Cardiovascular Disease: Global Impact and Statistics

• Cardiovascular Disease (CVD) is an umbrella term for a collection of diseases and conditions affecting the heart and vasculature.
• CVD affects 100 million men and 80 million women.
• 9 million people die each year from CVD.
• CVD is the cause of 1 in 6 deaths around the world.

Societal Impact of CVD

• CVD is the number one killer of both men and women in the U.S
• CVD has been the leading cause of death since 1900, except for 1918.
• 695,000 people in the U.S. died from CVD in 2021.
• 1 in every 2.7 deaths is associated with CVD.
• CVD results in 2,552 American deaths every day, about 1 death every 34 seconds.
• 1,905 deaths are from heart disease daily.
• CVD claims more lives than the next four leading causes of death combined, including cancer, chronic lower respiratory disease, accidents, and diabetes mellitus.
• The estimated cost of CVD for 2006 was $403 billion.
• Ischemic heart disease is the leading cause of CV death, accounting for 9.44 million deaths in 2021.
• Hypertension is the most modifiable risk factor for premature CV death.
• Central Asia has the highest age-standardized total CVD mortality.

CVD Terminology

• Disease of the Heart (Heart Disease)
• Disease of the Vasculature: Includes arteries, veins, capillaries, and lymphatics.

Diseases of the Heart

• Coronary Artery Disease (CAD)
• Coronary Heart Disease (CHD)
• Cardiomyopathy
• Valvular Heart Disease
• Pericardial Disease
• Congenital Heart Disease
• Congestive Heart Failure

Diseases of the vasculature

• Arteriosclerosis & Atherosclerosis
• Hypertension
• Stroke
• Aneurysm
• Peripheral artery disease (PAD)
• Vasculitis
• Venous incompetence
• Venous thrombosis
• Varicose veins

Development of Atherosclerotic Plaques

• Normal development of plaque starts with the normal artery progressing through formation of fatty streaks.
• This is followed by foam cell and lipid-rich plaque formation.
• This eventually leads to a thrombus, which is covered by a fibrous cap and contains a lipid core.

Coronary Heart Disease Pathophysiology

• Decreased blood flow to arteries surrounding and serving the heart muscle causes ischemia.
• Atherosclerosis typically causes this decreased blood flow, due to hardening and narrowing of arteries with plaque deposits.
• The end points of this disease process are angina, heart attack, stroke, and sudden death.

CHD Risk factors

• Modifiable risk factors include:
  • Dyslipidemia with; High LDL, Low HDL, High TGs
  • Smoking
  • Hypertension
  • DM, Obesity
  • Poor diet
  • Sedentary lifestyle
• Nonmodifiable risk factors include:
  • Age
  • Sex
  • Family history

Symptoms of heart attack

• Males Common symptoms:
  • Lightheadedness
  • Perspiration
  • Chest pain and pressure
  • Stomach pain
• Females Common Symptoms:
  • Dizziness
  • Anxiety
  • Shortness of breath
  • Back and neck pain
  • Nausea and vomiting

Diagnosis

• Medical and family history is taken.
• Blood lipid panel
• Electrocardiogram
• Exercise stress test
• Cardiac catheterization
• Coronary angiography
• Nuclear heart scans

Treatment

• Medical Nutrition Therapy & Lifestyle Modification
• Pharmacologic Management
• Medical Intervention

Diet and Exercise

• Therapeutic Lifestyle Changes (TLC) Diet:
  • Adopted by the American Heart Association in 2001.
  • Emphasis is placed on foods and overall health rather than percentages of food components.
  • Includes a healthy eating pattern, appropriate body weight, desirable cholesterol profile, and desirable blood pressure.
• TLC diet specifics outline:
  • Total fat intake = 25-35% of calories consumed
  • Less than or equal to 7% of calories from saturated and trans fats
  • Cholesterol intake less than 200 mg/day
  • Dietary options for lowering cholesterol include:
    • Plant sterols at 2g/day
    • Fiber to increase intake by 10-25 g/day
  • Adjust total calories to maintain desirable body weight.
  • Expend 200 kcals/day with physical activity.

DASH Diet

• Dietary Approaches to Stop Hypertension
  • Low in total fat, saturated fat, and cholesterol.
  • Emphasis on fruits, vegetables, whole grains, low-fat dairy, fish, nuts, and lean meats.
  • Sodium intake around 1500 mg/day

DASH diet vs Control Diet

• Fat (% of cals.)
  • DASH = 27
  • Control Diet = 37
• Saturated Fat (% of cals.)
  • DASH = 6
  • Control Diet = 16
• Monounsaturated Fat (% of cals.)
  • DASH = 13
  • Control Diet = 13
• Carbs (% of cals.)
  • DASH = 55
  • Control Diet = 48
• Cholesterol (mg per day)
  • DASH = 150
  • Control Diet = 300
• Fiber (grams per day)
  • DASH = 31
  • Control Diet = 9
• Potassium (mg per day)
  • DASH = 4700mg per day
  • Control Diet = 1700mg per day
• Magnesium (mg per day)
  • DASH = 500mg per day
  • Control Diet = 165mg per day
• Calcium (mg per day)
  • DASH = 1240mg per day
  • Control Diet = 450mg per day
• Sodium (mg per day)
  • DASH = 3000mg per day
  • Control Diet = 3000mg per day

Pharmacologic management

• Initiated after diet modification has failed.
  • Statins
  • Bile acid sequestrants
  • Nicotinic acid
  • Fibrates
  • ACE inhibitors

Statins

• HMG CoA reductase inhibitor, which inhibits cholesterol synthesis.
• It causes a 20-60% reduction in LDL levels.
• Causes a modest decrease in TGs and increase in HDL.

Bile Acid Sequestrants

• Binds with bile acids in GI to inhibit reabsorption.
• Causes about 10-20% reduction in LDL.
• Often used in conjunction with statins.

Nicotinic Acid

• Inhibits VLDL secretion at doses of 1.5-3 g/day.
• Leads to 10-20% reduction in LDL levels.
• Causes a 20-50% reduction in TGs.
• Also, causes a 15-35% increase in HDL levels.

Fibrates

• Does not effectively lower LDL.
• Causes a 20-50% reduction in TGs.
• Leads to a 10-15% increase in HDL levels.

ACE Inhibitors

• Inhibits angiotensin converting enzyme to block Angiotensin I from converting to Angiotensin II.
• Angiotensin II is a vasoconstrictor, so ACE inhibitors cause vasodilation and reduced BP.

Medical interventions

• Angioplasty & Stent Placement
  • A balloon is used to open arteries narrowed or blocked by plaque.
  • Stent placed to maintain to keep artery open.
• Coronary Artery Bypass Graft (CABG)
  • Vein (usually from leg) grafted onto arteries of the heart to bypass blockage.
• Transplants
  • Needed after extensive damage to heart muscle from CVD leads to heart failure.
  • Typically, after multiple hospitalizations.

Heart transplant patients

• Pre transplant intervention goal:
  • optimize nutritional status.

Pre-transplant concerns

• Patients hypermetabolic due to elevated TNF & Proinflammatory cytokines
• Impaired blood perfusion to GI
  • Results in Nausea, poor absorption, Diarrhea, and early satiety
• Weakness and fatigue worsening through the day.

Pre-Transplant Recommendations

• Energy needs increased 20-30%
• Protein intake = 1.2-1.5 g/kg to prevent wasting
• Supplement intake may improve intake.
• 2-3 grams Na and 1-2 L fluid.

Post Transplant concerns

• Limited oral intake
• Impaired wound healing
• Immunosuppressive drugs

Post Transplant Goals

• Promote wound healing, reduce infection risk, and replete nutritional stores
• Regain strength for cardiac rehabilitation.

Post-Transplant Recommendations

• Increase energy needs 30-50%.
• Recommendation of 1.0-1.5 g/kg of protein to promote healing, 2g if depleted.
• Increase need in case of infection.
• Prescribe a diet low in saturated fat and with no added salt.
• Monitor BG due to steroid use.

Heart Transplant Patients: Survival Rates

• 1 year: 93%
• 5 years: 72%
• 10 years: 55%
• Causes of death post transplant is most commonly graft rejection
• A heart-healthy diet is recommended for the rest of life.

Explore the significant impact of Cardiovascular Disease (CVD) on global health. This lesson covers the proportion of global deaths attributable to CVD, its prevalence as the leading cause of death, and key statistics on annual deaths worldwide and in the U.S. Understand risk factors and underlying causes like coronary heart disease.