Cardiovascular disease 512662 224322690 2008-07-08T09:57:56Z StigBot 5316354 robot Adding: [[zh:心血管疾病]] Modifying: [[de:Herz-Kreislauferkrankung]] {{Infobox_Disease | Name = Cardiovascular disease | Image = | Caption = | DiseasesDB = 28808 | ICD10 = {{ICD10|I|51|6|i|30}} | ICD9 = {{ICD9|429.2}} | ICDO = | OMIM = | MedlinePlus = |bl.ahlfdfrsthws eMedicineSubj = | eMedicineTopic = | MeshID = D002318 | }} '''Cardiovascular disease''' refers to the class of diseases that involve the [[heart]] or [[blood vessel]]s ([[artery|arteries]] and [[vein]]s). <ref>{{cite book | last = Maton | first = Anthea | authorlink = Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryanna Quon Warner, David LaHart, Jill D. Wright | coauthors = | title = Human Biology and Health | publisher = Prentice Hall | date = 1993 | location = Englewood Cliffs, New Jersey | pages = | url = | doi = | id = | isbn = 0-13-981176-1}}</ref> While the term technically refers to any disease that affects the [[Circulatory system|cardiovascular system]] (as used in [[MeSH]]), it is usually used to refer to those related to [[atherosclerosis]] (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by [[cardiology|cardiologists]], [[thoracic surgery|thoracic surgeons]], [[vascular surgery|vascular surgeons]], [[neurology|neurologists]], and [[interventional radiology|interventional radiologists]], depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital. Most Western countries face high and increasing rates of cardiovascular disease. Each year, [[heart disease]] kills more Americans than cancer.<ref>{{cite web | last = United States | authorlink = Centers for Disease Control | title = Chronic Disease Overview | publisher = United States Government | date = 1999 | url = http://www.cdc.gov/nccdphp/overview_text.htm | accessdate =2007-02-07 }}</ref> Diseases of the heart alone caused 30% of all deaths, with other diseases of the cardiovascular system causing substantial further death and disability. Two out of three cardiac deaths occur without any diagnosis of cardiovascular disease.<ref>Informational page on cardiovascular disease at [http://www.itamar-medical.com/Product.asp?pid=3982&ppid=3005 Itamar Medical]</ref> Up until the year 2005, it was the number 1 cause of death and disability in the United States and most European countries. A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.<ref>Rainwater DL, McMahan CA, Malcom GT, Scheer WD, Roheim PS, McGill HC Jr, Strong JP. Lipid and apolipoprotein predictors of atherosclerosis in youth: apolipoprotein concentrations do not materially improve prediction of arterial lesions in PDAY subjects. The PDAY Research Group. Arterioscler Thromb Vasc Biol. 1999; 19: 753-61.</ref><ref>Mcgill, HC, Jr., Mcmahan, CA, Zieske, AW et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler. Thromb. Vasc. Biol. 2000; 20: 1998–2004.</ref> By the time that heart problems are detected, the underlying cause ([[atherosclerosis]]) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as [[Healthy diet|healthy eating]], [[Physical exercise|exercise]] and avoidance of [[tobacco smoking|smoking]]. ==Biomarkers== Some [[Biomarker (medicine)|biomarkers]] are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.<ref>{{cite journal |author=Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino RB, Vasan RS |title=Multiple biomarkers for the prediction of first major cardiovascular events and death |journal=N. Engl. J. Med. |volume=355 |issue=25 |pages=2631–9 |year=2006 |pmid=17182988 |doi=10.1056/NEJMoa055373}}</ref> Currently, biomarkers which may reflect a higher risk of cardiovascular disease include: * Higher [[fibrin]]ogen and [[Plasminogen activator inhibitor-1|PAI-1]] blood concentrations * Elevated [[homocysteine]], or even upper half of normal * Elevated blood levels of [[asymmetric dimethylarginine]] * High inflammation as measured by [[C-reactive protein]] * Elevated blood levels of [[brain natriuretic peptide]] (also known as B-type) (BNP) <ref>{{cite journal |author=Ramachandran Vasan, et al |journal=N. Engl. J.| title = }}</ref> ==Prevention== Attempts to prevent cardiovascular disease are more effective when they remove and prevent causes, and they often take the form of modifying risk factors. Some factors, such as gender, age, and family history, cannot be modified. [[Smoking cessation]] (or abstinence) is one of the most effective and easily modifiable changes. Regular [[cardiovascular exercise]] ([[aerobic exercise]]) complements the healthful eating habits. According to the American Heart Association, build up of plaque on the arteries ([[atherosclerosis]]), partly as a result of high cholesterol and fat diet, is a leading cause for cardiovascular diseases. The combination of healthy diet and exercise is a means to improve serum [[cholesterol]] levels and reduce risks of cardiovascular diseases; if not, a physician may prescribe "cholesterol-lowering" drugs, such as the [[statin]]s. These medications have additional protective benefits aside from their lipoprotein profile improvement. [[Aspirin]] may also be prescribed, as it has been shown to decrease the [[Thrombus|clot]] formation that may lead to myocardial infarctions and strokes; it is routinely prescribed for patients with one or more cardiovascular risk factors. One possible way to decrease risk of cardiovascular disease is keep your total cholesterol below 150. In the [[Framingham Heart Study]], those with total cholesterol below 150 only very rarely got coronary heart disease. A [[magnesium deficiency (medicine)|magnesium deficiency]], or lower levels of [[magnesium]], can contribute to heart disease and a [[healthy diet]] that contains adequate [[magnesium]] may prevent heart disease.<ref>[http://www.ars.usda.gov/is/AR/archive/may04/energy0504.htm Lack Energy? Maybe It's Your Magnesium Level]</ref> [[Magnesium]] can be used to enhance long term treatment, so it may be effective in long term prevention.<ref name="Rosanoff">[http://www.jacn.org/cgi/reprint/23/5/501S.pdf Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals] Andrea Rosanoff, PhD, Mildred S. Seelig, MD. Journal of the American College of Nutrition, Vol. 23, No. 5, 501S–505S (2004)</ref> Excess calcium may contribute to a buildup of calcium in the veins. Excess calcium can cause a [[magnesium deficiency (medicine)|magnesium deficiency]], and [[magnesium]] can reduce excess calcium. ====Foods for cardiovascular health==== Research has shown that a diet that includes dark chocolate, almonds, fish, wine, fruits, vegetables, and garlic can increase life expectancy and decrease your risk for cardiovascular disease.<ref name= Franco > {{cite journal | author= Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J | title= Franco, O, Bonneux, L, de Laet. C, Steyerberg, E, Mackenbach, J | journal=BMJ. | year=2004 | pages= 1447–1450 | volume=329 | doi= 10.1136/bmj.329.7480.1447 | pmid= 15604180 }}</ref> Eating [[oily fish]] at least twice a week may help reduce the risk of sudden death and arrhythmias. A 2005 review of 97 clinical trials by Studer et al. noted that omega-3 fats gave lower risk ratios than did statins.<ref>Studer M, Briel M, Liemenstoll B, Blass TR, Bucher HC. "Effect of different antilipidemic agents and diets on mortality: a systematic review." Arch. Intern. Med. 2005; 165(7): 725-730.</ref> [[Olive oil]] is said to have benefits. Studies of individual heart cells showed that fatty acids blocked excessive [[sodium]] and [[calcium]] currents in the [[heart]], which could otherwise cause dangerous, unpredictable changes in its rhythm. ===Cardiovascular disease and salt=== There is evidence from one large unblinded randomised controlled trial of more than 3000 patients that reducing the amount of sodium in the diet reduced the risk of cardiovascular events by more than 25%.<ref name="TOHP2007">{{cite journal | title=Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP) | author=Cook NR, Cutler JA, Obarzanek E, ''et al.'' | journal=Br Med J | year=2007 | doi=10.1136/bmj.39147.604896.55 | volume=334 | pages=885 | pmid=17449506}}</ref> This re-affirms evidence from the [[Intersalt study]] published in 1988, that high levels of dietary salt are harmful;<ref>{{cite journal | author=Elliott P, Stamler J, Nichols R, ''et al.'' | title=Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group | journal=Br Med J | year=1996 | volume=312 | issue=7041 | pages=1249&ndash;53 | pmid=8634612 }}</ref> these results were at the time heavily disputed by the [[Salt Institute]] (the salt producers' trade organisation).<ref>{{cite journal | author=Godlee F | title=Editor's Choice: Time to talk salt | journal=Br Med J | year=2007 | volume=334 | issue=7599 | doi=10.1136/bmj.39196.679537.47 | pages=0}}</ref> In the results of a [http://www.aecom.yu.edu/home/news.asp?id=197 study of 8,700 adults in the US] released in 2008 by the Albert Einstein College of Medicine of Yeshiva University, researchers found that the people who ranked in the 25% of the lower sodium intake in their diet were 80% more likely to die of cardiovascular disease than the 25% who had the higher intake of sodium in their diet. This particular research implies that low sodium intake is also harmful. ===Oral Hygiene and Cardiovascular Disease=== Many recent clinical research discuss the direct relation between poor [[oral hygiene]] and cardiovascular disease. Oral bacteria and periodontal disease may trigger the inflammation in the coronary arteries and contribute to atherosclerosis (artery hardening and narrowing); same bacteria may determine the clot formation increasing the risk of heart attack or cerebral stroke. <ref>[http://www.americanheart.org/presenter.jhtml?identifier=3014399 Oral Hygiene and Cardiovascular Disease] American Heart Association</ref> <ref>[http://www.ns.umich.edu/htdocs/releases/story.php?id=2566 Real connection between oral health and heart disease] University of Michigan Jan. 22, 1999</ref> ==Awareness== [[Atherosclerosis]] is a process that develops over decades and is often silent until an acute event (heart attack) develops in later life. Population based studies in the youth show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as 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 15–19 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.<ref>Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA. Awareness, knowledge, and perception of heart disease among adolescents. European Journal of Cardiovascular Prevention and Rehabilitation. October, 2006; 13(5): 718-723. ISSN 1741-8267</ref> This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken. ==Treatment== Treatment of cardiovascular disease depends on the specific form of the disease in each patient, but effective treatment always includes preventive lifestyle changes discussed above. Medications, such as [[antihypertensive|blood pressure reducing medications]], aspirin and the statin cholesterol-lowering drugs may be helpful. In some circumstances, [[Coronary artery bypass surgery|surgery]] or [[angioplasty]] may be warranted to reopen, repair, or replace damaged blood vessels. ==Types of cardiovascular diseases== * [[Aneurysm]] * [[Angina pectoris|Angina]] * [[Cardiac arrhythmia|Arrhythmia]] * [[Atherosclerosis]] * [[Cardiomyopathy]] * Cerebrovascular Accident ([[Stroke]]) * [[Cerebrovascular disease]] * [[Congenital heart disease]] * [[Heart failure|Congestive Heart Failure]] * [[Myocarditis]] * [[Valvular heart disease|Valve Disease]] * [[Coronary heart disease|Coronary Artery Disease]] * [[Dilated cardiomyopathy]] * [[Diastolic dysfunction]] * [[Endocarditis]] * [[Hypertension|High Blood Pressure (Hypertension)]] * [[Hypertrophic cardiomyopathy]] * [[Mitral valve prolapse]] * [[Myocardial infarction]] (Heart Attack) * [[vein|Venous]] [[Thrombosis|Thromboembolism]] ==Research== The causes, prevention, and/or treatment of all forms of cardiovascular disease are active fields of [[biomedical research]], with hundreds of scientific studies being published on a weekly basis. A fairly recent emphasis is on the link between low-grade [[inflammation]] that hallmarks atherosclerosis and its possible interventions. [[C-reactive protein]] (CRP) is an inflammatory marker that may be present in increased levels in the blood in patients at risk for cardiovascular disease. Its exact role in predicting disease is the subject of debate. Some areas currently being researched include possible links between [[infection]] with ''[[Chlamydophila pneumoniae]]'' and coronary artery disease. The ''Chlamydia'' link has become less plausible with the absence of improvement after antibiotic use.<ref>Andraws R, Berger JS, Brown DL. ''Effects of antibiotic therapy on outcomes of patients with coronary artery disease''. [[Journal of the American Medical Association|JAMA]] 2005;293:2641-7. PMID 15928286.</ref> == See also == * [[Oral hygiene]] ==References== {{reflist|2}} ==External links== '''Informational''' * [http://www.lipidsonline.org/slides/slide01.cfm?q=cholesterol+distribut&dpg=1 Total Cholesterol Distribution vs. CHD deaths] * [http://www.ohsu.edu/drugeffectiveness/reports/documents/BB_final_report_update%203.pdf Drug Class Review on Beta Adrenergic Blockers Sep 2007] '''Organizations''' * [http://www.americanheart.org/downloadable/heart/1140534985281Statsupdate06book.pdf Heart Disease and Stroke Statistics - 2006 Update] from the American Heart Association * [http://www.cvdf.org Cardiovascular Disease Foundation] * [http://www.bhf.org.uk The British Heart Foundation] * [http://www.who.int/cardiovascular_diseases/en/ World Health Organization cardiovascular disease site] {{Circulatory system pathology}} {{Vascular diseases}} {{Certain conditions originating in the perinatal period}} [[Category:Cardiovascular diseases| ]] [[Category:Medical conditions related to obesity]] [[de:Herz-Kreislauferkrankung]] [[fr:Maladie cardio-vasculaire]] [[lv:Sirds slimības]] [[no:Hjerte- og karsykdommer]] [[pl:Choroby układu krążenia]] [[pt:Doença cardiovascular]] [[sl:Bolezni srca in ožilja]] [[sv:Hjärt- och kärlsjukdomar]] [[zh:心血管疾病]]