Cardiovascular Disease
Cardiovascular disease refers to the class of diseases that involve
the heart and/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.
Over 71.3 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 smoking.
Cardiovascular Disease Risk factors
There are many risk factors which predispose to various forms of cardiovascular
disease. These include the following:
- Age
- Absence of key nutritional elements, such as polyphenol antioxidants
- Diabetes mellitus
- Hypercholesterolemia (elevated cholesterol levels) and abnormal
lipoprotein particle profile (cholesterol subtypes)
- Tobacco smoking
- Higher fibrinogen and PAI-1 blood concentrations
- Elevated homocysteine, or even upper half of normal
- Elevated blood levels of asymmetric dimethylarginine
- High blood pressure
- Exposure to high levels of environmental noise
- Obesity, especially central or male-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 of cardiovascular disease
- Physical inactivity/ Sedentary lifestyle
- Depression
- Stress
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.
Cardiovascular Disease Prevention
Attempts to prevent cardiovascular disease take the form of modifying
risk factors. Some, such as sex (male or female), 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. Therefore,
the combination of healthy diet and exercise is a means to improve
serum cholesterol levels and thereby 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 little known or discussed, but powerful way to almost eliminate
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.
Eating oily fish at least twice a week may help reduce the risk of
sudden death and arrhythmias. Olive oil is said to have the greatest
benefits. 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.
Cardiovascular Disease Awareness
Interestingly, although heart disease is the number one cause of death
for individuals in Western Society, a majority of people are unconcerned
about their risk for development of this disease. Atherosclerosis is
a process that develops over decades and is often silent until an acute
event developments in later life. Population based studies in 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 risk
such as HIV, accidents, and cancer than heart disease. (reference:
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). This is extremely important considering
that 1 in 3 people will die from complications attributable to cardiovascular
disease. In order to stem the tide of cardiovascular disease, primary
prevention is needed. Primary prevention starts with education of adolescents
and making them aware that cardiovascular disease poses the greatest
threat towards them in their lifetimes.
Cardiovascular Disease 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.
References
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
Resources
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