular disease is hormonal difference.[9] Among women, estrogen is the predominant sex hormone. Estrogen may have protective effects through glucose metabolism and hemostatic system, and it may have a direct effect on improving endothelial cell function.[9] The production of estrogen decreases after menopause, and may change the female lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level and by increasing LDL and total cholesterol levels.[9] Women who have experienced early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age group who have not yet gone through menopause.[13]

Among men and women, there are differences in body weight, height, body fat distribution, heart rate, stroke volume, and arterial compliance.[14] In the very elderly, age related large artery pulsatility and stiffness is more pronounced in women.[15]This may be caused by the smaller body size and arterial dimensions independent of menopause.[16]

Air pollution

Particulate matter have been studied for their short- and long-term exposure effects on cardiovascular disease. Currently, PM2.5 is the major focus, in which gradients are used to determine CVD risk. For every 10 μg/m3 of PM2.5 long-term exposure, there was an estimated 8-18% CVD mortality risk.[17] Women had a higher relative risk (RR) (1.42) for PM2.5 induced coronary artery disease than men (0.90) did.[17] Overall, long-term PM exposure increased rate of atherosclerosis and inflammation. In regards to short-term exposure (2 hours), every 25 μg/m3 of PM2.5 resulted in a 48% increase of CVD mortality risk.[18] Additionally, after only 5 days of exposure, a rise in systolic (2.8 mmHg) and diastolic (2.7 mmHg) blood pressure occurred for every 10.5 μg/m3 of PM2.5.[19] Other research has implicated PM2.5 in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure.[20][21] PM2.5 is also linked to carotid artery thickening and increased risk of acute myocardial infarction.[22][23]

Pathophysiology

Population based studies show that atherosclerosis the major precursor of cardiovascular disease begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 7–9 years.[24]

This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken.

Obesity and diabetes mellitus are often linked to cardiovascular disease,[25] as are a history of chronic kidney disease and hypercholesterolaemia .[26] In fact, cardiovascular disease is the most life threatening of the diabetic complications and diabetics are two- to four-fold more likely to die of cardiovascular-related causes than nondiabetics.[27][28][29]

Screening

Some biomarkers are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.[30] Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:

Prevention

Measures to prevent cardiovascular disease may include:

  • a low fat high fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[32]
  • a diet high in vegetables and fruit[33]
  • tobacco cessation and avoidance of second-hand smoke;[32]
  • limit alcohol consumption to the recommended daily limits;[32]
  • lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed];
  • decrease body fat (BMI) if overweight or obese[citation needed];
  • increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[32]
  • decrease emotional stress[citation needed].
  • Consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[34][35]

Diet

Evidence shows that the Mediterranean diet improves cardiovascular outcomes.[36] As of 2010 however vitamins have not been found to be effective at preventing cardiovascular disease.[37] Evidence to support omega-3 fatty acid supplementation is equally poor.[38]

The link between fat in take and cardiovascular disease is controversial. While substitution polyunsaturated fats for saturated fats may reduce risk, substitution with refined carbohydrates does not change or may increase risk.[39][40] Evidence does not support a direct association between the consumption of saturated fat and cardiovascular disease.[41] Trans fatty acids however do significantly increase the risk.[42]

Medication

Aspirin has not been found to be of benefit over all in those at low risk of heart disease as the risk of serious bleeding is equal to the benefit with respect to cardiovascular problems.[43]

Management

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.[44][45][46] Medication may also be useful for prevention.

Epidemiology

Disability-adjusted life year for cardiovascular diseases per 100,000 inhabitants in 2004.[47] Template:Multicol
  no data
  <900
  900-1650
  1650-2300
  2300-3000
  3000-3700
  3700-4400
Template:Multicol-break
  4400-5100
  5100-5800
  5800-6500
  6500-7200
  7200-7900
  >7900
Template:Multicol-end

According to the World Health Organization, chronic diseases are responsible for 63% of all deaths in the world, with cardiovascular disease as the leading cause of death.[48]

Indians are known to be at major risk from heart diseases

Research

The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 1958.[49] The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis. A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease. These studies include those conducted by the Ryan Mackey Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular Health. Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with healthier menu options.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is a common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular disease.[50] Also osteoprotegerin which involved with regulation of a key inflammatory transcription factor called NF-κB has been found to be a risk factor of cardiovascular disease and mortality.[51][52]

Some areas currently being researched include possible links between infection with Chlamydophila pneumoniae and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.[53]


References

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External links

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