Cardiovascular disease. Jacquelyn Ferrance, Sini Poulose. Definition.
Jacquelyn Ferrance, Sini Poulose
Cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure (WHO)
Cardiovascular disease is a disease of the heart and diseases of the blood vessel system within a person's entire body such as the brain, legs, and lungs. In the name Cardiovascular, "Cardio" refers to the heart and "Vascular" refers to the blood vessel system. Cardiovascular Disease causes dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining areas of the body like the brain, the heart, and other organs. Oxygen has to carry to tissues and organs in order for a person to maintaining life.
What are cardiovascular diseases?
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include:
Major modifiable risk factors
•High blood pressure - Major risk for heart attack and the most important risk factor for stroke.
•Abnormal blood lipids
High total cholesterol, LDL-cholesterol and triglyceride levels, and low levels of HDL- cholesterol increase risk of coronary heart disease and ischaemic stroke.
Increases risks of cardiovascular disease, especially in people who started young, and heavy smokers. Passive smoking an additional risk.
•Physical inactivity :Increases risk of heart disease and stroke by 50%.
Other modifiable risk factors
•Low socioeconomic status (SES)
Consistent inverse relationship with risk of heart disease and stroke.
Depression is associated with an increased risk of coronary heart disease.
Chronic life stress, social isolation and anxiety increase the risk of heart disease and stroke.
Alcohol use : One to two drinks per day may lead to a 30% reduction in heart disease, but heavy drinking damages the heart muscle
Use of certain medication
Some oral contraceptives and hormone replacement therapy increase risk of heart disease.
• Lipoprotein(a) : Increases risk of heart attacks especially in presence of high LDL-cholesterol.
Left ventricular hypertrophy (LVH) : A powerful marker of cardiovascular death.
Non-modifiable risk factors
•Advancing age : Most powerful independent risk factor for cardiovascular disease; risk of stroke doubles every decade after age 55.
•Heredity or family history : Increased risk if a first-degree blood relative has had coronary heart disease or stroke before the age of 55 years (for a male relative) or 65 years (for a female relative).
•Gender : Higher rates of coronary heart disease among men compared with women (premenopausal age); risk of stroke is similar for men and women.
•Ethnicity or race: Increased stroke noted for Blacks, some Hispanic Americans, Chinese, and Japanese populations. Increased cardiovascular disease deaths noted for South Asians and American Blacks in comparison with Whites.
Novel risk factors
•Excess homocysteine in blood (is a non-protein α-amino acid)
High levels may be associated with an increase in cardiovascular risk.
Several inflammatory markers are associated with increased cardiovascular risk, e.g. elevated C-reactive protein (CRP). •Abnormal blood coagulation
Elevated blood levels of fibrinogen and other markers of blood clotting increase the risk of cardiovascular complications.
17 million of people die of CVDs, particularly heart attacks and strokes
In order to accurately measure Americans’ cardiovascular health and monitor progress toward the 2020 goal, the American Heart Association for the first time defined “ideal cardiovascular health.” We define it as the absence of disease and the presence of seven key health factors and behaviors that we call “Life’s Simple 7.” Below are the measurements we use to determine whether someone is in ideal, intermediate or poor cardiovascular health.
A stroke or "brain attack" occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain. When either of these things happen, brain cells begin to die and brain damage occurs. (National Stroke Association)
Types of stroke
Large Vessel Thrombosis
Small Vessel Disease/Lacunar Infarction
● An estimated 6 .8 million Americans ≥20 years of age have had a stroke (extrapolated to 2010 by use of NHANES 2007–2010 data) . Overall stroke prevalence during this period is an estimated 2 .8% (NHANES, NHLBI) .
● According to data from the 2012 BRFSS (CDC), 2 .9% of men and 2 .9% of women ≥18 years of age had a history of stroke; 3 .0% of non-Hispanic whites, 3 .8% of non- Hispanic blacks, 1 .9% of Asian/Pacific Islanders, 1 .8% of Hispanics (of any race), 5 .8% of American Indian/Alaska Natives, and 4 .1% of other races or multiracial people had a history of stroke .
The prevalence of silent cerebral infarction is estimated to range from 6% to 28%, with higher prevalence with increasing age .
● Projections show that by 2030, an additional 3 .4 million people aged ≥18 years will have had a stroke, a 20 .5% increase in prevalence from 2012 . The highest increase (29%) is projected to be in Hispanic men .
● Each year, ≈795 000 people experience a new or recurrent stroke . Approximately 610000 of these are first attacks, and 185 000 are recurrent attacks (GCNKSS, NINDS, and NHLBI; GCNKSS and NINDS data for 1999 provided July 9, 2008; estimates compiled by NHLBI) .
● Of all strokes, 87% are ischemic and 10% are ICH strokes, whereas 3% are SAH strokes (GCNKSS, NINDS, 1999)
● On average, every 40 seconds, someone in the United States has a stroke (AHA computation based on the latest available data)
● Each year, ≈55000 more women than men have a stroke (GCNKSS, NINDS)
● Women have a higher lifetime risk of stroke than men . In the FHS, lifetime risk of stroke among those 55 to75 years of age was 1 in 5 for women (20% to 21%) and ≈1 in 6 for men (14% to 17%) .
● The age-adjusted incidence of first ischemic stroke per 1000 was 0.88 in whites, 1 .91 in blacks, and 1 .49 in Hispanics according to data from NOMAS (NINDS) for 1993 to 1997 . Among blacks, compared with whites, the relative rate of intracranial atherosclerotic stroke was 5 .85; of extracranial atherosclerotic stroke, 3 .18; of lacunar stroke, 3 .09; and of cardioembolic stroke, 1 .58 . Among Hispanics (primarily Cuban and Puerto Rican), compared with whites, the relative rate of intracranial atherosclerotic stroke was 5 .00; of extracranial atherosclerotic stroke, 1 .71; of lacunar stroke, 2 .32; and of cardioembolic stroke, 1 .42 .
Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack (AHA/ASA Guidline)
High Blood Pressure
High Blood Cholesterol and Other Lipids
Disorders of Heart Rhythm
High Blood Cholesterol and Other Lipids
Family History and Genetics
Chronic Kidney Disease
—50% had some hemiparesis
—30% were unable to walk without some assistance —46% had cognitive deficits
—35% had depressive symptoms
—19% had aphasia
—26% were dependent in activities of daily living —26% were institutionalized in a nursing home
(CDC.gov, American Heart Association)