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{{Infobox_Disease |
⚫
'''Cardiovascular disease''' refers to the class of diseases that involve the [[heart]] and/or [[blood vessel]]s ([[artery|arteries]] and [[vein]]s). While the term technically refers to any disease that affects the [[cardiovascular system]], it is usually used to refer to those related to [[atherosclerosis]] (arterial disease). These conditions have similar causes, mechanisms, and treatments.
  
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Name = {{PAGENAME}} |
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Image = |
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Caption = |
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DiseasesDB = 28808 |
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ICD10 = {{ICD10|I|51|6|i|30}} |
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ICD9 = {{ICD9|429.2}} |
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ICDO = |
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OMIM = |
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MedlinePlus = |
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eMedicineSubj = |
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eMedicineTopic = |
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MeshID = D002318 |
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}}
  ⚫
'''Cardiovascular disease''' refers to the class of diseases that involve the [[heart]] or [[blood vessel]]s ([[artery|arteries]] and [[vein]]s). While the term technically refers to any disease that affects the [[Circulatory system|cardiovascular system]], it is usually used to refer to those related to [[atherosclerosis]] (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by [[cardiology|cardiologists]], [[thoracic surgery|thoracic surgeons]], [[vascular surgery|vascular surgeons]], [[neurology|neurologists]], and [[interventional radiology|interventional radiologists]], depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital.
   
  +
Most Western countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer.<ref>{{cite web
⚫
Over 50 million Americans have cardiovascular problems, and most other Western countries face high and increasing rates of cardiovascular disease. It is the number 1 cause of death and disability in the United States and most European countries. By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as [[healthy eating]], [[exercise]] and avoidance of [[tobacco smoking|smoking]].
  
  +
| last = United States
  +
| authorlink = Centers for Disease Control
  +
| title = Chronic Disease Overview
  +
| publisher = United States Government
  +
| date = 1999
  +
| url = http://www.cdc.gov/nccdphp/overview_text.htm
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| accessdate =2007-02-07 }}</ref> Diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability.
  +
Up until the year 2005, it was the number 1 cause of death and disability in the United States and most European countries. A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.<ref>Rainwater DL, McMahan CA, Malcom GT, Scheer WD, Roheim PS, McGill HC Jr, Strong JP. Lipid and apolipoprotein predictors of atherosclerosis in youth: apolipoprotein concentrations do not materially improve prediction of arterial lesions in PDAY subjects. The PDAY Research Group. Arterioscler Thromb Vasc Biol. 1999; 19: 753-61.</ref><ref>Mcgill, HC, Jr., Mcmahan, CA, Zieske, AW et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler. Thromb. Vasc. Biol. 2000; 20: 1998–2004.</ref>
   
−
==Forms==
  
−
Cardiovascular disease usually occurs as a result of arterial damage. The symptoms and treatments depend on which set (or sets) of arteries are affected.
 
   
  ⚫
By the time that heart problems are detected, the underlying cause ([[atherosclerosis]]) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as [[Healthy diet|healthy eating]], [[Physical exercise|exercise]] and avoidance of [[tobacco smoking|smoking]].
−
In [[coronary heart disease]], atherosclerotic plaques (inflamed fatty deposits in the blood vessel wall) obstruct the [[coronary artery|coronary arteries]] (blood vessels supplying the heart). Narrowing of arteries is called arterial [[stenosis]]. When the blockages become severe enough, the blood flow to the heart is restricted (cardiac [[ischemia]]), especially during increased demand (''i.e.'' during exertion or emotion). This results in [[angina pectoris]]. The [[acute]] stage of coronary heart disease occurs when one of the plaques ruptures, forming a [[thrombus]] (blood clot) that acutely occludes the whole artery. The portion of the heart muscle supplied by that artery dies; this is known as a [[myocardial infarction]] (or a ''heart attack'' in lay parlance). This may result in the death of the patient if the affected area is large enough. If the patient survives, [[congestive heart failure]] may result.
  
   
  ⚫
==Risk factors==
−
Similarly, inflammation and blood clots may obstruct the [[cerebral]] arteries (those supplying the [[human brain|brain]]). As the disease progresses, an artery may be transiently blocked, causing cerebral ischemia. This results in a [[transient ischemic attack]] (TIA), called a ''mini-stroke'' in lay parlance. If the obstruction is severe, a [[cerebrovascular accident]], or ''stroke'' may result, due to the death of brain tissue supplied by the artery.
 
   
  ⚫
There are many risk factors which associate with (but are not all causes of) various forms of cardiovascular disease. These include the following:
−
In [[peripheral artery disease]], obstruction occurs in the arteries of the arms or legs. This results initially in pain, during temporary obstruction, and finally in tissue death and [[gangrene]] if not treated.
  
  +
* Non-modifiable Risk Factors
  ⚫
** Age
  +
** [[Gender]], men under age 64 are much more likely to die of coronary heart disease than women, although the gender difference declines with age.<ref>{{cite journal | author=Jousilahti P, Vartiainen E, Tuomilehto J, Puska P | title=Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14,786 middle-aged men and women in Finland | journal=CIRCULATION | volume=99 | issue=9 | year=1999 | pages=1165-1172 | url=http://circ.ahajournals.org/cgi/content/full/99/9/1165 * [[Diabetes mellitus]]|id=PMID 10069784}}</ref> (The gender difference is less pronounced in blacks than in whites, but it is still significant <ref>{{cite journal | author=Ho JE, Paultre F, Mosca L | title=The gender gap in coronary heart disease mortality: is there a difference between blacks and whites? | journal=JOURNAL OF WOMEN'S HEALTH | volume=14 | issue=2 | year=2005 | pages=117-127 | id=PMID 15775729}}</ref>)
  ⚫
** [[Genetics|Genetic factors]]/[[Family history (medicine)|Family history]] of cardiovascular disease
  +
** Race (or [[ethnicity]]), Studies show that [[African American]]s are twice as likely to develop high blood pressure as [[Caucasian race|Caucasians]].
  +
** [[Environmental quality|Environment]], your chances can increase because of areas with a lot of smog or other form of [[air pollution]], including [[passive smoking]].
   
  +
*Modifiable Risk Factors
−
There are many specific illnesses that may occur in association with these and other cardiovascular disease. In addition to the ones mentioned above, these include [[hypertension]] (high blood pressure), [[arterial]] [[aneurysm]]s (arterial enlargement and weakening), [[cardiomegaly]] (abnormal enlargement of the heart), [[tachycardia]]/[[bradycardia]]/[[arrhythmia]] (fast/slow/irregular heart rates), [[cardiac arrest]] (heart stoppage), [[cardiomyopathy]] (heart muscle weakness), [[Mitral regurgitation|heart valve regurgitation]] (leakage), and [[heart valve stenosis]] (narrowing).
  
  ⚫
** [[Tobacco smoking]]
  ⚫
** [[Insulin resistance]] & [[Diabetes mellitus]]
  ⚫
** [[Hypercholesterolemia]] (elevated [[cholesterol]] levels) and abnormal [[lipoprotein]] particle profile (cholesterol subtypes)
  ⚫
** [[Obesity]], especially [[central obesity|central]] or male-type obesity; apart from being linked to diabetes, this form of obesity independently increases cardiovascular risk, presumably by inducing an [[Inflammation|inflammatory]] and procoagulant state
  ⚫
** [[Hypertension|High blood pressure]]
  +
** [[Sleep deprivation]]
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** Elevated [[heart rate]]<ref>{{cite journal |author=Cook S, Togni M, Schaub MC, Wenaweser P, Hess OM |title=High heart rate: a cardiovascular risk factor? |journal=Eur. Heart J. |volume=27 |issue=20 |pages=2387-93 |year=2006 |pmid=17000632}}</ref>
  ⚫
** Physical inactivity/[[Sedentary lifestyle]]
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** Absence of key nutritional elements, such as [[omega-3 fatty acid]]s and [[polyphenol antioxidant]]s
  ⚫
** [[Noise health effects|Exposure to high levels of environmental noise]]
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** [[Stress (medicine)|Stress]]
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** Rocky Relationships<ref>http://news.bbc.co.uk/1/hi/health/7035169.stm</ref>
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** [[Depression (mood)|Depression]]
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** [[Periodontal disease]]
   
  ⚫
Although men have a higher rate of cardiovascular disease than women, it is also the number one health problem for women in industrialized countries. After [[menopause]], the risk for women approaches that of men. [[Hormone replacement therapy]] alleviates a number of post-menopausal problems, but appears to increase the risk of cardiovascular disease.
⚫
==Risk factors==
  
  +
⚫
There are many risk factors which predispose to various forms of cardiovascular disease. These include the following:
  
  +
==Biomarkers==
⚫
* Age
  
  +
Some [[Biomarker (medicine)|biomarkers]] are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.<ref>{{cite journal |author=Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino RB, Vasan RS |title=Multiple biomarkers for the prediction of first major cardiovascular events and death |journal=N. Engl. J. Med. |volume=355 |issue=25 |pages=2631-9 |year=2006 |pmid=17182988}}</ref> Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:
⚫
* [[Diabetes mellitus]]
  
  +
⚫
* [[Hypercholesterolemia]] (elevated [[cholesterol]] levels) and less than excellent [[lipoprotein]] particle profile (cholesterol subtypes)
  
  ⚫
* Higher [[Fibrin|fibrinogen]] and [[Plasminogen activator inhibitor-1|PAI-1]] blood concentrations
⚫
* [[Tobacco smoking]]
  
⚫
* Higher [[fibrinogen]] and [[Plasminogen activator inhibitor-1|PAI-1]] blood concentrations
 
 
* Elevated [[homocysteine]], or even upper half of normal
  
* Elevated [[homocysteine]], or even upper half of normal
 
* Elevated blood levels of [[asymmetric dimethylarginine]]
 
* Elevated blood levels of [[asymmetric dimethylarginine]]
  +
* High inflammation as measured by [[C-reactive protein]]
⚫
* [[Arterial hypertension|High blood pressure]]
  
  +
* Elevated blood levels of [[B-type natriuretic peptide (BNP)]] <ref>{{cite journal |author=Ramachandran Vasan, et al |journal=N. Engl. J.}}</ref>
⚫
* [[Noise health effects|exposure to high levels of environmental noise]]
  
⚫
* [[Obesity]], especially [[central obesity|central]] or female-type obesity; apart from being linked to diabetes, this form of obesity independently increases cardiovascular risk, presumedly by inducing an inflammatory and procoagulant state
  
⚫
* Genetic factors/[[Family history (medicine)|Family history]] of cardiovascular disease
  
⚫
* Physical inactivity
  
−
* Being a member of the male sex
  
−  
⚫
Although men have a higher rate of cardiovascular disease than women, it is also the number one health problem for women in industrialized countries. After [[menopause]], the risk for women approaches that of men. [[Hormone replacement therapy]] alleviates a number of post-menopausal problems, but appears to increase the risk of cardiovascular disease.
  
   
 
==Prevention==
  
==Prevention==
⚫
Attempts to prevent cardiovascular disease take the form of modifying risk factors. Some, such as gender (male or female), age, and family history, cannot be modified. Smoking cessation (or abstinence) is one of the most effective and easily modifiable changes. Also important is a low-fat, low-calorie diet, which helps one to maintain a healthy [[body mass index]] (BMI) and preventing obesity. Regular [[cardiovascular exercise]] ([[aerobic exercise]]) complements the healthful eating habits. Sometimes, the combination of diet and exercise will improve lipoprotein (cholesterol) levels; if not, a physician may prescribe "cholesterol-lowering" drugs, such as the [[statin]]s. These medications have additional protective benefits aside from their lipoprotein profile improvement. [[Aspirin]] may also be prescribed, as it has been shown to decrease the clot formation that may lead to myocardial infarctions and strokes; it is routinely prescribed for patients with one or more cardiovascular risk factors.
  
   
  ⚫
Attempts to prevent cardiovascular disease are more effective when they remove and prevent causes, and they often take the form of modifying risk factors. Some factors, such as gender, age, and family history, cannot be modified. [[Smoking cessation]] (or abstinence) is one of the most effective and easily modifiable changes. Regular [[cardiovascular exercise]] ([[aerobic exercise]]) complements the healthful eating habits. According to the American Heart Association, build up of plaque on the arteries ([[atherosclerosis]]), partly as a result of high cholesterol and fat diet, is a leading cause for cardiovascular diseases. The combination of healthy diet and exercise is a means to improve serum [[cholesterol]] levels and reduce risks of cardiovascular diseases; if not, a physician may prescribe "cholesterol-lowering" drugs, such as the [[statin]]s. These medications have additional protective benefits aside from their lipoprotein profile improvement. [[Aspirin]] may also be prescribed, as it has been shown to decrease the [[Thrombus|clot]] formation that may lead to myocardial infarctions and strokes; it is routinely prescribed for patients with one or more cardiovascular risk factors.
⚫
Eating [[oily fish]] at least twice a week may help reduce the risk of sudden death and arrhythmias. Studies of individual heart cells showed that the fatty acids blocked excessive [[sodium]] and [[calcium]] currents in the [[heart]], which could otherwise cause dangerous, unpredictable changes in its rhythm (Leaf ''et al'' 2003).
  
  +
  +
One possible way to decrease risk of cardiovascular disease is keep your total cholesterol below 150. In the [[Framingham Heart Study]], those with total cholesterol below 150 only very rarely got coronary heart disease.
  +
  +
A [[magnesium deficiency (medicine)|magnesium deficiency]], or lower levels of [[magnesium]], can contribute to heart disease and a [[healthy diet]] that contains adequate [[magnesium]] may prevent heart disease.<ref>[http://www.ars.usda.gov/is/AR/archive/may04/energy0504.htm Lack Energy? Maybe It's Your Magnesium Level]</ref> [[Magnesium]] can be used to enhance long term treatment, so it may be effective in long term prevention.<ref name="Rosanoff">[http://www.jacn.org/cgi/reprint/23/5/501S.pdf Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals] Andrea Rosanoff, PhD, Mildred S. Seelig, MD. Journal of the American College of Nutrition, Vol. 23, No. 5, 501S–505S (2004)</ref> Excess calcium may contribute to a buildup of calcium in the veins. Excess calcium can cause a [[magnesium deficiency (medicine)|magnesium deficiency]], and [[magnesium]] can reduce excess calcium.
  +
  +
==== Foods for Cardiovascular Health ====
  +
Research has shown that a diet that includes dark chocolate, almonds, fish, wine, fruits, vegetables, and garlic can increase life expectancy and decrease your risk for cardiovascular disease.<ref name= Franco >
  +
  +
{{cite journal
  +
| author= Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J | title= Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J | journal=BMJ. | year=2004 | pages= 1447–1450 | volume=329|
  +
}}</ref>
  +
  ⚫
Eating [[oily fish]] at least twice a week may help reduce the risk of sudden death and arrhythmias. A 2005 review of 97 clinical trials by Studer et al. noted that omega-3 fats gave lower risk ratios than did statins.<ref>Studer M, Briel M, Liemenstoll B, Blass TR, Bucher HC. "Effect of different antilipidemic agents and diets on mortality: a systematic review." Arch. Intern. Med. 2005; 165(7): 725-730.</ref> [[Olive oil]] is said to have benefits. Studies of individual heart cells showed that fatty acids blocked excessive [[sodium]] and [[calcium]] currents in the [[heart]], which could otherwise cause dangerous, unpredictable changes in its rhythm.
  +
  +
===Cardiovascular disease and salt===
  +
There is evidence from one large unblinded randomised controlled trial of more than 3000 patients that reducing the amount of sodium in the diet reduced the risk of cardiovascular events by more than 25%.<ref name="TOHP2007">{{cite journal | title=Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP) | author=Cook NR, Cutler JA, Obarzanek E, ''et al.'' | journal=Br Med J | year=2007 | doi=10.1136/bmj.39147.604896.55 }}</ref> This re-affirms evidence from the [[Intersalt study]] published in 1996, that high levels of dietary salt are harmful;<ref>{{cite journal | author=Elliott P, Stamler J, Nichols R, ''et al.'' | title=Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group | journal=Br Med J | year=1996 | volume=312 | issue=7041 | pages=1249&ndash;53 | id=PMID 8634612 }}</ref> these results were at the time heavily disputed by the [[Salt Institute]] (the salt producers' trade organisation).<ref>{{cite journal | author=Godlee F | title=Editor's Choice: Time to talk salt | journal=Br Med J | year=2007 | volume=334 | issue=7599 | doi=10.1136/bmj.39196.679537.47 }}</ref>
  +
  +
==Awareness==
  +
[[Atherosclerosis]] is a process that develops over decades and is often silent until an acute event (heart attack) develops in later life. Population based studies in the youth show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as 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 15–19 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.<ref>Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA. Awareness, knowledge, and perception of heart disease among adolescents. European Journal of Cardiovascular Prevention and Rehabilitation. October, 2006; 13(5): 718-723. ISSN 1741-8267</ref> This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken.
   
 
==Treatment==
  
==Treatment==
−
Treatment of cardiovascular disease depends on the specific form of the disease in each patient, but effective treatment always includes preventative lifestyle changes discussed above. Medications, such as [[antihypertensive|blood pressure reducing medications]], aspirin and other treatments may be involved. In some circumstances, surgery or [[angioplasty]] may be warranted to reopen, repair, or replace damaged blood vessels.
 +
Treatment of cardiovascular disease depends on the specific form of the disease in each patient, but effective treatment always includes preventive lifestyle changes discussed above. Medications, such as [[antihypertensive|blood pressure reducing medications]], aspirin and the statin cholesterol-lowering drugs may be helpful. In some circumstances, [[Coronary artery bypass surgery|surgery]] or [[angioplasty]] may be warranted to reopen, repair, or replace damaged blood vessels.
  +
  +
==Types of Cardiovascular Diseases==
  +
*[[Aneurysms]]
  +
*[[Angina pectoris|Angina]]
  +
*[[Arrhythmia]]
  +
*[[Atherosclerosis]]
  +
*[[Blood pressure disorders]]
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*[[Cardiomyopathy]]
  +
*Cerebrovascular accident ([[Stroke]])
  +
*[[Cerebrovascular disorders]]
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*[[Congenital heart disease]]
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*[[Congestive heart failure]]
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*[[Embolisms]]
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*[[Hypertension]]
  +
*[[Ischemia]]
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*[[Myocarditis]]
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*[[Valvular heart disease|Valve disease]]
  +
*[[Coronary artery disease]]
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*[[Dilated cardiomyopathy]]
  +
*[[Diastolic dysfunction]]
  +
*[[Endocarditis]]
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*[[Hypertrophic ardiomyopathy]]
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*[[Mitral valve prolapse]]
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*[[Myocardial infarction]] (Heart Attack)
  +
*[[Thrombosis]]
  +
  +
[[vein|Venous]] [[Thromboembolism]]
   
 
==Research==
  
==Research==
−
The causes, prevention, and/or treatment of all forms of cardiovascular disease are active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis.
 +
The causes, prevention, and/or treatment of all forms of cardiovascular disease are active fields of [[biomedical research]], with hundreds of scientific studies being published on a weekly basis.
   
−
A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. [[C-reactive protein]] (CRP) is an inflammatory marker that may be present in increased levels in the blood in patients at risk for cardiovascular disease. Its exact role in predicting disease is the subject of debate.
 +
A fairly recent emphasis is on the link between low-grade [[inflammation]] that hallmarks atherosclerosis and its possible interventions. [[C-reactive protein]] (CRP) is an inflammatory marker that may be present in increased levels in the blood in patients at risk for cardiovascular disease. Its exact role in predicting disease is the subject of debate.
   
−
Some areas currently being researched include possible links between [[infection]] with ''[[Chlamydia pneumoniae]]'' and coronary artery disease. The ''Chlamydia'' link has become less plausible with the absence of improvement after antibiotic use (Andraws ''et al'' 2005).
 +
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.<ref>Andraws R, Berger JS, Brown DL. ''Effects of antibiotic therapy on outcomes of patients with coronary artery disease''. [[Journal of the American Medical Association|JAMA]] 2005;293:2641-7. PMID 15928286.</ref>
  +
  +
==See also==
  +
*[[Cardiovascular system]]
  +
*[[Coronary prone behavior]]
  +
*[[Dyspnea]]
  +
*[[Heart disorders]]
  +
*[[Heart rate affecting drugs]]
  +
*[[Hemorrhage]]
   
 
==References==
  
==References==
  +
{{reflist|2}}
−
* Andraws R, Berger JS, Brown DL. ''Effects of antibiotic therapy on outcomes of patients with coronary artery disease''. JAMA 2005;293:2641-7. PMID 15928286.
  
−
* Leaf A, Kang JX, Xiao YF, Billman GE. ''Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils.'' Circulation 2003;107:2646-52. PMID 12782616.
  
   
 
==External links==
  
==External links==
  +
*[[American Heart Association]] "Heart Disease and Stroke Statistics-2006 Update". http://www.americanheart.org/downloadable/heart/1140534985281Statsupdate06book.pdf
−
* [http://www.medical.siemens.com/webapp/wcs/stores/servlet/CategoryDisplay?catalogId=-1&storeId=10001&categoryId=14195&langId=-1&catTree=100002,14195&level=0 Clinical Solutions in Cardiovascular Disease] from Siemens
  
  +
*[http://www.cvdf.org Cardiovascular Disease Foundation] Your connection to prevention, research, and education.
⚫
* ''[http://news.bbc.co.uk/1/hi/health/4764891.stm Heart disease 'costing UK £29bn']'' at [[BBC News]], [[14 May]] [[2006]]
  
  +
*[http://www.sistertosister.org Sister to Sister] Information about Women's Heart Disease
  +
*[http://www.nature.com/ncpcardio/index.html NCP Cardiovascular Medicine] A Journal Covering Clinical Cardiovascular Medicine
  +
*[http://www.dietaryfiberfood.com/cholesterol-high-avoid.php Cholesterol Content in Food]
  +
*[http://www.americanheart.org/presenter.jhtml?identifier=3039313 The lacking awareness of cardiovascular disease by youth] A study by Dr Thomas E. Vanhecke, MD.
  +
*[http://www.americanheart.org/presenter.jhtml?identifier=3000333 American Heart Association]
  +
*[http://www.who.int/cardiovascular_diseases/en/ World Health Organization cardiovascular disease site]
  ⚫
*[http://news.bbc.co.uk/1/hi/health/4764891.stm Heart disease 'costing UK £29bn'] at [[BBC News]], [[14 May]] [[2006]]
  +
*[http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including cardiovascular diseases) by a Joint [[WHO]]/[[FAO]] Expert consultation (2003)
  +
*[http://www.lipidsonline.org/slides/slide01.cfm?q=cholesterol+distribut&dpg=1 Total Cholesterol Distribution vs. CHD deaths]
  +
*[http://www.ohsu.edu/drugeffectiveness/reports/documents/BB_final_report_update%203.pdf Drug Class Review on Beta Adrenergic Blockers Sep 2007]
  +
  +
{{Circulatory system pathology}}
   
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[[Category:Cardiovascular diseases| ]]
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[[Category:Cardiovascular disorders| ]]
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[[category:Heart disorders]]
 
[[Category:Medical conditions related to obesity]]
  
[[Category:Medical conditions related to obesity]]
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[[Category:Physical disorders]]
   
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{{enWP|Cardiovascular disease}}

Latest revision as of 10:08, 19 December 2009

Cardiovascular disease
ICD-10 I00-I78
ICD-9 390-434, 436-448
OMIM {{{OMIM}}}
DiseasesDB {{{DiseasesDB}}}
MedlinePlus {{{MedlinePlus}}}
eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}}
MeSH {{{MeshNumber}}}
Cardiovascular disorders
ICD-10 I516
ICD-9 429.2
OMIM [1]
DiseasesDB 28808
MedlinePlus [2]
eMedicine /
MeSH {{{MeshNumber}}}

Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital.

Most Western countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer.[1] Diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability. Up until the year 2005, it was the number 1 cause of death and disability in the United States and most European countries. A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.[2][3]


By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and avoidance of smoking.

Risk factors

There are many risk factors which associate with (but are not all causes of) various forms of cardiovascular disease. These include the following:

  • Non-modifiable Risk Factors
    • Age
    • Gender, men under age 64 are much more likely to die of coronary heart disease than women, although the gender difference declines with age.[4] (The gender difference is less pronounced in blacks than in whites, but it is still significant [5])
    • Genetic factors/Family history of cardiovascular disease
    • Race (or ethnicity), Studies show that African Americans are twice as likely to develop high blood pressure as Caucasians.
    • Environment, your chances can increase because of areas with a lot of smog or other form of air pollution, including passive smoking.

Although men have a higher rate of cardiovascular disease than women, it is also the number one health problem for women in industrialized countries. After menopause, the risk for women approaches that of men. Hormone replacement therapy alleviates a number of post-menopausal problems, but appears to increase the risk of cardiovascular disease.

Biomarkers

Some biomarkers are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.[8] Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:

  • Higher fibrinogen and PAI-1 blood concentrations
  • Elevated homocysteine, or even upper half of normal
  • Elevated blood levels of asymmetric dimethylarginine
  • High inflammation as measured by C-reactive protein
  • Elevated blood levels of B-type natriuretic peptide (BNP) [9]

Prevention

Attempts to prevent cardiovascular disease are more effective when they remove and prevent causes, and they often take the form of modifying risk factors. Some factors, such as gender, age, and family history, cannot be modified. Smoking cessation (or abstinence) is one of the most effective and easily modifiable changes. Regular cardiovascular exercise (aerobic exercise) complements the healthful eating habits. According to the American Heart Association, build up of plaque on the arteries (atherosclerosis), partly as a result of high cholesterol and fat diet, is a leading cause for cardiovascular diseases. The combination of healthy diet and exercise is a means to improve serum cholesterol levels and reduce risks of cardiovascular diseases; if not, a physician may prescribe "cholesterol-lowering" drugs, such as the statins. These medications have additional protective benefits aside from their lipoprotein profile improvement. Aspirin may also be prescribed, as it has been shown to decrease the clot formation that may lead to myocardial infarctions and strokes; it is routinely prescribed for patients with one or more cardiovascular risk factors.

One possible way to decrease risk of cardiovascular disease is keep your total cholesterol below 150. In the Framingham Heart Study, those with total cholesterol below 150 only very rarely got coronary heart disease.

A magnesium deficiency, or lower levels of magnesium, can contribute to heart disease and a healthy diet that contains adequate magnesium may prevent heart disease.[10] Magnesium can be used to enhance long term treatment, so it may be effective in long term prevention.[11] Excess calcium may contribute to a buildup of calcium in the veins. Excess calcium can cause a magnesium deficiency, and magnesium can reduce excess calcium.

Foods for Cardiovascular Health

Research has shown that a diet that includes dark chocolate, almonds, fish, wine, fruits, vegetables, and garlic can increase life expectancy and decrease your risk for cardiovascular disease.[12]

Eating oily fish at least twice a week may help reduce the risk of sudden death and arrhythmias. A 2005 review of 97 clinical trials by Studer et al. noted that omega-3 fats gave lower risk ratios than did statins.[13] Olive oil is said to have benefits. Studies of individual heart cells showed that fatty acids blocked excessive sodium and calcium currents in the heart, which could otherwise cause dangerous, unpredictable changes in its rhythm.

Cardiovascular disease and salt

There is evidence from one large unblinded randomised controlled trial of more than 3000 patients that reducing the amount of sodium in the diet reduced the risk of cardiovascular events by more than 25%.[14] This re-affirms evidence from the Intersalt study published in 1996, that high levels of dietary salt are harmful;[15] these results were at the time heavily disputed by the Salt Institute (the salt producers' trade organisation).[16]

Awareness

Atherosclerosis is a process that develops over decades and is often silent until an acute event (heart attack) develops in later life. Population based studies in the youth show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as 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 15–19 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.[17] This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken.

Treatment

Treatment of cardiovascular disease depends on the specific form of the disease in each patient, but effective treatment always includes preventive lifestyle changes discussed above. Medications, such as blood pressure reducing medications, aspirin and the statin cholesterol-lowering drugs may be helpful. In some circumstances, surgery or angioplasty may be warranted to reopen, repair, or replace damaged blood vessels.

Types of Cardiovascular Diseases

Venous Thromboembolism

Research

The causes, prevention, and/or treatment of all forms of cardiovascular disease are active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is an inflammatory marker that may be present in increased levels in the blood in patients at risk for cardiovascular disease. Its exact role in predicting disease is the subject of debate.

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.[18]

See also

References

  1. ↑ United States Chronic Disease Overview. United States Government. URL accessed on 2007-02-07.
  2. ↑ Rainwater DL, McMahan CA, Malcom GT, Scheer WD, Roheim PS, McGill HC Jr, Strong JP. Lipid and apolipoprotein predictors of atherosclerosis in youth: apolipoprotein concentrations do not materially improve prediction of arterial lesions in PDAY subjects. The PDAY Research Group. Arterioscler Thromb Vasc Biol. 1999; 19: 753-61.
  3. ↑ Mcgill, HC, Jr., Mcmahan, CA, Zieske, AW et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler. Thromb. Vasc. Biol. 2000; 20: 1998–2004.
  4. ↑ Jousilahti P, Vartiainen E, Tuomilehto J, Puska P (1999). * Diabetes mellitus Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14,786 middle-aged men and women in Finland. CIRCULATION 99 (9): 1165-1172. PMID 10069784.
  5. ↑ Ho JE, Paultre F, Mosca L (2005). The gender gap in coronary heart disease mortality: is there a difference between blacks and whites?. JOURNAL OF WOMEN'S HEALTH 14 (2): 117-127. PMID 15775729.
  6. ↑ Cook S, Togni M, Schaub MC, Wenaweser P, Hess OM (2006). High heart rate: a cardiovascular risk factor?. Eur. Heart J. 27 (20): 2387-93.
  7. ↑ http://news.bbc.co.uk/1/hi/health/7035169.stm
  8. ↑ Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino RB, Vasan RS (2006). Multiple biomarkers for the prediction of first major cardiovascular events and death. N. Engl. J. Med. 355 (25): 2631-9.
  9. ↑ Ramachandran Vasan, et al. {{{title}}}. N. Engl. J..
  10. ↑ Lack Energy? Maybe It's Your Magnesium Level
  11. ↑ Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals Andrea Rosanoff, PhD, Mildred S. Seelig, MD. Journal of the American College of Nutrition, Vol. 23, No. 5, 501S–505S (2004)
  12. ↑ Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J (2004). Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J. BMJ. 329: 1447–1450.
  13. ↑ Studer M, Briel M, Liemenstoll B, Blass TR, Bucher HC. "Effect of different antilipidemic agents and diets on mortality: a systematic review." Arch. Intern. Med. 2005; 165(7): 725-730.
  14. ↑ Cook NR, Cutler JA, Obarzanek E, et al. (2007). Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). Br Med J.
  15. ↑ Elliott P, Stamler J, Nichols R, et al. (1996). Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group. Br Med J 312 (7041): 1249–53. PMID 8634612.
  16. ↑ Godlee F (2007). Editor's Choice: Time to talk salt. Br Med J 334 (7599).
  17. ↑ Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA. Awareness, knowledge, and perception of heart disease among adolescents. European Journal of Cardiovascular Prevention and Rehabilitation. October, 2006; 13(5): 718-723. ISSN 1741-8267
  18. ↑ Andraws R, Berger JS, Brown DL. Effects of antibiotic therapy on outcomes of patients with coronary artery disease. JAMA 2005;293:2641-7. PMID 15928286.

External links


v·d·e
Circulatory system pathology (I, 390-459)
Hypertension

Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)

Ischaemic heart disease

Angina pectoris (Prinzmetal's angina) - Myocardial infarction - Dressler's syndrome

Pulmonary circulation

Pulmonary embolism - Cor pulmonale

Pericardium

Pericarditis - Pericardial effusion - Cardiac tamponade

Endocardium/heart valves

Endocarditis - mitral valves (regurgitation, prolapse, stenosis) - aortic valves (stenosis, insufficiency) - pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, insufficiency)

Myocardium

Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia

Electrical conduction system
of the heart

Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block
Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest
Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Sick sinus syndrome

Other heart conditions

Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)

Cerebrovascular diseases

Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) - Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease

Arteries, arterioles
and capillaries

Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma

Veins, lymphatic vessels
and lymph nodes

Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins/Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph(Lymphadenitis, Lymphedema, Lymphangitis)

See also congenital (Q20-Q28, 745-747)

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