Are You CVD Savvy?

Cardiovascular Disease: Causes, Risk Factors, and Assessment

• Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels, including coronary artery diseases, stroke, heart failure, hypertensive heart disease, rheumatic heart disease, and more.
• The underlying mechanisms of CVD vary depending on the disease, but dietary risk factors are associated with 53% of CVD deaths.
• Up to 90% of CVD may be preventable through healthy eating, exercise, avoiding tobacco smoke, and limiting alcohol intake.
• CVD is the leading cause of death worldwide except in Africa, resulting in 17.9 million deaths in 2015, up from 12.3 million in 1990.
• Age, sex, tobacco use, physical inactivity, unhealthy diet, obesity, genetic predisposition, raised blood pressure, raised blood sugar, raised blood cholesterol, and poor sleep are all risk factors for CVD.
• Genetics is an important risk factor, with more than 40 inherited cardiovascular diseases that can be traced to a single disease-causing DNA variant.
• Age is the most important risk factor in developing CVD, with approximately a tripling of risk with each decade of life.
• Men are at greater risk of heart disease than pre-menopausal women, with coronary heart diseases being 2 to 5 times more common among middle-aged men than women.
• Cigarette smoking is attributed to 10% of CVD, and physical inactivity is the fourth leading risk factor for mortality worldwide.
• High dietary intakes of saturated fat, trans-fats, and salt, and low intake of fruits, vegetables, and fish are linked to cardiovascular risk.
• The relationship between alcohol consumption and cardiovascular disease is complex, with high levels of drinking alcohol directly linked to CVD.
• Mental health problems, such as depression and traumatic stress, are linked to an increased risk of cardiovascular diseases.
• Occupational exposure is also linked to CVD, but little is known about the relationship between work and CVD.Causes, Prevention, and Management of Cardiovascular Disease

Non-chemical risk factors:

• Exposure to ionizing radiation, job strain, and shift work are associated with an increased risk of stroke.
• Men are at a higher risk of heart attacks and stroke than women during working life.

Chemical risk factors:

• Workplace exposure to silica dust, engine exhaust, welding fumes, arsenic, benzopyrenes, lead, dynamite, carbon disulphide, carbon monoxide, metalworking fluids, occupational exposure to tobacco smoke, and certain compounds no longer permitted in certain work environments are associated with heart disease.
• Workplace exposure to silica dust or asbestos is also associated with pulmonary heart disease.
• Exposure to lead, carbon disulphide, phenoxyacids containing TCDD, and working in an environment where aluminum is being electrolytically produced is associated with stroke.

Somatic mutations:

• Certain leukemia-associated mutations in blood cells may lead to an increased risk of cardiovascular disease.

Radiation therapy:

• Radiation treatments for cancer can increase the risk of heart disease and death, as observed in breast cancer therapy.
• Radiation-induced heart disease or radiation-induced vascular disease may occur due to therapeutic radiation.

Pathophysiology:

• Atherosclerosis, the major precursor of cardiovascular disease, begins in childhood.
• Obesity, diabetes mellitus, chronic kidney disease, and hypercholesterolemia are linked to cardiovascular disease.

Screening:

• Screening ECGs, echocardiography, myocardial perfusion imaging, and cardiac stress testing are not recommended in those at low risk who do not have symptoms.
• Lipid testing is recommended in children beginning at the age of 2 if there is a family history of heart disease or lipid problems.

Prevention:

• Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.
• A diet high in fruits and vegetables and a Mediterranean diet may improve cardiovascular outcomes.
• Blood pressure medication and statins are effective in reducing the risk of all major cardiovascular events.
• Exercise-based cardiac rehabilitation following a heart attack reduces the risk of death from cardiovascular disease.

Management:

• Influenza vaccination may decrease the chance of cardiovascular events and death in people with heart disease.

• Proper CVD management necessitates a focus on MI and stroke cases, especially in developing countries with low or middle-income levels.Summary Title: Cardiovascular Disease: Prevention, Treatment, and Cost

• Cardiovascular diseases are the leading cause of death worldwide, accounting for 30% of all global deaths in 2008.

• Over 80% of all global deaths caused by cardiovascular diseases occurred in low- and middle-income countries.

• By 2030, it is estimated that over 23 million people will die from cardiovascular diseases each year.

• The South Asian subcontinent is estimated to have 60% of the world's cardiovascular disease burden, despite only accounting for 20% of the world's population.

• Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in certain regions showed single QALY costs of $350, while streptokinase cost about $680, and t-PA was $16,000.

• Surgical or procedural interventions for heart valve problems, arrhythmias, and heart attacks can save or prolong lives.

• Lowering blood pressure targets to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg has no additional benefit in terms of mortality and serious adverse events.

• Research into cardiovascular disease dates back to at least the 18th century and remains an active field of biomedical research.

• Recent areas of research include the link between inflammation and atherosclerosis, potential novel therapeutic interventions, and the genetics of coronary heart disease.

• Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about the high burden of cardiovascular disease in the South Asian subcontinent.

• Environmental factors and genetic predisposition may contribute to the high burden of cardiovascular disease in the South Asian subcontinent.

• Hundreds of scientific studies on the causes, prevention, and/or treatment of all forms of cardiovascular disease are published on a weekly basis.