Cardiovascular disease

Cardiovascular disease
Classification and external resources
Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.
ICD-10	I51.6
ICD-9	429.2
DiseasesDB	28808
MeSH	D002318

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

• Coronary heart disease (also ischaemic heart disease or coronary artery disease)

• Cardiomyopathy - diseases of cardiac muscle

• Hypertensive heart disease - diseases of the heart secondary to high blood pressure

• Heart failure

• Cor pulmonale - a failure of the right side of the heart

• Cardiac dysrhythmias - abnormalities of heart rhythm

• Inflammatory heart disease
  • Endocarditis – inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves.
  • Inflammatory cardiomegaly
  • Myocarditis – inflammation of the myocardium, the muscular part of the heart.
• Valvular heart disease

• Stroke and cerebrovascular disease

• 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.^{[citation needed]} Some of these risk factors, such as age, gender or family history are unavoidable, 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^[6]. At the same time, the risk of stroke doubles every decade after age 55.^[7]

Multiple explanations have been proposed to explain why age increases the risk of cardiovascular diseases. One of them is related to serum cholesterol level.^[8]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.^[8]

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.^[9]

Gender

Men are at greater risk of heart disease than pre-menopausal women.^[10] However, once past menopause, a woman’s risk is similar to a man’s.^[10]

Among middle-aged people, coronary heart disease is 2 to 5 times more common in men than in women.^[8] 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.^[11]Another study reports similar results that gender difference explains nearly half of the risk associated with cardiovascular diseases^[8] One of the proposed explanations for the gender difference in cardiovascular disease is hormonal difference.^[8] 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.^[8] 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.^[8] 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.^[12]

Among men and women, there are differences in body weight, height, body fat distribution, heart rate, stroke volume, and arterial compliance.^[13] In the very elderly, age related large artery pulsatility and stiffness is more pronounced in women.^[14]This may be caused by the smaller body size and arterial dimensions independent of menopause.^[15]

Air pollution

Particulate matter have been studied for their short- and long-term exposure effects on cardiovascular disease. Currently, PM_2.5 is the major focus, in which gradients are used to determine CVD risk. For every 10 μg/m³ of PM_2.5 long-term exposure, there was an estimated 8-18% CVD mortality risk.^[16] Women had a higher relative risk (RR) (1.42) for PM_2.5 induced coronary artery disease than men (0.90) did.^[16] Overall, long-term PM exposure increased rate of atherosclerosis and inflammation. In regards to short-term exposure (2 hours), every 25 μg/m³ of PM_2.5 resulted in a 48% increase of CVD mortality risk.^[17] 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 PM_2.5.^[18] Other research has implicated PM_2.5 in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure.^[19][20] PM_2.5 is also linked to carotid artery thickening and increased risk of acute myocardial infarction.^[21][22]

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.^[23]

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,^[24] as are a history of chronic kidney disease and hypercholesterolaemia .^[25] 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.^[26][27][28]

Screening

Some biomarkers are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.^[29] 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
• Inflammation as measured by C-reactive protein
• Elevated blood levels of brain natriuretic peptide (also known as B-type) (BNP)^[30]

Prevention

Lifestyle

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)^[31]
• a diet high in vegetables and fruit^[32]
• tobacco cessation and avoidance of second-hand smoke;^[31]
• limit alcohol consumption to the recommended daily limits;^[31]
• 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;^[31]
• decrease emotional stress^{[citation needed]}.
• Consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%^[33][34]

The generally accepted viewpoint is that dietary saturated fat and cholesterol intake is associated with cardiovascular disease. However, this viewpoint has been disputed.^[35] While many studies have affirmed the link between consumption of saturated fats and heart disease, some studies have not found a statistically significant link or have been inconclusive. A study of rats suggests that the links between a diet high in sugar and saturated fat compared with a sugar-free, low fat diet lead to cardiac dysfunction despite modest levels of obesity, and a diet for humans that is low in sugar and rapidly absorbed starches and high in polyunsaturated fatty acids are associated with a reduced risk of coronary heart disease.^[36] Some experts suggest that the focus should reassess the recommendations to switch away from saturated fats and instead focus on carbohydrates, particularly switching refined carbohydrates (especially refined grains and sugar) to unsaturated fats and/or healthy sources of protein, a moved to whole grains and limiting sugar-sweetened beverage consumption. Though diets high in saturated fats or refined carbohydrates are not suitable for ischemic heart disease prevention, refined carbohydrates are likely to cause even greater metabolic damage than saturated fat in a predominantly sedentary and overweight population^[37] Another study agrees with the approach and suggests this may be linked to the macronutrients associated with refined carbohydrates.^[38]

Evidence shows that the Mediterranean diet improves cardiovascular outcomes.^[39] As of 2010 however vitamins have not been found to be effective at preventing cardiovascular disease.^[40]

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.^[41]

Management

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.^[42][43][44] Medication may also be useful for prevention.

Epidemiology

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.^[46]

Research

The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 1958.^[47] 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.^[48] 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.^[49][50]

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.^[51]

References

External links

• Cardiovascular disease at the Open Directory Project

v t e Pathology: Medical conditions and ICD code (Disease / Disorder / Illness, Syndrome / Sequence, Symptom / Sign, Injury, etc.) (A/B, 001–139) Infectious disease/Infection: Bacterial disease (G+, G-) · Virus disease · Parasitic disease (Protozoan infection, Helminthiasis, Ectoparasitic infestation) · Mycosis · Zoonosis (C/D, 140–239 & 279–289) Cancer (C00–D48, 140–239) Tumor Myeloid hematologic (D50–D77, 280–289) Anemia · Coagulopathy Lymphoid immune (D80–D89, 279) Immunodeficiency · Immunoproliferative disorder · Hypersensitivity (E, 240–278) Endocrine disease · Nutrition disorder · Inborn error of metabolism (F, 290–319) Mental disorder (G, 320–359) Nervous system disease (CNS, PNS) · Neuromuscular disease (H, 360–389) Eye disease · Ear disease (I, 390–459) Cardiovascular disease (Heart disease, Vascular disease) (J, 460–519) Respiratory disease (Obstructive lung disease, Restrictive lung disease, Pneumonia) (K, 520–579) Stomatognathic disease (Tooth disease) · Digestive disease (Esophageal, Stomach, Enteropathy, Liver, Pancreatic) (L, 680–709) Skin disease · skin appendages (Nail disease, Hair disease, Sweat gland disease) (M, 710–739) Musculoskeletal disorders: Myopathy · Arthropathy · Osteochondropathy (Osteopathy, Chondropathy) (N, 580–629) Urologic disease (Nephropathy, Urinary bladder disease) · Male genital disease · Breast disease · Female genital disease (O, 630–679) Complications of pregnancy · Obstetric labor complication · Puerperal disorder (P, 760–779) Fetal disease (Q, 740–759) Congenital disorder (Congenital abnormality) (R, 780–799) Syndromes · Medical signs (Eponymous) (S/T, 800–999) Bone fracture · Joint dislocation · Sprain · Strain · Subluxation · Head injury · Chest trauma · Poisoning

v t e Cardiovascular disease: heart disease · Circulatory system pathology (I00–I52, 390–429) Ischaemic CD/CHD CAD · Coronary thrombosis · Coronary vasospasm · Coronary artery aneurysm · Coronary artery dissection · Myocardial Bridge Active ischemia Angina pectoris (Prinzmetal's angina, Stable angina) · Acute coronary (Unstable angina, Myocardial infarction / heart attack) Sequelae hours (Myocardial stunning, Hibernating myocardium) · days (Myocardial rupture) · weeks (Aneurysm of heart/Ventricular aneurysm, Dressler's syndrome) Layers Pericardium Pericarditis (Acute, Chronic/Constrictive) · Pericardial effusion (Hemopericardium, Cardiac tamponade) Myocardium Myocarditis (Chagas disease) Cardiomyopathy: Dilated (Alcoholic) · Hypertrophic · Restrictive (Loeffler endocarditis, Cardiac amyloidosis, Endocardial fibroelastosis) Arrhythmogenic right ventricular dysplasia Endocardium/ valves Endocarditis Infective endocarditis (Subacute bacterial endocarditis) · noninfective endocarditis (Nonbacterial thrombotic endocarditis, Libman-Sacks endocarditis) Valves mitral (regurgitation, prolapse, stenosis) · aortic (stenosis, insufficiency) · tricuspid (stenosis, insufficiency) · pulmonary (stenosis, insufficiency) Conduction/ arrhythmia Bradycardia Sinus bradycardia · Sick sinus syndrome Heart block: Sinoatrial · AV (1°, 2°, 3°) · Intraventricular (Bundle branch/Right/Left, Left anterior fascicular/Left posterior fascicular, Bifascicular/Trifascicular) · Adams–Stokes syndrome Tachycardia (paroxysmal and sinus) Supraventricular Atrial (Multifocal) · Junctional (AV nodal reentrant, Junctional ectopic) Ventricular Torsades de pointes · Catecholaminergic polymorphic · Accelerated idioventricular rhythm Premature contraction Atrial · Ventricular Pre-excitation syndrome Wolff-Parkinson-White · Lown-Ganong-Levine Flutter/fibrillation Atrial flutter · Ventricular flutter · Atrial fibrillation (Familial) · Ventricular fibrillation Pacemaker Wandering pacemaker · Ectopic pacemaker/Ectopic beat · Parasystole · Multifocal atrial tachycardia · Pacemaker syndrome Long QT syndrome Romano-Ward syndrome · Andersen-Tawil syndrome · Jervell and Lange-Nielsen syndrome Cardiac arrest Sudden cardiac death · Asystole · Pulseless electrical activity · Sinoatrial arrest Other/ungrouped hexaxial reference system (Right axis deviation, Left axis deviation) · QT (Short QT syndrome) · T (T wave alternans) · ST (Osborn wave, ST elevation, ST depression) Cardiomegaly Ventricular hypertrophy (Left, Right/Cor pulmonale) · Atrial enlargement (Left, Right) Other Cardiac fibrosis · Heart failure (Diastolic heart failure, Cardiac asthma) · Rheumatic fever M: HRT anat/phys/devp noco/cong/tumr, sysi/epon, injr proc, drug (C1A/1B/1C/1D), blte

v t e Cardiovascular disease: vascular disease · Circulatory system pathology (I70–I99, 440–456) Arteries, arterioles and capillaries Inflammation Arteritis (Aortitis) · Buerger's disease Arterial occlusive disease/ peripheral vascular disease Arteriosclerosis Atherosclerosis (Foam cell, Fatty streak, Atheroma, Intermittent claudication) · Monckeberg's arteriosclerosis · Arteriolosclerosis (Hyaline, Hyperplastic, oxycholesterol, cholesterol, LDL, trans fat) Stenosis Renal artery stenosis · Carotid artery stenosis Other Fibromuscular dysplasia · Degos disease · Aortoiliac occlusive disease · Raynaud's phenomenon/Raynaud's disease · Erythromelalgia Aneurysm/dissection/ pseudoaneurysm torso: Aortic aneurysm (Thoracic aortic aneurysm, Abdominal aortic aneurysm) · Aortic dissection · Coronary artery aneurysm head/neck: Cerebral aneurysm · Intracranial berry aneurysm · Carotid artery dissection · Vertebral artery dissection · Familial aortic dissection Vascular malformation Arteriovenous malformation · Arteriovenous fistula · Telangiectasia (Hereditary hemorrhagic telangiectasia) Vascular nevus Spider angioma · Halo nevus · Cherry hemangioma Veins Inflammation Phlebitis Venous thrombosis/ Thrombophlebitis primarily lower limb (Deep vein thrombosis) abdomen (Hepatic veno-occlusive disease, Budd–Chiari syndrome, May-Thurner syndrome, Portal vein thrombosis, Renal vein thrombosis) upper limb/torso (Paget-Schroetter disease, Mondor's disease) head (Cerebral venous sinus thrombosis) Post-thrombotic syndrome Varicose veins Varicocele · Gastric varices · Portacaval anastomosis (Hemorrhoid, Esophageal varices, Caput medusae) Other Superior vena cava syndrome · Inferior vena cava syndrome · Venous ulcer · Chronic venous insufficiency · Chronic cerebrospinal venous insufficiency Arteries or veins Vasculitis · Thrombosis · Embolism (Pulmonary embolism, Cholesterol embolism, Paradoxical embolism) · Angiopathy (Macroangiopathy, Microangiopathy) Blood pressure Hypertension Hypertensive heart disease · Hypertensive nephropathy · Essential hypertension  · Secondary hypertension (Renovascular hypertension) · Pulmonary hypertension · Malignant hypertension · Benign hypertension · Systolic hypertension · White coat hypertension Hypotension Orthostatic hypotension M: VAS anat(a:h/u/t/a/l,v:h/u/t/a/l)/phys/devp/cell/prot noco/syva/cong/lyvd/tumr, sysi/epon, injr proc, drug(C2s+n/3/4/5/7/8/9)

v t e Certain conditions originating in the perinatal period / fetal disease (P, 760–779) Maternal factors and complications of pregnancy, labour and delivery placenta: Placenta praevia · Placental insufficiency · Twin-to-twin transfusion syndrome chorion/amnion: Chorioamnionitis umbilical cord: Umbilical cord prolapse · Nuchal cord · Single umbilical artery Length of gestation and fetal growth Small for gestational age/Large for gestational age · Preterm birth/Postmature birth · Intrauterine growth restriction Birth trauma scalp (Cephalhematoma, Chignon, Caput succedaneum, Subgaleal hemorrhage) · Brachial plexus lesion (Erb's palsy, Klumpke paralysis) By system Respiratory Intrauterine hypoxia · Infant respiratory distress syndrome · Transient tachypnea of the newborn · Meconium aspiration syndrome · pleural disease (Pneumothorax, Pneumomediastinum) · Wilson-Mikity syndrome · Bronchopulmonary dysplasia Cardiovascular Pneumopericardium · Persistent fetal circulation Haemorrhagic and hematologic disease Vitamin K deficiency (Haemorrhagic disease of the newborn) HDN (ABO • Anti-Kell • Rh c • Rh D • Rh E) · Hydrops fetalis · Hyperbilirubinemia (Kernicterus, Neonatal jaundice) Velamentous cord insertion Intraventricular hemorrhage (Germinal matrix hemorrhage) Anemia of prematurity Digestive Ileus · Necrotizing enterocolitis · Meconium peritonitis Integument and temperature regulation Erythema toxicum · Sclerema neonatorum Nervous system Periventricular leukomalacia Musculoskeletal Gray baby syndrome · muscle tone (Congenital hypertonia, Congenital hypotonia) Infectious Perinatal infection (Congenital rubella syndrome, Neonatal herpes simplex) · Omphalitis · Neonatal sepsis (Group B streptococcal infection) · Neonatal conjunctivitis Other Perinatal mortality (Stillbirth, Infant mortality) · Neonatal withdrawal M: OBS phys/devp/memb mthr/fetu/infc, epon proc, drug(2A/G2C)