Cardiovascular Disease Overview and Risk

Cardiovascular disease (CVD) is an encompassing term that includes a wide range of conditions affecting the heart and blood vessels, constituting a significant global health challenge. It spans conditions like coronary heart disease, hypertension, peripheral artery disease, stroke, heart failure, cardiomyopathy, valvular heart disease, and congenital heart disease, making it a multifaceted health concern. A common thread linking these varied conditions is atherosclerosis, the process involving the loss of natural artery elasticity, which is intrinsic to CVD.

Atherothrombotic CVD, primarily manifesting as coronary heart disease and stroke, significantly contributes to the global burden of mortality and disability. Ongoing research continually uncovers new insights into the mechanisms and risk factors associated with these conditions, driving advancements in preventive strategies and treatment modalities. The cardiovascular system, comprised of both the heart and circulatory system, plays a pivotal role in maintaining bodily functions by facilitating the distribution of oxygen and nutrients to cells while eliminating carbon dioxide and other waste products.

Recognizing the complex interplay of genetic and environmental factors in cardiovascular health, there is a growing emphasis on evaluating individual cardiovascular risk. For those with a familial predisposition to premature cardiovascular disease or displaying symptoms indicative of cardiovascular issues, a thorough risk assessment is imperative. This evaluation should consider a range of factors, including ethnicity, smoking history, family cardiovascular disease history, weight, blood pressure, non-fasting lipids, and non-fasting glucose levels. These comprehensive assessments aid in early detection, personalized intervention, and the formulation of effective preventive measures, thus contributing to the ongoing efforts to mitigate the global impact of cardiovascular diseases.
Cardiovascular Disease Overview and Risk

What is hypertensive heart disease?

Hypertension remains a major public health problem associated with considerable morbidity and mortality. It’s the leading cause of death from high blood pressure. Hypertensive heart disease encompasses anatomical changes and altered physiology of heart muscle, coronary arteries, and great vessels.

Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium and coronary arteries as a result of chronic blood pressure elevation. It’s a group of medical problems ― like heart failure and conduction arrhythmias ― that can happen when the person doesn’t control his high blood pressure (hypertension).

Essential hypertension accounts for 90% of cases of hypertension in adults. Secondary causes of hypertension account for the remaining 10% of cases of chronically elevated BP.

Hypertension increases the workload on the heart inducing structural and functional changes in the myocardium. These changes include hypertrophy of the left ventricle, which can progress to heart failure.

Clinically, hypertensive heart disease is characterized by the presence of left ventricular hypertrophy (LVH) in the absence of a cause other than arterial hypertension.

The main risk factor for hypertensive heart disease is high blood pressure. The risk increases if the person overweight, not exercise enough, smoking, eating food high in fat and cholesterol. Chronic high blood pressure (higher than 120/80 mmHg) causes hypertensive heart disease. As people get older and continue to have high blood pressure, their risk of heart disease increases.

Hypertensive heart disease can cause serious health problems. Hypertensive heart disease can lead to either diastolic heart failure, systolic failure or a combination of the two. Such patients are at a higher risk for developing acute complications such as decompensated heart failure, acute coronary syndrome or sudden cardiac death.

The types of hypertensive heart disease include:
*Narrowing of the arteries
*Thickening and enlargement of the heart
What is hypertensive heart disease?

Vitamin D reduces risk of heart disease

Many studies suggest that vitamin D may play a significant role in many aspects of heart and vascular health. 

In one study published in January 2008 in Circulation, researchers followed 1739 participants for the development of heart disease.

The study analyzed data on 1739 men and women (average age, 59) without cardiovascular disease. About 40% had high blood pressure.

In a five year period, 120 people had a cardiovascular event, which may have included the new onset of cardiac chest pain, heart attacks, heart failure, strokes, and leg pain due to inadequate blood supply.

Based on blood tests, people moderately deficient in vitamin D were 62% more likely to have had heart trouble than were those with higher vitamin D levels.

The patients who had high blood pressure with the lowest levels of vitamin D had twice as many serious cardiovascular events compared to these with high blood pressure and the highest blood levels of vitamin D. 

Another study published in June 9, 2008 in Archives of Internal Medicine, researchers found at the level of vitamin D in men who developed a heart attack during a 10 year follow-up period.

The result was the lower the vitamin D level, the higher the risk for heart attack.

Food sources of vitamin D include milk, fortified cereal, salmon, mackerel, sardines, and tuna, Sunshine is another source.

The researchers found that vitamin D was able to prevent the uptake of LDL cholesterol by the cells in the arterial walls, which is the main reason for narrowing of the coronary arteries.

Vitamin D deficiency is common among patients with myocardial diseases because sun-induced vitamin D production in the skin and dietary intake of vitamin D is often insufficient.
Vitamin D reduces risk of heart disease

What are lipids?

Lipids are organic compounds that contain hydrocarbons which are the foundation for the structure and function of living cells.

Lipid molecules contain large hydrocarbon portion and not many polar functional group, which accounts for their solubility behavior. Their intermolecular interactions are dominated by the hydrophobic effect and van der Waals interactions.

Lipids are water insoluble organic compounds. They are hydrophobic (nonpolar) or amphipathic (containing both nonpolar and polar regions)
*Free fatty acids
*Triacylglycerols
*Phospholipids
*Glycolipids
*Steroids

Fatty acids are “carboxylic acids (or organic acid), often with a long aliphatic tails (long chains), either saturated or unsaturated.” When a fatty acid is saturated it is an indication that there are no carbon-carbon double bonds and if the fatty acid is saturated it is an indication that it has at least one carbon-carbon double bond.

Lipids are major components of cell membranes, and are responsible for most of the permeability filter functions of membranes. Membranes act as barriers to separate compartments within eukaryotic cells, and to separate all cells from their surroundings.

A lipid abnormality is one of the causal factors of cardiovascular disease. Excess LDL cholesterol (say a total serum cholesterol > 4-5mmol/L) is the most widely accepted risk factor for heart disease. Excess triglycerides (say >1.8mmol/L) are probably important in CHD but this is controversial. A low concentration of HDL cholesterol (say less than 1.0mmol/L) is also accepted as a major risk factor.
What are lipids?

Causes of heart arrhythmia

Heart arrhythmia is the scenario where the heart beats at an irregular pace or pattern, sometimes more than a 200 beats per minute or sometimes as low as 50-60 per minutes.

The causes of arrhythmia can be divided into two categories. Primary rhythm disturbances, which not associated with any underlying heart disease and secondary rhythm disturbances, arise from existing heart conditions.

Primary rhythm disturbances such as:
*Smoking
*Excessive use of alcohol or caffeine
*Drug abuse
*Some prescription medications and herbal remedies

While secondary rhythm disturbances including:
*Heart defects at birth
*Electrolyte imbalances in your blood (such as sodium or potassium)
*Changes in your heart muscle
*Injury from a heart attack
*Stress
*Healing process after heart surgery
*Irregular heart rhythms can also occur in "normal, healthy" hearts.

Risk factors include: coronary artery disease; high blood pressure, high blood cholesterol levels, unhealthy lipid or triglyceride blood levels; atherosclerosis, diabetes, thyroid-gland orders; and damaged heart valves.
Causes of heart arrhythmia

Cerebrovascular disease

Cerebral vascular disorders are characterized by sudden neurologic deficits resulting from ischemia or hemorrhagic events.

Cerebrovascular disease is one of the most common neurologic diseases, with a relatively high cases fatality ratio and a substantial personal, familial and social impact among the survivors.

Cerebrovascular disease is the third leading cause of death and the leading cause of disability in the United States.  Many different cerebrovascular diseases may cause cognitive decline and dementia, including stroke, silent infarcts, ischemic white matter lesions, hereditary cerebral hemorrhage with amyloidosis, granular cortical atrophy, hypertensive encephalopathy, cerebral amyloid angiopathy and cerebral vasculitis.

The major risk factors for the development of cerebrovascular disease are hypertension and diabetes.

Other risk factors include atherosclerosis, inflammatory processes, dissecting aneurysm, disorders affecting the myocardium, congestive heart failure, polycythemia, cigarette smoking, use of oral contraceptives and postpartum infection.
Cerebrovascular disease

What is stroke?

Stroke has been recognized for thousands of years and is the third most common cause of death after heart disease and cancer in developed countries.

Approximately 550,000 people suffer a stroke each year nearly 150, 000 people die from stroke, and about 3 million stroke survivors have varying degrees of residual neurological impairment.

It is a disease of the brain and is caused by a blockage or rupture of the essential blood supply that results in an acute clinical syndrome lasting more than 24 hours.

There is clear neurological deficit and some degree of permanent brain damage.

Based on the blood vessel involved the symptoms are different and specific and often help pinpoint the exact location of the lesion in the central nervous system.

The two most common types of stroke are:
*Ischemic – blockage
*Hemorrhagic (intracerebral) – bleeding

While some risk factors for ischemic and hemorrhagic stroke are different, the following risk factors are applicable to 90% of strokes:
*High blood pressure
*Smoking
*Waist to hip ratio
*Unhealthy diet
*Consuming too much alcohol
What is stroke?

Coffee reduces the risk of heart disease

Men who drank more than five cups of coffee a day reduced their risk of developing heart disease by 44 percent.

Women who drank four to five cups each day lowered their risk by 34 percent. Coffee contains antioxidants that help prevent heart disease and it raises neither blood pressure nor cholesterol.

Coffee consumption decreased the relative risks of stroke across categories of coffee consumption in the more than 83,000 women of the Nurses’ Health Study.

Coffee reduces inflammation and improves the health of the endothelial lining of arteries. Some substances in coffee also have significant antioxidant effects.

The antioxidants in coffee are polyphenol which may prevent and reduce the risks of heart disease.
Coffee reduces the risk of heart disease