Understanding Cardiovascular Disease (CVD)

Cardiovascular Disease (CVD)

• CVD is a broad term encompassing various conditions affecting the heart and blood vessels.
• Principal causes are blood clots (thrombosis) and atherosclerosis.
• Atherosclerosis involves plaque buildup in arteries, causing hardening and narrowing, restricting blood flow.
• Conditions stemming from atherosclerosis include coronary heart disease (angina, myocardial infarction), stroke, transient ischaemic attack (TIA), and peripheral arterial disease.

Statistics

• CVD is the leading cause of morbidity and mortality (one in three deaths are related to CVD).
• It places a significant economic burden (>£29 billion on the NHS).
• Prevalence varies regionally due to lifestyle differences, healthcare accessibility, and living standards.
• Black men are particularly vulnerable to early CVD mortality.

Risk Factors

• Risk factors are categorized as modifiable and non-modifiable.

Non-modifiable Risk Factors

• Age: CVD risk increases significantly with age, primarily affecting those over 50.
• Gender: Men typically experience CVD earlier (~10 years) and at higher rates than women across all ages.
• Family History: Shared environment and genetics contribute to an increased risk. Premature CVD death in relatives raises early and lifetime risk.
• Ethnic Background: South Asian and sub-Saharan African populations have higher risks, while South American and Chinese populations often have lower risks compared to those of European descent.

Modifiable Risk Factors

• Smoking

• Low HDL cholesterol

• High non-HDL cholesterol

• Sedentary Lifestyle/Lack of Physical Activity

• Unhealthy Diet

• Excessive Alcohol Consumption

• Obesity

• Modifiable risk factors account for approximately 90% of first heart attack cases.

Comorbidities

• Conditions that elevate CVD risk include hypertension, diabetes (pre-diabetes/metabolic syndrome), chronic kidney disease, dyslipidaemia (familial and non-familial), atrial fibrillation, systemic inflammatory disorders (e.g., rheumatoid arthritis, lupus), influenza, serious mental health issues (e.g., schizophrenia, PTSD – with anxiety being an independent risk factor for coronary artery disease), and periodontitis.
• These comorbidities exacerbate pre-existing CVD and can lead to further complications.

Risk Evaluation

• Tools like the HA2DS2-VASc score (evaluating stroke risk in atrial fibrillation patients) and QRISK 3-2018 (predicting 10-year CVD risk in adults) aid in risk assessment.

CVD Prevalence

• Improved healthcare & increased lifespan contribute to increased prevalence
• Non-cardiac & cardiac comorbidities are factors.

Health Check Programmes

• England's health check program targets individuals aged 40-74 without diagnosed CVD, diabetes, or CKD.
• Comprehensive checks (every 5 years) include CVD risk assessment, alcohol assessment, physical activity evaluation, cholesterol/BMI checks, dementia screening (65-74), and screening for diabetes & CKD.

Aortic Valve Stenosis

• Aortic stenosis is a narrowing of the aortic valve, potentially leading to significant narrowing (less than 0.8 cm² against a normal 3.5-4 cm²).
• Untreated, symptoms like angina, fatigue, syncope, and congestive heart failure emerge with limited life expectancy (2-5 years).
• Risk factors include age, previous heart disease (congestive), rheumatic heart disease, calcification, radiation therapy to the heart, chronic kidney disease (normal >90ml/min/1.73m²) and existing CVD risk factors.
• Treatment includes valve replacement (mechanical and biological).
• Complications include heart failure, arrhythmias, blood clots, bleeding, endocarditis, stroke, and death.

Cardiomyopathies

• Cardiomyopathies are heart muscle disorders, some inherited

• Main types include hypertrophic (HCM), dilated (DCM), and arrhythmogenic right ventricular (ARVC).

  • Takotsubo cardiomyopathy is stress-related, not inherited, and resolves.
    • HCM is an inherited autosomal dominant disorder with heart muscle thickening, often stemming from mutations (e.g., beta-myosin heavy chain, and myosin binding protein).
    • DCM is the stretching, thinning, and weakening of heart muscle rendering inefficient pumping.
    • ARVC is primarily autosomal dominant with disruptions to muscle proteins, leading to muscle detachment and thinning, with viral myocarditis being an acquired cause.

• Diagnosis frequently includes echocardiography.

• Treatments involve pharmacotherapy, cardiac resynchronization therapy, septal ablation, surgical myectomy for HCM, and potentially heart transplantation for advanced cases.

Heart Failure

• Heart failure is evaluated by the ejection fraction (EF).
• An EF of 50% or higher is considered good; lower values suggest failing heart function. A thicker muscle wall may have a higher EF but lower stroke volume.
• Factors leading to heart failure include obesity, chronic kidney disease, sleep apnea, longstanding uncontrolled hypertension, ischemia from CAD, myocardial infarction, valvular heart disease, myocarditis, congenital issues, familial cardiomyopathies.
• Diagnosis entails symptoms, ECG, echocardiography, and cardiac MRI.

Treatments

• Treatments for CVD are classified as curative, palliative, or symptomatic.

• Medications: statins (cholesterol-lowering), cardioinhibitory drugs like beta-blockers and calcium channel blockers, diuretics, and vasodilators.

• Procedures: heart valve replacement, ablation procedures, and pacemakers/defibrillators.

• Anti-coagulants: such as vitamin K inhibitors (e.g., warfarin) and direct oral anticoagulants (e.g., apixaban, rivaroxaban). Anti-platelets such as aspirin and clopidogrel

• Lifestyle intervention: cessation of smoking, weight management, healthy diet, alcohol consumption within recommended limits, and regular physical activity.

This quiz explores the various conditions under the umbrella of cardiovascular disease, principal causes such as thrombosis and atherosclerosis, and their impact on mortality and morbidity. Examine regional statistics and risk factors that contribute to CVD, including those that can be modified versus those that cannot.