Cardiovascular Disease (CVD)

• Cardiovascular disease (CVD) includes diseases of the heart and blood vessels.
• Common forms of CVD are hypertension, coronary heart disease, stroke, heart failure, and peripheral arterial disease.

CVD Statistics

• In the U.S., someone dies from CVD approximately every 37 seconds.
• CVD causes about 647,000 deaths annually in the U.S.
• CVD accounts for 1 in every 4 deaths in the US.
• Coronary heart disease is the most prevalent type of CVD.

Coronary Heart Disease (CHD)

• CHD is also known as coronary artery disease.

Atherosclerosis

• Coronary Artery Disease (CAD) results from plaque buildup in the coronary arteries, also called atherosclerosis.
• Atherosclerosis is the accumulation of lipid deposits or plaque in large and medium-sized arteries.
• Atherosclerosis usually begins early in life and worsens over time.
• The process is initiated as a "response to injury."

"Response to Injury" Process: Endothelial Damage

• Endothelial damage is the first step in the "response to injury" process.
• The endothelium is the inner lining of blood vessels.
• Damage to the endothelium can be caused by physical or toxic stress.
• Cardiovascular risk factors have the potential to damage the endothelial lining.

"Response to Injury" Process: Inflammatory Response

• Monocytes, a type of white blood cell, adhere to the site of injury.
• Monocytes that migrate to the area of injury become macrophages.
• Macrophages work to destroy foreign substances or antigens.

"Response to Injury" Process: Macrophages and Lipids

• Macrophages ingest modified lipids, usually oxidized LDL molecules (bad cholesterol).
• These macrophages transform into foam cells and develop into fatty streaks.

Cholesterol

• Cholesterol is a fat necessary for cell and hormone synthesis.
• LDL (Low Density Lipoprotein) transports cholesterol FROM the liver to the periphery and is mostly cholesterol.
• HDL (High Density Lipoprotein) transports cholesterol TOWARD the liver to be broken down and is mostly protein.
• LDL stores cholesterol in the bloodstream, while HDL regulates LDL storage and promotes excretion.

"Response to Injury" Process: Attempt for Repair

• The body attempts to repair the injured site, similar to how it repairs a skin injury.
• Growth factors are released, leading to the formation of a connective tissue matrix.
• The matrix accumulates lipids, smooth muscle cells, and toxins.
• Eventually, this forms into a fibrous plaque.
• A fatty streak is the first lesion that appears and consists primarily of foam cells in the subendothelial space.

Myocardial Infarction

• A heart attack or myocardial infarction occurs when the blood supply to the heart muscle is severely reduced or stopped.
• This often happens due to blockage in one or more of the coronary arteries.
• Plaque buildup, or atherosclerosis, causes this blockage.

Acute Thrombosis Role

• Atherosclerotic plaque restricts blood flow leading to oxygen demand exceeding oxygen supply.
• Ischemia results from a lack of oxygen, causing myocardial cell death and myocardial infarction.

Stress and Heart Attack

• Stressful situations or strenuous activity increases CNS stimulation, heart rate, and blood pressure.
• This leads to increased myocardial oxygen demand.

Risk Factors for CAD: Modifiable Behaviors

• Smoking: Negatively affects endothelium function and exacerbates other risk factors.
• Psychosocial Factors: Chronic stress increases SNS activity, and Socio-economic and social interaction affect behaviors.
• Fruit/Vegetable Consumption: Increases antioxidants and phytochemicals reduce oxidation and inflammation.
• Sedentary Lifestyle: Reduces cardio metabolic risk factors and reduce systemic inflammation.

Risk Factors for CAD: Modifiable Cardio Metabolic Factors

• Abnormal blood lipids: contribute to lipid deposits in vascular walls and Endothelial dysfunction.
• Hypertension: places increased force on vascular walls, and increases load on the left ventricle.
• Obesity: Increases inflammation.
• Impaired Fasting Glucose: Insulin resistance is associated with abnormal lipids, hypertension.
• Abdominal Adiposity: Often coexists with abnormal blood lipids, hypertension, and impaired fasting glucose.