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Cardiovascular disease or cardiovascular diseases is a class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the 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 cardiologists, thoracic surgeons, vascular surgeons, neurologists, and 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 countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer.

It is the number one cause of death and disability in the United States and most European countries (data available through 2005). A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.

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 eating, exercise and avoidance of smoking.

Causes

In his book “The Heart Healthy Program”, the cardiologist Dr Richard M. Fleming has identified several key dietary factors that can lower the risk of heart disease, including:

• Lowering of LDL cholesterol by reducing saturated fat intake.
• Lowering of Triglyceride levels by reducing consumption of sugary and processed foods.
• Reduction of Homocysteine levels by supplementation with Vitamins B6 and B12, and folic acid.
• Increased antioxidant activity by higher consumption of fruits and vegetables.
• Lowering of fibrinogen and growth factors by cutting back on foods such as red meat, dairy products, poultry and eggs.

Pathophysiology

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 7–9 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease. 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

Diagnosis

Associated diagnostic markers

• Low-density lipoprotein
• Lipoprotein(a)
• Apolipoprotein A1
• Apolipoprotein B
• Ratio of Apolipoprotein A1/Apolipoprotein B

Screening

Some biomarkers are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable. Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:

• Higher fibrinogen and 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)

Management

Unlike many other chronic medical conditions, Cardiovascular disease is treatable and reversible, even after a long history of disease. Treatment is primarily focused on diet and stress reduction.

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