Cardiovascular disease

Cardiovascular disease

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Heart disease or cardiovascular disease are the class of diseases that involve the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

 or blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

s (arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....

 and vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...

s). While the term technically refers to any disease that affects the cardiovascular system
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...

 (as used in MeSH C14
Medical Subject Headings
Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching...

), it is usually used to refer to those related to atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

 (arterial disease). These conditions usually have similar causes, mechanisms, and treatments.

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 but have increased at an astonishingly fast rate in low- and middle-income countries. The percentage of premature deaths from cardiovascular disease range from 4% in high-income countries to 42% in low-income countries. More than 17 million people died from cardiovascular diseases in 2008. Each year, heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

 kills more Americans than cancer. In recent years, cardiovascular risk in women has been increasing and has killed more women than breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

. (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.

By the time that heart problems are detected, the underlying cause (atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating
Healthy diet
A healthy diet is one that helps maintain or improve general health. It is important for lowering many chronic health risks, such as obesity, heart disease, diabetes, hypertension and cancer. A healthy diet involves consuming appropriate amounts of all essential nutrients and an adequate amount of...

, exercise
Physical exercise
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...

, and avoidance of smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...

.

Pathophysiology


Population based studies 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 7–9 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.

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
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...

 are often linked to cardiovascular disease, as are a history of chronic kidney disease and hypercholesterolaemia
. 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.

Associated diagnostic markers

  • Low-density lipoprotein
  • Lipoprotein(a)
    Lipoprotein(a)
    Lipoprotein is a lipoprotein subclass. Studies have identified Lp as a putative risk factor for atherosclerotic diseases such as coronary heart disease and stroke....

  • Apolipoprotein A1
    Apolipoprotein A1
    Apolipoprotein A-I is a protein that in humans is encoded by the APOA1 gene. It has a specific role in lipid metabolism.Apolipoprotein A-I is the major protein component of high density lipoprotein in plasma. Chylomicrons secreted from the intestinal enterocyte also contain ApoA1 but it is quickly...

  • Apolipoprotein B
    Apolipoprotein B
    Apolipoprotein B is the primary apolipoprotein of low-density lipoproteins , which is responsible for carrying cholesterol to tissues. While it is unclear exactly what functional role APOB plays in LDL, it is the primary apolipoprotein component and is absolutely required for its formation...

    ho


Screening


Some biomarkers
Biomarker (medicine)
In medicine, a biomarker is a term often used to refer to a protein measured in blood whose concentration reflects the severity or presence of some disease state...

 are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable. Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:
  • Higher fibrinogen
    Fibrinogen
    Fibrinogen is a soluble plasma glycoprotein, synthesised by the liver, that is converted by thrombin into fibrin during blood coagulation. This is achieved through processes in the coagulation cascade that activate the zymogen prothrombin to the serine protease thrombin, which is responsible for...

     and PAI-1
    Plasminogen activator inhibitor-1
    Plasminogen activator inhibitor-1 also known as endothelial plasminogen activator inhibitor or serpin E1 is a protein that in humans is encoded by the SERPINE1 gene....

     blood concentrations
  • Elevated homocysteine
    Homocysteine
    Homocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...

    , or even upper half of normal
  • Elevated blood levels of asymmetric dimethylarginine
    Asymmetric dimethylarginine
    Asymmetric dimethylarginine is a naturally occurring chemical found in blood plasma. It is a metabolic by-product of continual protein modification processes in the cytoplasm of all human cells. It is closely related to L-arginine, a conditionally-essential amino acid...

  • Inflammation as measured by C-reactive protein
    C-reactive protein
    C-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...

  • Elevated blood levels of brain natriuretic peptide
    Brain natriuretic peptide
    Brain natriuretic peptide , now known as B-type natriuretic peptide or GC-B, is a 32 amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells...

     (also known as B-type) (BNP)

Prevention


Modifiable risk factors to improve or prevent atherosclerosis may include:
  • a low fat high fiber diet
    Diet (nutrition)
    In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

     including whole grains and plenty of fresh fruit and vegetables (at least five portions a day) (though the advice continues to recommend you lower your saturated fat intake while eating some unsaturated fats, since this will help with cholesterol levels);
  • limit the amount of salt
    Salt
    In chemistry, salts are ionic compounds that result from the neutralization reaction of an acid and a base. They are composed of cations and anions so that the product is electrically neutral...

     in your diet to no more than 6g (0.2 oz) a day;
  • tobacco
    Tobacco
    Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...

     cessation and avoidance of second-hand smoke;
  • limit alcohol
    Alcohol
    In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

     consumption to the recommended daily limits;
  • lower blood pressures if elevated through the use of antihypertensive
    Antihypertensive
    The antihypertensives are a class of drugs that are used to treat hypertension . Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from...

     medications;
  • strict diabetes management;
  • decrease body fat (BMI
    Body mass index
    The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...

    ) if overweight or obese;
  • increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;
  • decrease emotional stress
    Stress (psychological)
    Stress The word stress is used in many different contexts. However, psychological stress is not as vague and all-encompassing as most people believe it to be...

    .
  • Consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%


The generally accepted viewpoint is that dietary saturated fat and cholesterol intake is associated with cardiovascular disease. However, this viewpoint has been disputed. 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. 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 Another study agrees with the approach and suggests this may be linked to the macronutrients associated with refined carbohydrates.

Evidence shows that the Mediterranean diet
Mediterranean diet
The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of southern Italy, Crete and much of the rest of Greece in the 1960s....

 improves cardiovascular outcomes. As of 2010 however vitamin
Vitamin
A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...

s have not been found to be effective at preventing cardiovascular disease.

Management


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

Epidemiology


The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 1958. The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research
Biomedical research
Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine...

, 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
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 that hallmarks atherosclerosis and its possible interventions. C-reactive protein
C-reactive protein
C-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...

 (CRP) is a common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular disease. Also osteoprotegerin
Osteoprotegerin
Osteoprotegerin , also known as osteoclastogenesis inhibitory factor , or tumor necrosis factor receptor superfamily member 11B , is a protein that in humans is encoded by the TNFRSF11B gene...

 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.

Some areas currently being researched include possible links between infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

 with Chlamydophila pneumoniae
Chlamydophila pneumoniae
Chlamydophila pneumoniae is a species of Chlamydophila, an obligate intracellular bacteria that infects humans and is a major cause of pneumonia....

and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.

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