Cardiovascular Disease

A CVD is any disease that affects blood vessels or the heart and includes conditions such as high blood pressure, subclinical atherosclerosis, coronary heart disease (CHD), acute coronary syndrome (myocardial ischemia), angina pectoris, stroke (cerebrovascular disease), congenital cardiovascular defects, cardiomyopathy, chronic heart failure (CHF), and other less prevalent conditions.

From: Progress in Molecular Biology and Translational Science, 2015

General Considerations

Bengt Sjögren, ... Per Gustavsson, in Handbook on the Toxicology of Metals (Fourth Edition), 2015

1 Introduction

Cardiovascular disease (CVD) is the leading cause of death in the developed as well as in the developing world. The annual mortality of CVD is expected to reach 23.6 million by 2030 (Alissa and Ferns, 2011).

CVD is a group of diseases that includes coronary heart disease (CHD), cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, deep vein thrombosis, and pulmonary embolism (WHO, 2012). Sometimes the term circulatory diseases is used to encompass all of these diseases. CHD is a disease of the blood vessels supplying the heart muscle. This condition is often called ischemic heart disease (IHD) and acute myocardial infarction belongs to this entity. Cerebrovascular diseases are subdivided into ischemic and hemorrhagic diseases. Stroke is a widely used unspecific term for a group of cerebrovascular diseases of abrupt onset that cause neurological damage. Approximately 85% of strokes are caused by inadequate blood flow to the brain, i.e. ischemic stroke. Hemorrhagic strokes are subdivided into hemorrhage into the brain tissue and hemorrhage into the subarachnoid space (Zivin, 2004). The main representative of peripheral arterial disease is hypertension. Terminology used in the different studies was retained in the following text.

The most common cause of CVD is atherosclerosis. Atherosclerosis has an inflammatory nature, which was described by the Austrian pathologist Carl von Rokitansky in the 1840s and by Rudolf Virchow somewhat later. Rokitansky believed that inflammation was secondary to other disease processes and Virchow promoted atherosclerosis as a primary inflammatory disease (Frostegård, 2010; Mayerl et al., 2006). The response-to-injury hypothesis was summarized by Ross (1993). This theory postulates alteration to the endothelium and intima, due to for example mechanical injury, toxins, and oxygen radicals, as the initiating event leading to endothelial dysfunction. During the last two decades more data has linked inflammation to the occurrence of atherosclerosis and thrombosis (Epstein et al., 1999; Libby et al., 2002; Ridker, 1999; Ross, 1999). Several markers of inflammation such as interleukin-6 (IL-6), fibrinogen, C-reactive protein (CRP), serum amyloid A protein, and increased leukocyte cell count are established risk factors for IHD (Danesh et al., 1998, 2000, 2005, 2008).

Environmental studies focus on the general population, and the exposure route is almost always ingestion of metals or metal-containing compounds. Prospective studies are more conclusive because the exposure by definition occurs prior to the effect or disease outcome. Consequently, cross-sectional studies are regarded as less conclusive. Occupational studies focus on a specific occupational group or a specific metal exposure, and the exposure route is inhalation as a rule. In many studies of occupational exposures, the CVD mortality for one specific occupational group is compared with the national mortality. Such comparisons may be biased because the general population includes sick and disabled people who are unable to work.

This is a condensed review, mainly focusing on epidemiological studies of environmental as well as occupational exposures to metals and metal-containing compounds and their relations with CVD.

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Health Psychology

David S. Krantz, Nicole R. Lundgren, in Comprehensive Clinical Psychology, 1998

8.08.4 Conclusion

There are many environmental, behavioral, and physiological variables that interact in the development of cardiovascular disorders. Many of the standard CHD risk factors have important behavioral components, and increasing evidence suggests important psychosocial risk factors for CHD, including occupational stress, hostility, and physiologic reactivity to stress. In cardiac patients, the presence of acute stress, low social support, lack of economic resources, and psychological depression also appear to be important psychosocial risk factors. The identification of psychosocial risk factors for coronary disease have led to several promising behavioral and psychosocial interventions to aid in the treatment and prevention of coronary disease in high-risk individuals.

There also appear to be important biobehavioral influences in the development and treatment of essential hypertension. These include excessive salt intake, obesity, and stress. Evidence also indicates that genetic and environmental factors interact in the development of hypertension. However, the modest effects of behavioral stress-reducing techniques such as relaxation training, biofeedback, and meditation in lowering blood pressure have proven disappointing. Nevertheless, the important necessity for the involvement of health psychologists in the treatment of essential hypertension is underscored by the potential efficacy of weight loss, dietary modification, and exercise conditioning, as well as the need to ensure that patients adhere to medication regimens in order for pharmacologic interventions that have been shown to reduce subsequent morbidity to be effective.

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Cardiovascular Disease

JAMY D. ARD MD, FRANK A. FRANKLINJr. MD, in Handbook of Clinical Nutrition (Fourth Edition), 2006

Cardiovascular Risk Factors

A consensus method for assessing cardiovascular risk and recommendations for its prevention and treatment have been promulgated by the National Cholesterol Education Program’s (NCEP) Adult Treatment Panel III (ATP III).1 Modifiable and non-modifiable risk factors for cardiovascular disease identified by the ATP III and other groups are shown in Box 20-1. Because many of them are modifiable, a significant proportion of cardiovascular events is preventable. The lipoprotein and metabolic syndrome risk factors comprise the emphasis in risk assessment and therapeutic approaches for CVD risk reduction.

The relationship between serum total cholesterol (TC) levels and CHD deaths is curvilinear, so that the mortality risk from a TC level of 250 mg/dL is twice that of 200 mg/dL, and at 300 mg/dL the risk is fourfold higher (Fig. 20-1). In addition, the risk declines with TC levels below 200 mg/dL, suggesting that even 200 mg/dL is not optimal. Although TC is an important identifier of risk, its subfractions have differential effects on risk. Both epidemiologic studies and controlled clinical trials have indicated that each 1 mg/dL increment in LDL causes an increase in CHD risk of 1%. Similarly, a 1 mg/dL decrease in high-density lipoprotein cholesterol (HDL-C) increases CHD risk by 2% to 3%. At any LDL level, the concentration of HDL-C has an inverse association with CVD risk. Therefore, the ATP III has identified LDL as the primary target for cholesterol-lowering therapy to reduce CVD risk. Recommended serum lipid levels are shown in Table 20-1.

Lowering LDL is effective and safe for primary and secondary prevention of CHD. Nutrition modifications can have a significant impact on LDL levels. In two randomized trials, a low-fat diet combined with smoking cessation or medication in persons with CHD resulted in less progression and more regression of coronary artery lesions than did the control regimen. The improvement in artery luminal diameter correlated with the extent of LDL lowering. In the Lifestyle Heart Trial, a diet with less than 10% of energy from fat and no dietary cholesterol reduced angina symptoms in only 1 month, suggesting an impact on vascular relaxation, while later angiograms showed net regression of CHD.

Elevated serum triglycerides (TG) appear to be an independent CVD risk factor as well. High serum TG levels are often associated with a pattern of dyslipidemia characterized by reduced HDL-C levels and raised levels of chylomicron remnants, very-low-density lipoprotein (VLDL) remnants, intermediate-density lipoprotein (IDL), and small, dense, cholesterol-depleted, apolipoprotein (Apo) B-rich LDL. This phenotype is often part of metabolic syndrome (discussed later).

At any given serum TC level, there is synergy with other CVD risk factors that greatly increases CVD risk. This has led the NCEP to propose a clinical strategy of diet and medications for individuals in the highest quintile of CVD risk, and a public health approach involving lifestyle modification for the general population.1 Dietary modification is an important part of both strategies.

The diagnosis of metabolic syndrome, as defined by the ATP III (see Chapter 16), is appropriate for persons with at least three of the following five criteria: elevated fasting plasma glucose levels (≥110 mg/dL); abdominal obesity (waist circumference >35 inches in women or >40 inches in men); hypertension (≥130/≥85 mmHg); hypertriglyceridemia (≥150 mg/dL); and low HDL-C (<50 in women, <40 in men). Up to 40% of the U.S. population older than 50 has metabolic syndrome. Compared to persons without metabolic syndrome, those who have it are twice as likely to have CHD.

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Volume 4

Danielle E. Haslam, ... Shilpa N. Bhupathiraju, in Encyclopedia of Human Nutrition (Fourth Edition), 2023

Introduction

Cardiovascular diseases (CVD) are the leading cause of death globally, accounting for approximately 19.1 million deaths in 2020. CVD cost the US an estimated $228.7 billion annually in direct and indirect costs in 2017–2018. A recent study found that poor diet quality is the top modifiable risk factor related to CVD-related morbidity and mortality, accounting for approximately half of CVD deaths annually. Importantly, <1% of US adults achieve dietary patterns associated with ideal cardiovascular health. Thus, improving diet quality worldwide has a high potential to reduce CVD burden, particularly CHD, which is the leading cause of CVD death. In this article, we provide a brief history of dietary guidance to reduce CHD with a major focus on recent evidence linking overall dietary patterns to CHD and CVD risk.

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The Influence of Fiber on Gut Microbiota: Butyrate as Molecular Player Involved in the Beneficial Interplay Between Dietary Fiber and Cardiovascular Health

Lorella Paparo, ... Roberto B. Canani, in Dietary Fiber for the Prevention of Cardiovascular Disease, 2017

1 Introduction

Cardiovascular diseases (CVD) are the main cause of death in industrialized countries and are responsible for high economic health care costs [1]. The World Health Organization estimated about 20 million CVD deaths in 2015, rendering CVD as the major contributor to mortality worldwide and a significant proportion of the population have risk factors that contribute to the development of CVD [2].

Diet has a pivotal role in the development and prevention of CVD, and it is considered an important target of intervention. A diet low in saturated fats, with plenty of fiber, significantly reduces the risk of major cardiac events [3].

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Overview of the Role of Antioxidant Vitamins as Protection Against Cardiovascular Disease

Koutatsu Maruyama, Hiroyasu Iso, in Aging, 2014

Abstract

Cardiovascular diseases, including coronary heart disease and stroke, are major and increasing causes of mortality throughout the world. Aging is a major determinant of cardiovascular diseases because it promotes oxidative stress and atherosclerosis. Oxidative stress, a potential factor in the promotion of cardiovascular diseases, is the result of an imbalance between the biologic reactions of reactive oxygen species and the factors that promote recovery from damage by reactive oxygen species; this imbalance may play a key role in promoting cardiovascular diseases. Antioxidant vitamins have potential preventive effects against cardiovascular diseases. Vitamins A, C, and E are well known antioxidant vitamins and are also well studied in relation to primary and secondary prevention against cardiovascular diseases. Whereas reports on many cohorts have supported a primary preventative effect of antioxidant vitamins on cardiovascular diseases, the evidence from clinical trials has been controversial. Some studies have implied that antioxidant vitamins may act as pro-oxidants and subsequently promote atherosclerosis. Several factors mask the association between antioxidant vitamins and cardiovascular diseases; therefore, more studies are needed to clarify this association.

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Early nutrition and development of cardiovascular disease

Tricia L. Hart, ... Penny M. Kris-Etherton, in Early Nutrition and Long-Term Health (Second Edition), 2022

Abstract

Cardiovascular disease (CVD) is caused by risk factors that can present at all ages, including early life. Healthy lifestyle practices can delay or prevent the onset of CVD risk factors. Consistent evidence demonstrates that a healthy dietary pattern in childhood prevents the early onset of CVD risk factors and lowers CVD risk in adulthood. Healthy dietary patterns are abundant in fruits, vegetables, whole grains and lean animal- or plant-protein foods, and limit foods and beverages higher in added sugars, saturated fat, and sodium. Meeting dietary recommendations in childhood reduces the risk of CVD risk factors including overweight/obesity, high blood pressure, dyslipidemia, and elevated fasting plasma glucose, thereby decreasing CVD risk in adulthood. Health professionals should screen and monitor lifestyle behaviors, including diet, throughout childhood. Teaching children and their caregivers about implementing a heart-healthy dietary pattern early in life could benefit primordial prevention and decrease CVD risk later in life.

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Lifestyle Features and Heart Disease

Vijay Singh, Ronald Ross Watson, in Lifestyle in Heart Health and Disease, 2018

Abstract

Cardiovascular disease is one of the most underlying health problems throughout the United States. Risk factors for cardiovascular disease may include age, poor diet, the lack of exercise, and smoking. Although there are a variety of risk factors that can influence patient progression of cardiovascular disease, there are many lifestyle changes that can be done in order to alleviate the prognosis. By ensuring proper lifestyle changes such as healthier diet, daily exercise, smoking cessation, and regular physician checkups, patients are able to better alleviate the symptoms associated with cardiovascular disease.

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Cardiovascular Disease in Chronic Kidney Disease

Mark J. Sarnak MD, MS, Daniel E. Weiner MD, MS, in Chronic Kidney Disease, Dialysis, and Transplantation (Fourth Edition), 2019

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The increased risk of CVD begins during the earlier stages of CKD before the onset of kidney failure. Although patients with CKD have a very high prevalence of traditional CVD risk factors such as diabetes and hypertension, they are also exposed to other nontraditional, uremia-related CVD risk factors such as abnormal calcium-phosphorus metabolism and inflammation. Although some of the burden of CVD in CKD may be due to atherosclerosis, it is apparent that patients with CKD also have a high prevalence of vascular stiffness due to nonatherogenic causes and disorders of left ventricular structure and function. In this chapter, we discuss the epidemiology and pathophysiology of CVD in patients with CKD, with a focus on dialysis patients and nontransplant recipients with stages 3 to 4 CKD. We also discuss the different manifestations of CVD in kidney disease and review diagnostic and therapeutic options.

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Section 9. Cardiovascular Disease in Women

Kathryn M. Rexrode, in Women and Health (Second Edition), 2013

Introduction

Cardiovascular disease (CVD) is the leading cause of death in women, both in the US and worldwide. While once considered a ‘western’ or ‘industrialized disease’, over 80% of CVD deaths in women now occur in low and middle-income countries as a result of increasing longevity and large population sizes. The rising obesity epidemic and associated increases in diabetes presage a continued rise in rates of CVD. Ischemic heart disease is the most common cause of CVD death, but CVD as defined by the World Health Organization also includes stroke, congestive heart failure (CHF), arrhythmias, hypertension and venous thromboembolism (VTE), all of which also contribute significantly to mortality as well as morbidity. This section addresses each of these CVD conditions, as well as their major risk factors, drawing attention to specific issues for women. Congenital heart disease and rheumatic heart disease also fall under this CVD category, but both are now rare in developed countries.

Once considered a ‘man’s disease’, awareness of CVD as an important cause of morbidity and mortality in women has increased since the last edition of Women and Health. About half of women in the US (52%) now recognize CVD as the leading cause of death in women; however, there are important disparities by race/ethnicity, with much lower awareness in African-American and Hispanic women.1 Continued education efforts are necessary in CVD risk recognition, as well as in identifying symptoms that should prompt emergent medical evaluation for CVD. Public health campaigns as well as discussions with providers should focus on helping women understand their CVD risk and how to reduce it.

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