Cardiovascular Disease

What is Cardiovascular Disease?

The cardiovascular system, which includes the heart and blood vessels, can be affected by various health problems. These could be endocarditis, rheumatic heart disease, irregular heart rhythms, among many others. However, in this article, we are going to concentrate on cardiovascular disease (CVD) or heart disease which primarily involves four conditions:

1. Coronary artery disease (CAD): Also known as Coronary Heart Disease (CHD), this is a condition where the heart’s blood supply gets reduced, leading to chest pain, heart attacks, or even heart failure. It’s responsible for about one-third to one-half of all cardiovascular disease cases.

2. Cerebrovascular disease (CVD): This includes conditions like strokes and transient ischemic attacks (TIA), which is a temporary period of symptoms similar to a stroke.

3. Peripheral artery disease (PAD): A condition where the blood vessels that supply the limbs get narrowed down, leading to claudication, a condition characterized by pain in the legs while walking.

4. Aortic atherosclerosis: This includes conditions like thoracic and abdominal aneurysms, both of which involve a bulging or swelling in the aorta, the main artery that carries blood away from the heart.

What Causes Cardiovascular Disease?

Cardiovascular diseases (CVD) can stem from many different causes, such as a stroke caused by blood clots in a patient with irregular heart rhythm, or valve disease because of rheumatic fever. However, the focus is on addressing risk factors related to atherosclerosis (hardening of the arteries), as this is often a common factor in the development of these diseases.

The shift from active to inactive jobs due to industrialization and our current technology-focused lifestyle might explain rising rates of CVD. Long work hours and lack of time for recreation mean people are less active and consume unhealthy, high-calorie diets. These changes contribute to the development of atherosclerosis and conditions like metabolic syndrome, diabetes, and high blood pressure— conditions frequently seen in people with CVD.

A study called INTERHEART looked at people from 52 countries and found that 90% of the risk for a first heart attack was related to nine risk factors that can be changed: smoking, cholesterol levels, high blood pressure, diabetes, abdominal obesity, stress, a diet low in fruits and vegetables, frequent alcohol consumption, and physical inactivity. It’s worth noting that smoking alone accounted for 36% of the population’s risk of heart attack in this study.

Other large studies like the Framingham Heart study and the Third National Health and Nutrition Examination Survey also revealed strong links between heart disease and high cholesterol levels, high blood pressure, smoking, and glucose intolerance. These conditions were present in 60% to 90% of people who experienced heart disease events.

Based on these findings, the American Heart Association has promoted health programs that emphasize seven ways to lower the risk of CVD: quit smoking, stay active, eat a healthy diet, maintain normal blood pressure, body weight, blood sugar, and cholesterol levels.

However, there are also non-modifiable factors like family history, age, and gender. For example, the risk of heart disease is higher if a close family member had CVD or died of it before reaching 55 years (in males) or 65 years (in females). The risk of CVD rises with each decade of life and research suggests women who smoke or have diabetes face a higher risk of CVD than men.

Other factors linked with increased heart disease rates include HIV, chest radiation, protein in urine, and increased inflammatory markers. The links between dietary factors like meat consumption, fiber, and coffee and heart disease, however, remain disputed due to inconsistencies in different studies.

Risk Factors and Frequency for Cardiovascular Disease

Cardiovascular diseases or heart diseases are one of the top two causes of death in the United States since 1975. This includes about 633,842 deaths which total to about 1 in 4 deaths. In 2015, heart disease was the leading cause of death, and was followed by cancer, which caused about 595,930 deaths. According to the World Health Organization, heart disease is the number one cause of death worldwide, leading to an estimated 17.7 million deaths in 2015. Apart from this, heart disease is also the most expensive to treat, costing more than Alzheimer’s disease and diabetes. The indirect costs of heart disease are about $237 billion per year, and this is expected to increase to $368 billion by 2035.

Even though the death rate and acute mortality from myocardial infarction (heart attack) have been decreasing over the years due to advancements in diagnosis and treatment, the risk of heart disease remains high. It’s calculated that 50% of people will have a risk of heart disease by the age of 45. The incidence of heart disease significantly increases with age and is higher in men at younger ages. However, the difference in its incidence between men and women decreases in the post-menopausal stage.

Signs and Symptoms of Cardiovascular Disease

Cardiovascular diseases can often be tricky as the symptoms range from none to very distinct signs. In some cases, a person may not show any symptoms even when medical scans indicate heart disease. On the other hand, someone could show classic symptoms such as severe chest pain resembling a heart attack. Stroke patients often suffer sudden weakness or lack of sensation on one side of the body.

Heart disease is often signaled by a special type of chest pain called angina. People describe this as a crushing or pressurized feeling in the chest that can spread to the left arm, neck, or jaw. It might also come with nausea, vomiting, heart palpitations, sweating, fainting, or in extreme cases, sudden death. Sometimes patients may have unusual symptoms like dizziness and nausea. This can be particularly true for people who already have a history of heart disease or are at risk. If chest pain gets worse with exercise and eases with rest or after taking nitroglycerin, it could suggest heart disease.

Stroke usually comes with its own obvious signs, namely sudden weakness in the limbs, slurred speech, and drooping facial muscles. However, symptoms can depend on which part of the brain is affected. People with strokes affecting the back of the brain often have problems with balance and coordination, dizziness, headache, fainting, nausea, or vomiting.

• Sudden weakness in limbs
• Slurred speech
• Drooping facial muscles
• Problems with balance and coordination
• Dizziness
• Headache
• Fainting
• Nausea or vomiting

Peripheral artery disease (PAD) might cause a cramp-like muscle pain in the legs when exercising, which usually eases at rest. In severe cases, skin may change color and become cooler. A thoracic aortic aneurysm might cause no symptoms early on, but as it worsens, may cause a cough, trouble breathing, or voice changes due to compression on surrounding tissues. It could also cause sudden, severe chest or back pain if it ruptures. The same can happen with abdominal aortic aneurysms.

In diagnosing heart disease, a thorough physical examination is crucial. Doctors will start by looking for signs of distress caused by angina or heart failure, or long-term skin changes from PAD. They’ll check the neck’s carotid artery and heart area, listening for abnormal sounds like heart murmurs and identifying areas where the heartbeat is strongest. They also palpate peripheral pulses to assess blood flow to the rest of the body.

Testing for Cardiovascular Disease

To diagnose cardiovascular disease (CVD), doctors usually rely on a patient’s clinical history and a physical examination focused on the heart and circulatory system. Certain symptoms, including obesity-related issues, chest pain, decreased ability to exercise, and certain types of breathlessness or fainting, might lead a doctor to further investigate a possible CVD diagnosis. This might involve additional tests such as an electrocardiogram or checks for specific enzymes linked to heart issues.

However, preventing CVD in the first place is often the main goal. To do this, doctors target people who are at risk due to factors like high cholesterol and work to manage these issues as much as possible. Starting from age 20, everyone should have regular discussions with their doctor about their CVD risk factors and have their cholesterol levels checked.

There are also calculation tools that take into account a person’s cholesterol levels and other risk factors to predict their future risk of developing CVD. Depending on the score, additional treatments may be recommended. But these tools aren’t perfect. For example, they may underestimate the risk for people with diabetes or familial hypercholesterolemia, and older people are often not considered in these calculations. For these patients, doctors often customize their approach, discussing the benefits and risks of different treatments and considering the patient’s life expectancy. Experts often recommend reassessing CVD risk using these calculators every 4 to 6 years.

In all patients, it’s crucial to maintain a healthy lifestyle. This includes eating a balanced diet, maintaining a healthy weight, and staying active, especially for those with non-modifiable risk factors like a family history of early heart disease or being post-menopausal.

Research is ongoing about the use of inflammatory markers and other methods, like measuring coronary artery calcification, in assessing CVD risk. Although these tools are promising for early detection and prevention of CVD by identifying people with early-stage atherosclerosis, their use should not replace looking for people with known risk factors.

Treatment Options for Cardiovascular Disease

The management of cardiovascular disease (CVD) varies widely depending on the specific medical condition. For instance, acute ischemic stroke may require a procedure known as catheter-directed thrombolysis, whereas peripheral vascular disease may be treated with angioplasty, and coronary heart disease might necessitate coronary stenting. However, it’s crucial for patients with known CVD to be well-informed about the importance of proactively taking steps to prevent the progression or recurrence of their condition. This often involves changes to their lifestyle and measures to control risk factors.

What else can Cardiovascular Disease be?

When a person experiences heart-related problems, there can be several different reasons causing these issues. Below are some possible causes:

• Acute pericarditis (inflammation of the tissue around the heart)
• Angina pectoris (chest pain caused by reduced blood flow to the heart)
• Atherosclerosis (hardening and narrowing of the arteries)
• Coronary artery vasospasm (sudden tightening of the muscles within the arteries of your heart).
• Dilated cardiomyopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body)
• Giant cell arteritis (an inflammation of the lining of your arteries)
• Hypertension (high blood pressure)
• Hypertensive heart disease (heart disease caused by high blood pressure)
• Kawasaki disease (a disease that causes inflammation in the walls of medium-sized arteries throughout the body, including the coronary arteries)
• Myocarditis (inflammation of the heart muscle)

These potential causes are why it’s crucial to see a doctor if you’re experiencing heart problems, as they can perform the necessary tests to find the root cause of the issue.

What to expect with Cardiovascular Disease

The outlook and impact of cardiovascular disease (CVD) have been addressed in other parts of this article.

Possible Complications When Diagnosed with Cardiovascular Disease

The complications of cardiovascular disease (CVD) are severe, with the most significant being death. Despite advances in medicine, CVD is still one of the leading causes of death globally due to its very widespread presence in the population. Other problematic outcomes include longer stays in hospital, physical disability, and higher costs of care. These issues will likely continue to increase in the future, which is a concern for those working in health care policy.

For those with a specific type of heart failure, known as heart failure with reduced ejection fraction (HFreEF), where less than 35% of the blood in the heart is pumped out with each beat, the possibility of dangerous irregular heart rhythms is very high. So, even if these patients are currently receiving the maximum amount of medication tolerated, physicians may recommend the implantation of a heart device called an implantable-cardioverter defibrillator (ICD). The device is suggested for patients at an intermediate to critical level of heart failure, as classified by the New York Heart Association (NYHA).

Strokes can leave lasting effects such as difficulty speaking or swallowing, muscle weakness, or even paralysis, which could be temporary or permanent. This disability could be so severe that the person affected may become bed-bound, leading to added potential complications like urinary tract infections or blood clots due to lack of movement.

Additionally, individuals who suffer from peripheral artery disease (PAD) face a higher risk of death from any cause, in comparison to those without this condition. Other complications of PAD like chronic wounds, physical limitations, and restricted blood flow to the limbs are also common.

Preventing Cardiovascular Disease

The key goal is to make efforts to prevent heart-related diseases by leading a healthy lifestyle and adopting a suitable diet as early as possible. This can help delay the start or even prevent heart-related diseases linked to the buildup of fats, cholesterol, and other substances in the artery walls. The American Heart Association (AHA) has outlined a concept known as “ideal cardiovascular health”, consisting of the following elements:

• Healthy behaviors: These include not smoking, keeping body mass index under 25 kg/m2, reaching the recommended levels of physical activity, and adhering to dietary recommendations.
• Healthy factors: Not having had treatment for total cholesterol levels under 200 mg/dL, blood pressure under 120/80 mm Hg, and fasting blood sugar levels under 100 mg/dL. The aim here is to improve the overall health of all Americans and decrease heart-related deaths by 20%.

It’s especially important for those at a higher risk for heart-related diseases, such as individuals with diabetes, high blood pressure, high cholesterol levels, smokers, and those who are overweight, to pay attention to these guidelines. Modifying risk factors by managing their medical conditions, quitting smoking, losing weight in a healthy way, and staying physically active, is very important. The use of cholesterol-lowering drugs (statins) and low-dose aspirin for prevention has been recommended in other sections.