Center for Cardiovascular Diseases

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Ash Jain, MD, FACC
Thirupathi Reddy, MD, FACC
Adil Irani, MD
Sanjay Bindra, MD, FACC
Lay Hwa Lou, MD
Seema Rikhy, MD
Simin Siddiq, MD
Shaista Shah, MD
Hui Zheng, MD
Sylvia Hoang, MD
Victor Maceda, MD
Archana Bindra, MD
Shakir Hyder, MD
Scott Kramer, MD
Uma Kantamuneni, MD
Micheal Heinrich, MD
Harry Lifschutz, MD
Hae Jin Lim

Center for Cardiovascular Disease

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries, capillaries and veins.

Cardiovascular disease refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of cardiovascular disease are diverse but arteriosclerosis and/or hypertension are the most common. Additionally, with aging come a number of physiological and morphological changes that alter cardiovascular function and lead to subsequently increased risk of cardiovascular disease, even in healthy asymptomatic individuals.

Cardiovascular disease is the leading cause of deaths worldwide, though since the 1970s, cardiovascular mortality rates have declined in many high-income countries. At the same time, cardiovascular deaths and disease have increased at a fast rate in low- and middle-income countries. Although cardiovascular disease usually affects older adults, the antecedents of cardiovascular disease, notably arteriosclerosis, begin in early life, making primary prevention efforts necessary from childhood. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and avoidance of smoking.

Types

  • Coronary heart disease (also ischemic heart disease or coronary artery disease)
  • Cardiomyopathy – diseases of cardiac muscle
  • Hypertensive heart disease – diseases of the heart secondary to high blood pressure
  • Heart failure
  • Cor pulmonale – a failure of the right side of the heart
  • Cardiac dysrhythmias – abnormalities of heart rhythm
  • Inflammatory heart disease
    • Endocarditis – inflammation of the inner layer of the heart, the endocardium. The structures most commonly involved are the heart valves.
    • Inflammatory cardiomegaly
    • Myocarditis – inflammation of the myocardium, the muscular part of the heart.
  • Valvular heart disease
  • Stroke and cerebrovascular disease
  • Peripheral arterial disease

Risk factors

Epidemiology suggests a number of risk factors for heart disease: age, gender, high blood pressure, high serum cholesterol levels, tobacco smoking, excessive alcohol consumption, family history, obesity, lack of physical activity, psychosocial factors, diabetes mellitus, air pollution. While the individual contribution of each risk factor varies between different communities or ethnic groups the consistency of the overall contribution of these risk factors to epidemiological studies is remarkably strong. Some of these risk factors, such as age, gender or family history, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, drug treatment or social change.

Age

Age is an important risk factor in developing cardiovascular diseases. It is estimated that 87 percent of people who die of coronary heart disease are 60 and older. At the same time, the risk of stroke doubles every decade after age 55.
Multiple explanations have been proposed to explain why age increases the risk of cardiovascular diseases. One of them is related to serum cholesterol level. In most populations, the serum total cholesterol level increases as age increases. In men, this increase levels off around age 45 to 50 years. In women, the increase continues sharply until age 60 to 65 years.

Aging is also associated with changes in the mechanical and structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and may subsequently lead to coronary artery disease.

Sex

Men are at greater risk of heart disease than pre-menopausal women. However, once past menopause, a woman’s risk is similar to a man’s.

Among middle-aged people, coronary heart disease is 2 to 5 times more common in men than in women. In a study done by the World Health Organization, sex contributes to approximately 40% of the variation in the sex ratios of coronary heart disease mortality. Another study reports similar results that gender difference explains nearly half of the risk associated with cardiovascular diseases. One of the proposed explanations for the gender difference in cardiovascular disease is hormonal difference. Among women, estrogen is the predominant sex hormone. Estrogen may have protective effects through glucose metabolism and hemostatic system, and it may have a direct effect on improving endothelial cell function. The production of estrogen decreases after menopause, and may change the female lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level and by increasing LDL and total cholesterol levels. Women who have experienced early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age group who have not yet gone through menopause.

Among men and women, there are differences in body weight, height, body fat distribution, heart rate, stroke volume, and arterial compliance. In the very elderly, age related large artery pulsatility and stiffness is more pronounced in women. This may be caused by the smaller body size and arterial dimensions independent of menopause.

Pathophysiology

Population based studies show that atherosclerosis the major precursor of cardiovascular disease begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 7–9 years.

This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken.

Obesity and diabetes mellitus are often linked to cardiovascular disease, as are a history of chronic kidney disease and hypercholestrolaemmia. In fact, cardiovascular disease is the most life threatening of the diabetic complications and diabetics are two- to four-fold more likely to die of cardiovascular-related causes than nondiabetics.

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