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Cardiovascular disease (CVD) is a class of diseases that involve the
heart The heart is a muscular MUSCULAR (DS-200B), located in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixed. The Guardian' and Telegraph' use ...

heart
or
blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A biological system is a comp ...
s. CVD includes
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
s (CAD) such as
angina Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in ...

angina
and
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
(commonly known as a heart attack). Other CVDs include
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
,
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
,
hypertensive heart disease Hypertensive heart disease includes a number of complications of high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Disease, medical condition in which the blood pressure in the artery, arter ...
,
rheumatic heart disease Valvular heart disease is any cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood ...
,
cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metaz ...
, abnormal heart rhythms,
congenital heart disease A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps b ...
,
valvular heart disease Valvular heart disease is any cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood ...
,
carditis Carditis (pl. carditides) is the inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritan ...
,
aortic aneurysm An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be abdominal, back, or leg pain. They are most commonly located ...

aortic aneurysm
s,
peripheral artery disease Peripheral artery disease (PAD) is an abnormal narrowing of artery, arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular ...
,
thromboembolic disease Venous thrombosis is thrombosis in a vein Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary vein, pulmonary and umbilical veins, both ...

thromboembolic disease
, and
venous thrombosis Venous thrombosis is blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (Embolism, embolizes) and flows to th ...
. The underlying mechanisms vary depending on the disease. Coronary artery disease, stroke, and peripheral artery disease involve
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
. This may be caused by
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...

high blood pressure
,
smoking Smoking is a practice in which a substance is burned and the resulting smoke Smoke is a collection of airborne and es emitted when a material undergoes or , together with the quantity of air that is or otherwise mixed into the ma ...

smoking
,
diabetes mellitus Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
, lack of
exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value ...
,
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. ...

obesity
, high blood cholesterol, poor diet, and excessive
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
consumption, among others. High blood pressure is estimated to account for approximately 13% of CVD deaths, while tobacco accounts for 9%, diabetes 6%, lack of exercise 6% and obesity 5%. Rheumatic heart disease may follow untreated
strep throat Streptococcal pharyngitis, also known as strep throat, is an infection of the back of the throat including the tonsils The tonsils are a set of lymphoid organs facing into the aerodigestive tract, which is known as Waldeyer's tonsillar ring ...

strep throat
. It is estimated that up to 90% of CVD may be preventable. Prevention of CVD involves improving risk factors through:
healthy eating A healthy diet is a diet Diet may refer to: Food * Diet (nutrition) In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for #Health, health or #Wei ...

healthy eating
, exercise, avoidance of tobacco smoke and limiting alcohol intake. Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial. Treating people who have strep throat with
antibiotic An antibiotic is a type of antimicrobial An antimicrobial is an agent that kills microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism In biology, an organism () is any organic, life, living system t ...
s can decrease the risk of rheumatic heart disease. The use of
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication used to reduce pain, fever, or inflammation. Specific inflammatory conditions which aspirin is used to treat include Kawasaki disease, pericarditis, and rheumatic fever. Aspirin ...

aspirin
in people, who are otherwise healthy, is of unclear benefit. Cardiovascular diseases are the
leading cause of death The following is a list of the causes of human deaths worldwide for different years arranged by their associated mortality rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a p ...
worldwide except Africa. Together CVD resulted in 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990. Deaths, at a given age, from CVD are more common and have been increasing in much of the
developing world A developing country is a sovereign state A sovereign state is a political entity A polity is an identifiable political entity—any group of people who have a collective identity, who are organized by some form of Institutionalisation, ...
, while rates have declined in most of the
developed world A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastructu ...
since the 1970s. Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD deaths in females. Most cardiovascular disease affects older adults. In the United States 11% of people between 20 and 40 have CVD, while 37% between 40 and 60, 71% of people between 60 and 80, and 85% of people over 80 have CVD. The average age of death from coronary artery disease in the developed world is around 80 while it is around 68 in the developing world. Diagnosis of disease typically occurs seven to ten years earlier in men as compared to women.


Types

There are many cardiovascular diseases involving the blood vessels. They are known as
vascular disease Vascular disease is a class of diseases of the blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues ...
s. *
Coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
(also known as coronary heart disease and ischemic heart disease) *
Peripheral arterial disease A peripheral or peripheral device is an auxiliary device used to put information into and get information out of a computer A computer is a machine that can be programmed to carry out sequences of arithmetic or logical operations automatica ...
– disease of blood vessels that supply blood to the arms and legs *
Cerebrovascular disease Cerebrovascular disease includes a variety of Medicine, medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often Angiopathy, damaged or deformed in ...
– disease of blood vessels that supply blood to the brain (includes
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
) *
Renal artery stenosis Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. T ...
*
Aortic aneurysm An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be abdominal, back, or leg pain. They are most commonly located ...

Aortic aneurysm
There are also many cardiovascular diseases that involve the heart. *
Cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metaz ...
– diseases of cardiac muscle *
Hypertensive heart disease Hypertensive heart disease includes a number of complications of high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Disease, medical condition in which the blood pressure in the artery, arter ...
– diseases of the heart secondary to high
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
or
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...

hypertension
*
Heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
- a clinical syndrome caused by the inability of the heart to supply sufficient blood to the tissues to meet their metabolic requirements *
Pulmonary heart disease Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chro ...
– a failure at the right side of the heart with respiratory system involvement *
Cardiac dysrhythmias Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate that is too fast – above 100 beats per minute in adults – is called tach ...
– abnormalities of heart rhythm * Inflammatory heart disease **
Endocarditis Endocarditis is an inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a p ...

Endocarditis
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
of the inner layer of the heart, the
endocardium The endocardium is the innermost layer of tissue that lines the chambers of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pumped ...
. The structures most commonly involved are the
heart valve A heart valve is a one-way valve check valve Image:Check Valve.svg, 140px, Check valve symbol on piping and instrumentation diagrams. The arrow shows the flow direction. A check valve, non-return valve, reflux valve, retention valve, foot valv ...
s. ** Inflammatory
cardiomegaly Cardiomegaly (sometimes megacardia or megalocardia) is a medical condition in which the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The ...
**
Myocarditis Myocarditis, also known as inflammatory cardiomyopathy, is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is ...
– inflammation of the
myocardium Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular A multicellular organism is an organism ...

myocardium
, the muscular part of the heart, caused most often by viral infection and less often by bacterial infections, certain medications, toxins, and autoimmune disorders. It is characterized in part by infiltration of the heart by
lymphocyte A lymphocyte is a type of white blood cell in the immune system The immune system is a network of biological processes that protects an organism In biology, an organism (from Ancient Greek, Greek: ὀργανισμός, ''organismos'' ...

lymphocyte
and
monocyte Monocytes are a type of ''leukocyte'', or white blood cell White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system The immune system is a network of biological processes that protects an organi ...

monocyte
types of
white blood cells White blood cells, also called leukocytes or leucocytes, are the cell (biology), cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and de ...
. **
Eosinophilic myocarditis Eosinophilic myocarditis is inflammation in the heart muscle that is caused by the infiltration and destructive activity of a type of white blood cell, the eosinophil. Typically, the disorder is associated with hypereosinophilia, i.e. an eosino ...
- inflammation of the myocardium caused by pathologically activated
eosinophilic Eosinophilic (Greek suffix -phil- A philia is the love or Fixation (psychology), obsession with a particular thing or subject. The suffix -philia is used to specify the love or obsession with something more specific. It is antonymic to -phobia. ...
white blood cells. This disorder differs from myocarditis in its causes and treatments. *
Valvular heart disease Valvular heart disease is any cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood ...
*
Congenital heart disease A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps b ...
– heart structure malformations existing at birth *
Rheumatic heart disease Valvular heart disease is any cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood ...
– heart muscles and valves damage due to
rheumatic fever Rheumatic fever (RF) is an inflammatory disease that can involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pumped blood ca ...
caused by ''
Streptococcus pyogenes ''Streptococcus pyogenes'' is a species In biology, a species is the basic unit of biological classification, classification and a taxonomic rank of an organism, as well as a unit of biodiversity. A species is often defined as the largest gr ...

Streptococcus pyogenes
'' a group A streptococcal infection.


Risk factors

There are many risk factors for heart diseases: age, sex, tobacco use, physical inactivity, excessive
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
consumption, unhealthy diet, obesity, genetic predisposition and family history of cardiovascular disease, raised blood pressure (
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...

hypertension
), raised blood sugar (
diabetes mellitus Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
), raised blood cholesterol (
hyperlipidemia Hyperlipidemia is abnormally elevated levels of any or all lipids (fats, cholesterol, or triglycerides) or lipoproteins in the blood. citing: and The term ''hyperlipidemia'' refers to the laboratory finding itself and is also used as an umbre ...
), undiagnosed
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
, psychosocial factors, poverty and low educational status, and
air pollution Air pollution is the presence of substances in the atmosphere that are harmful to the health of humans and other Outline of life forms, living beings, or cause damage to the climate or to materials. There are different types of air pollutants, ...

air pollution
. While the individual contribution of each risk factor varies between different communities or ethnic groups the overall contribution of these risk factors is very consistent. Some of these risk factors, such as age, sex or family history/genetic predisposition, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, social change, drug treatment (for example prevention of hypertension, hyperlipidemia, and diabetes). People with obesity are at increased risk of
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
of the
coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation Coronary circulation is the circulation of blood in the blood vessels that supply the cardiac muscle, heart muscle (myocardium). Coronary arteries supply oxygen saturat ...

coronary arteries
.


Genetics

Genetic factors influence the development of cardiovascular disease in men who are less than 55 years old and in women who are less than 65 years old. Cardiovascular disease in a person's parents increases their risk by 3 fold. Multiple
single nucleotide polymorphisms In genetics, a single-nucleotide polymorphism (SNP ; plural ) is a substitution of a single nucleotide at a specific position in the genome that is present in a sufficiently large fraction of the population (e.g. 1% or more). For example, at a s ...
(SNP) have been found to be associated with cardiovascular disease in genetic association studies, but usually, their individual influence is small, and genetic contributions to cardiovascular disease are poorly understood.


Age

Age is the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life. Coronary fatty streaks can begin to form in adolescence. It is estimated that 82 percent of people who die of coronary heart disease are 65 and older. Simultaneously, the risk of stroke doubles every decade after age 55. Multiple explanations are proposed to explain why age increases the risk of cardiovascular/heart diseases. One of them relates 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. Once past
menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 48 and 52. Medical professionals often ...
, it has been argued that a woman's risk is similar to a man's although more recent data from the WHO and UN disputes this. If a female has diabetes, she is more likely to develop heart disease than a male with diabetes. Coronary heart diseases are 2 to 5 times more common among middle-aged men than women. In a study done by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
, sex contributes to approximately 40% of the variation in sex ratios of coronary heart disease mortality. Another study reports similar results finding that sex differences explains nearly half the risk associated with cardiovascular diseases One of the proposed explanations for sex differences in cardiovascular diseases is hormonal difference. Among women, estrogen is the predominant sex hormone.
Estrogen Estrogens or oestrogens, are a class of natural or synthetic s responsible for the development and regulation of the female and s. There are three major estrogens that have estrogenic hormonal activity: (E1), (E2), and (E3). Estradiol, an ...

Estrogen
may have protective effects on glucose metabolism and hemostatic system, and may have direct effect in improving
endothelial Endothelium is a single layer of squamous Epithelium () is one of the four basic types of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biology), biological kingdom Animalia. With ...
cell function. The production of estrogen decreases after menopause, and this may change the female lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level while increasing LDL and total cholesterol levels. 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 among women than men. This may be caused by the women's smaller body size and arterial dimensions which are independent of menopause.


Tobacco

Cigarettes are the major form of smoked tobacco. Risks to health from tobacco use result not only from direct consumption of tobacco, but also from exposure to second-hand smoke. Approximately 10% of cardiovascular disease is attributed to smoking; however, people who quit smoking by age 30 have almost as low a risk of death as never smokers.


Physical inactivity

Insufficient physical activity (defined as less than 5 x 30 minutes of moderate activity per week, or less than 3 x 20 minutes of vigorous activity per week) is currently the fourth leading risk factor for mortality worldwide. In 2008, 31.3% of adults aged 15 or older (28.2% men and 34.4% women) were insufficiently physically active. The risk of ischemic heart disease and diabetes mellitus is reduced by almost a third in adults who participate in 150 minutes of moderate physical activity each week (or equivalent). In addition, physical activity assists weight loss and improves blood glucose control, blood pressure, lipid profile and insulin sensitivity. These effects may, at least in part, explain its cardiovascular benefits.


Diet

High dietary intakes of saturated fat, trans-fats and salt, and low intake of fruits, vegetables and fish are linked to cardiovascular risk, although whether all these associations indicate causes is disputed. The World Health Organization attributes approximately 1.7 million deaths worldwide to low fruit and vegetable consumption. Frequent consumption of high-energy foods, such as processed foods that are high in fats and sugars, promotes obesity and may increase cardiovascular risk. The amount of dietary salt consumed may also be an important determinant of blood pressure levels and overall cardiovascular risk. There is moderate quality evidence that reducing saturated fat intake for at least two years reduces the risk of cardiovascular disease. High trans-fat intake has adverse effects on blood lipids and circulating inflammatory markers, and elimination of trans-fat from diets has been widely advocated. In 2018 the World Health Organization estimated that trans fats were the cause of more than half a million deaths per year. There is evidence that higher consumption of sugar is associated with higher blood pressure and unfavorable blood lipids, and sugar intake also increases the risk of diabetes mellitus. High consumption of processed meats is associated with an increased risk of cardiovascular disease, possibly in part due to increased dietary salt intake.


Alcohol

The relationship between alcohol consumption and cardiovascular disease is complex, and may depend on the amount of alcohol consumed. There is a direct relationship between high levels of drinking alcohol and cardiovascular disease. Drinking at low levels without episodes of heavy drinking may be associated with a reduced risk of cardiovascular disease, but there is evidence that associations between moderate alcohol consumption and protection from stroke are non-causal. At the population level, the health risks of drinking alcohol exceed any potential benefits.


Celiac disease

Untreated
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
can cause the development of many types of cardiovascular diseases, most of which improve or resolve with a
gluten-free diet A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten, which is a mixture of proteins found in wheat (and all of its species and hybrids, such as spelt, Khorasan wheat, kamut, and triticale), as well as barley, rye, and oa ...
and intestinal healing. However, delays in recognition and diagnosis of celiac disease can cause irreversible heart damage.


Sleep

Sleep disorders such as sleep disordered breathing and
insomnia Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping Sleep is a naturally recurring state of mind and body, characterized by altered consciousness , an English Paracelsian physician Conscious ...

insomnia
, as well as particularly short duration of sleep or particularly long duration of sleep, have been found to be associated with a higher cardiometabolic risk.


Socioeconomic disadvantage

Cardiovascular disease affects low- and middle-income countries even more than high-income countries. There is relatively little information regarding social patterns of cardiovascular disease within low- and middle-income countries, but within high-income countries low income and low educational status are consistently associated with greater risk of cardiovascular disease. Policies that have resulted in increased socio-economic inequalities have been associated with greater subsequent socio-economic differences in cardiovascular disease implying a cause and effect relationship. Psychosocial factors, environmental exposures, health behaviours, and health-care access and quality contribute to socio-economic differentials in cardiovascular disease. The Commission on Social Determinants of Health recommended that more equal distributions of power, wealth, education, housing, environmental factors, nutrition, and health care were needed to address inequalities in cardiovascular disease and non-communicable diseases.


Air pollution

Particulate matter upright=1.7, Movie map of distribution of aerosol particles, based on data from the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite: * Green areas show aerosol plumes dominated by larger particles. * Red area ...
has been studied for its short- and long-term exposure effects on cardiovascular disease. Currently, airborne particles under 2.5 micrometers in diameter (PM2.5) are the major focus, in which gradients are used to determine CVD risk. Overall, long-term PM exposure increased rate of atherosclerosis and inflammation. In regards to short-term exposure (2 hours), every 25 μg/m3 of PM2.5 resulted in a 48% increase of CVD mortality risk. In addition, after only 5 days of exposure, a rise in systolic (2.8 mmHg) and diastolic (2.7 mmHg) blood pressure occurred for every 10.5 μg/m3 of PM2.5. Other research has implicated PM2.5 in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure. PM2.5 is also linked to
carotid arteryCarotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of t ...
thickening and increased risk of acute myocardial infarction.


Cardiovascular risk assessment

Existing cardiovascular disease or a previous cardiovascular event, such as a heart attack or stroke, is the strongest predictor of a future cardiovascular event. Age, sex, smoking, blood pressure, blood lipids and diabetes are important predictors of future cardiovascular disease in people who are not known to have cardiovascular disease. These measures, and sometimes others, may be combined into composite risk scores to estimate an individual's future risk of cardiovascular disease. Numerous risk scores exist although their respective merits are debated. Other diagnostic tests and biomarkers remain under evaluation but currently these lack clear-cut evidence to support their routine use. They include family history, coronary artery
calcification Calcification is the accumulation of calcium Calcium is a chemical element with the Symbol (chemistry), symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when expose ...
score,
high sensitivity C-reactive protein C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin-6 s ...
(hs-CRP), ankle–brachial pressure index, lipoprotein subclasses and particle concentration, lipoprotein(a), apolipoproteins A-I and B,
fibrinogen Fibrinogen (factor I) is a glycoprotein protein complex, complex, made in the liver, that circulates in the blood of all vertebrates. During tissue and vascular injury, it is converted Enzyme, enzymatically by thrombin to fibrin and then to a fi ...
, white blood cell count,
homocysteine Homocysteine is a non-proteinogenic α-amino acid Amino acids are organic compound , CH4; is among the simplest organic compounds. In chemistry, organic compounds are generally any chemical compounds that contain carbon-hydrogen chemical ...
, N-terminal pro B-type natriuretic peptide (NT-proBNP), and markers of kidney function. High blood phosphorus is also linked to an increased risk.


Depression and traumatic stress

There is evidence that mental health problems, in particular depression and traumatic stress, is linked to cardiovascular diseases. Whereas mental health problems are known to be associated with risk factors for cardiovascular diseases such as smoking, poor diet, and a sedentary lifestyle, these factors alone do not explain the increased risk of cardiovascular diseases seen in depression, stress, and anxiety. Moreover,
posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi ...
is independently associated with increased risk for incident coronary heart disease, even after adjusting for depression and other covariates.


Occupational exposure

Little is known about the relationship between work and cardiovascular disease, but links have been established between certain toxins, extreme heat and cold, exposure to tobacco smoke, and mental health concerns such as stress and depression.


Non-chemical risk factors

A 2015 SBU-report looking at non-chemical factors found an association for those: * with mentally stressful work with a lack of control over their working situation — with an effort-reward imbalance * who experience low social support at work; who experience injustice or experience insufficient opportunities for personal development; or those who experience job insecurity * those who work night schedules; or have long working weeks * those who are exposed to noise Specifically the risk of
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
was also increased by exposure to ionizing radiation. Hypertension develops more often in those who experience job strain and who have shift-work. Differences between women and men in risk are small, however men risk suffering and dying of
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...
s or stroke twice as often as women during working life.


Chemical risk factors

A 2017 SBU report found evidence that workplace exposure to silica dust, engine exhaust or
welding fumes Welding is a fabrication Fabrication may refer to: * Manufacturing, specifically the crafting of individual parts as a solo product or as part of a larger combined product. Processes in arts, crafts and manufacturing *Semiconductor device fab ...
is associated with heart disease. Associations also exist for exposure to
arsenic Arsenic is a chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In chemistry, an element is a pure substance consisting only of atoms that all have the same num ...

arsenic
, ,
lead Lead is a chemical element In chemistry, an element is a pure Chemical substance, substance consisting only of atoms that all have the same numbers of protons in their atomic nucleus, nuclei. Unlike chemical compounds, chemical elements ...

lead
,
dynamite Dynamite is an explosive made of nitroglycerin, sorbents (such as powdered shells or clay) and Stabilizer (chemistry), stabilizers. It was invented by the Swedish people, Swedish chemist and engineer Alfred Nobel in Geesthacht, Northern Germany ...

dynamite
,
carbon disulphide Carbon disulfide, also spelled as carbon disulphide, is a colorless volatility (chemistry), volatile liquid with the chemical formula, formula CS2. The Chemical compound, compound is used frequently as a building block in organic chemistry as well ...
,
carbon monoxide Carbon monoxide (chemical formula CO) is a colorless, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom. It is the simplest molecule of the oxocarbon family. In ...

carbon monoxide
, metalworking fluids and occupational exposure to
tobacco smoke Tobacco smoke is a soot, sooty aerosol produced by the incomplete combustion of tobacco during the tobacco smoking, smoking of cigarettes and other tobacco products. Temperatures in burning cigarettes range from about 400 °C between puffs to a ...
. Working with the
electrolytic An electrolyte is a substance that produces an conductivity (electrolytic), electrically conducting solution when dissolved in a polar solvent, such as water. The dissolved electrolyte separates into cations and anions, which disperse uniformly thr ...
production of aluminium or the production of paper when the sulphate pulping process is used is associated with heart disease. An association was also found between heart disease and exposure to compounds which are no longer permitted in certain work environments, such as phenoxy acids containing TCDD(dioxin) or
asbestos Asbestos (pronounced: or ) is a naturally occurring fibrous silicate mineral Silicate minerals are rock-forming mineral In geology and mineralogy, a mineral or mineral species is, broadly speaking, a solid chemical compound with a fair ...
. Workplace exposure to silica dust or asbestos is also associated with
pulmonary heart disease Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chro ...
. There is evidence that workplace exposure to lead, carbon disulphide, phenoxyacids containing TCDD, as well as working in an environment where aluminum is being electrolytically produced, is associated with
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
.


Somatic mutations

As of 2017, evidence suggests that certain
leukemia Leukemia ( also spelled leukaemia and pronounced ), is a group of blood cancer Tumors of the hematopoietic and lymphoid tissues (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English ...

leukemia
-associated
mutation In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, physiological mechan ...
s in
blood cell A blood cell, also called a hematopoietic cell, hemocyte, or hematocyte, is a cell Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Closed spaces * Monastic cell, a small room, hut, or ...

blood cell
s may also lead to increased risk of cardiovascular disease. Several large-scale research projects looking at human genetic data have found a robust link between the presence of these mutations, a condition known as clonal hematopoiesis, and cardiovascular disease-related incidents and mortality.


Radiation Therapy (RT)

Radiation treatments for cancer can increase the risk of heart disease and death as observed in previous breast RT regimens. Therapeutic radiation increases the risk of a subsequent cardiovascular event (i.e., heart attack or stroke) by 1.5 to 4 times the normal rate. The increase is dose dependent, related to the RT's dose strength, volume and location. Cardiovascular late side-effects have been termed radiation-induced heart disease (RIHD) and radiation-induced vascular disease (RIVD). Symptoms are dose dependent and include
cardiomyopathy Cardiomyopathy is a group of diseases that affect the heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metaz ...
, myocardial fibrosis,
valvular heart disease Valvular heart disease is any cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood ...
,
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
,
heart arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rateHeart rate is the speed of the heartbeat measured by the number of contraction ...
and
peripheral artery disease Peripheral artery disease (PAD) is an abnormal narrowing of artery, arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular ...
. Radiation-induced fibrosis, vascular
cell damage Cell damage (also known as cell injury) is a variety of changes of stress that a cell suffers due to external as well as internal environmental changes. Amongst other causes, this can be due to physical, chemical, infectious, biological, nutritiona ...
and
oxidative stress Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species Reactive oxygen species (ROS) are highly chemicals formed from O2. Examples of ROS include s, , , , and . The reduction of molecular oxygen ...
can lead to these and other late side-effect symptoms.


Pathophysiology

Population-based studies show that atherosclerosis, the major precursor of cardiovascular disease, begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) 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 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 Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
are often linked to cardiovascular disease, as are a history of chronic
kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of i ...
and
hypercholesterolaemia Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol Cholesterol is any of a class of certain organic compound, organic molecules. A cholesterol is a sterol (or chemical modification, modified ster ...
. 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.


Screening

Screening
ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is an electrogram of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood ...

ECG
s (either at rest or with exercise) are not recommended in those without symptoms who are at low risk. This includes those who are young without risk factors. In those at higher risk the evidence for screening with ECGs is inconclusive. Additionally
echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
,
myocardial perfusion imaging Myocardial perfusion imaging or scanning (also referred to as MPI or MPS) is a nuclear medicine procedure that illustrates the function of the heart muscle (myocardium Cardiac muscle (also called heart muscle or myocardium) is one of three types ...
, and
cardiac stress test A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures the heart The heart is a cardiac muscle, muscular Organ (biology), organ in ...
ing is not recommended in those at low risk who do not have symptoms. Some
biomarkers A biomarker, or biological marker is a measurable indicator Indicator may refer to: Biology * Indicator (genus), ''Indicator'' (genus), a genus of birds in the honeyguide family * Environmental indicator of environmental health (pressures, cond ...
may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the value of some biomarkers is questionable. Ankle-brachial index (ABI),
high-sensitivity C-reactive protein C-reactive protein (CRP) is an annular (ring-shaped) pentameric proteinA pentameric protein is a quaternary protein structure that consists of five protein protein subunit, subunits. Examples Ligand-gated ion channels Five sub-units come togeth ...
(hsCRP), and
coronary artery calcium A coronary CT calcium scan is a computed tomography (CT) scan of the heart for the assessment of severity of coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simp ...
, are also of unclear benefit in those without symptoms as of 2018. The NIH recommends lipid testing in children beginning at the age of 2 if there is a family history of heart disease or lipid problems. It is hoped that early testing will improve lifestyle factors in those at risk such as diet and exercise. Screening and selection for primary prevention interventions has traditionally been done through absolute risk using a variety of scores (ex. Framingham or Reynolds risk scores). This stratification has separated people who receive the lifestyle interventions (generally lower and intermediate risk) from the medication (higher risk). The number and variety of risk scores available for use has multiplied, but their efficacy according to a 2016 review was unclear due to lack of external validation or impact analysis. Risk stratification models often lack sensitivity for population groups and do not account for the large number of negative events among the intermediate and low risk groups. As a result, future preventative screening appears to shift toward applying prevention according to randomized trial results of each intervention rather than large-scale risk assessment.


Prevention

Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Currently practiced measures to prevent cardiovascular disease include: * Reduction in consumption of
saturated fat A saturated fat is a type of fat In nutrition Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and ...
: there is moderate quality evidence that reducing the proportion of saturated fat in the diet, and replacing it with unsaturated fats or carbohydrates over a period of at least two years, leads to a reduction in the risk of cardiovascular disease. * Stopping smoking and avoidance of second-hand smoke. Stopping smoking reduces risk by about 35%. * Maintain a
healthy diet A healthy diet is a diet Diet may refer to: Food * Diet (nutrition) In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for #Health, health or #We ...
, such as the
Mediterranean diet The Mediterranean diet is a diet inspired by the eating habits of people who live near the Mediterranean Sea The Mediterranean Sea is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean Basin and almost completely enclosed ...
. Dietary interventions are effective in reducing cardiovascular risk factors over a year, but the longer term effects of such interventions and their impact on cardiovascular disease events is uncertain. * At least 150 minutes (2 hours and 30 minutes) of moderate exercise per week. *Limit alcohol consumption to the recommended daily limits; People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease. However, people who are genetically predisposed to consume less alcohol have lower rates of cardiovascular disease suggesting that alcohol itself may not be protective. Excessive alcohol intake increases the risk of cardiovascular disease and consumption of alcohol is associated with increased risk of a cardiovascular event in the day following consumption. * Lower blood pressure, if elevated. A 10 mmHg reduction in blood pressure reduces risk by about 20%. * Decrease non-
HDL cholesterol High-density lipoprotein (HDL) is one of the five major groups of lipoproteins. Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules ( lipids) around the body within the water outside cells. They are ...
.
Statin Statins, also known as HMG-CoA reductase inhibitors, are a of s that reduce and mortality in those who are at high risk of . They are the most common cholesterol-lowering drugs. (LDL) carriers of play a key role in the development of and ...

Statin
treatment reduces cardiovascular mortality by about 31%. * Decrease body fat if overweight or obese. The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited. In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk. * Decrease psychosocial stress. This measure may be complicated by imprecise definitions of what constitute psychosocial interventions. Mental stress–induced
myocardial ischemia Coronary artery disease (CAD), also called coronary heart disease (CHD), Ischemia, ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the myocardium, heart muscle due to build-up of plaque (atherosclero ...
is associated with an increased risk of heart problems in those with previous heart disease. Severe emotional and physical stress leads to a form of heart dysfunction known as Takotsubo syndrome in some people. Stress, however, plays a relatively minor role in hypertension. Specific relaxation therapies are of unclear benefit. * There have been studies that show that garlic and soy may help with lowering cholesterol, However, the effects of holistic dietary supplements are relatively insignificant when compared to medicines prescribed for lowering cholesterol. * Stress relieving techniques such as practices like yoga, meditation, and tai chi have been shown to provide some positive effects on managing blood pressure. *Ethylene diamine tetra-acetic acid is a new therapy that has shown some promising evidence for reducing the risks of coronary disease in people with diabetes However, the therapy is still being studied and because there has only been a single clinical trial the results are not sufficient enough for clinical use at this time. * Not enough sleep also raises the risk of high blood pressure. Adults need about 7-9 hours of sleep. Sleep apnea is also a major risk as it causes one to stop breathing which can put stress on your body which can raise your risk of heart disease. Most guidelines recommend combining preventive strategies. A 2015 Cochrane Review found some evidence that interventions aiming to reduce more than one cardiovascular risk factor may have beneficial effects on blood pressure, body mass index and waist circumference; however, evidence was limited and the authors were unable to draw firm conclusions on the effects on cardiovascular events and mortality. For adults without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease, routine counseling to advise them to improve their diet and increase their physical activity has not been found to significantly alter behavior, and thus is not recommended. Another Cochrane review suggested that simply providing people with a cardiovascular disease risk score may reduce cardiovascular disease risk factors by a small amount compared to usual care. However, there was some uncertainty as to whether providing these scores had any effect on cardiovascular disease events. It is unclear whether or not dental care in those with
periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the Periodontium, tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. It is considered the ...
affects their risk of cardiovascular disease.


Diet

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and
death Death is the permanent, irreversible cessation of all biological functions that sustain a living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorganic objects and dead organi ...

death
. Evidence suggests that the
Mediterranean diet The Mediterranean diet is a diet inspired by the eating habits of people who live near the Mediterranean Sea The Mediterranean Sea is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean Basin and almost completely enclosed ...
may improve cardiovascular outcomes. There is also evidence that a Mediterranean diet may be more effective than a
low-fat dietImage:F pyramid.JPG, 250px, USDA's original Food pyramid (nutrition), Food Pyramid A low-fat diet is one that restricts fat, and often saturated fat and cholesterol as well. Low-fat diets are intended to reduce the occurrence of conditions such as ...
in bringing about long-term changes to cardiovascular risk factors (e.g., lower cholesterol level and
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
). The DASH diet (high in nuts, fish, fruits and vegetables, and low in sweets, red meat and fat) has been shown to reduce blood pressure, lower total and low density lipoprotein cholesterol and improve
metabolic syndrome Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, hypertension, high blood pressure, hyperglycemia, high blood sugar, Hypertriglyceridemia, high serum triglycerides, and ''low'' seru ...
; but the long-term benefits have been questioned. A
high fiber diet Dietary fiber (British spelling fibre) or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical composition, and can be grouped generally by their ...
is associated with lower risks of cardiovascular disease. Worldwide, dietary guidelines recommend a reduction in
saturated fat A saturated fat is a type of fat In nutrition Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and ...
, and although the role of dietary fat in cardiovascular disease is complex and controversial there is a long-standing consensus that replacing saturated fat with unsaturated fat in the diet is sound medical advice. Total fat intake has not been found to be associated with cardiovascular risk. A 2020 systematic review found moderate quality evidence that reducing saturated fat intake for at least 2 years caused a reduction in cardiovascular events. A 2015 meta-analysis of observational studies however did not find a convincing association between saturated fat intake and cardiovascular disease. Variation in what is used as a substitute for saturated fat may explain some differences in findings. The benefit from replacement with
polyunsaturated fat In nutrition Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided ...
s appears greatest, while replacement of saturated fats with
carbohydrates is a disaccharide A disaccharide (also called a double sugar or ''biose'') is the sugar Sugar is the generic name for sweet-tasting, soluble carbohydrate is a disaccharide found in animal milk. It consists of a molecule of D-galacto ...
does not appear to have a beneficial effect. A diet high in trans fatty acids is associated with higher rates of cardiovascular disease, and in 2015 the Food and Drug Administration (FDA) determined that there was 'no longer a consensus among qualified experts that partially hydrogenated oils (PHOs), which are the primary dietary source of industrially produced trans fatty acids (IP-TFA), are generally recognized as safe (GRAS) for any use in human food'. There is conflicting evidence concerning dietary supplements of
omega-3 fatty acid Omega−3 fatty acids, also called Omega-3 oils, ω−3 fatty acids or ''n''−3 fatty acids, are polyunsaturated fatty acid Polyunsaturated fatty acids (PUFAs) are fatty acids that contain more than one double bond in their backbone. This ...
s (a type of polysaturated fat in oily fish) added to diet improve cardiovascular risk. A 2014
Cochrane review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based Evidence-based practice (EBP) is the idea that occupation ...
found unclear benefit of recommending a low-salt diet in people with high or normal blood pressure. In those with heart failure, after one study was left out, the rest of the trials show a trend to benefit. Another review of dietary salt concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; both as a result of the increased blood pressure ''and'', quite likely, through other mechanisms. Moderate evidence was found that high salt intake increases cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes, and
left ventricular hypertrophy Left ventricular hypertrophy (LVH) is of the of the left of the , that is, left-sided . Causes While ventricular hypertrophy as a reaction to and , it is most frequently referred to as a pathological reaction to , or . It is one aspect of . ...
.


Medication

Blood pressure medication reduces cardiovascular disease in people at risk, irrespective of age, the baseline level of cardiovascular risk, or baseline blood pressure. The commonly-used drug regimens have similar efficacy in reducing the risk of all major cardiovascular events, although there may be differences between drugs in their ability to prevent specific outcomes. Larger reductions in blood pressure produce larger reductions in risk, and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure. Adherence to medications is often poor and while mobile phone text messaging has been tried to improve adherence, there is insufficient evidence that it alters secondary prevention of cardiovascular disease.
Statins Statins, also known as HMG-CoA reductase inhibitors, are a class Class or The Class may refer to: Common uses not otherwise categorized * Class (biology), a taxonomic rank * Class (knowledge representation), a collection of individuals or o ...
are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease. As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women. In those at risk, but without a history of cardiovascular disease (primary prevention), statins decrease the risk of death and combined fatal and non-fatal cardiovascular disease. The benefit, however, is small. A United States guideline recommends statins in those who have a 12% or greater risk of cardiovascular disease over the next ten years.
Niacin Niacin, also known as nicotinic acid, is an organic compound and a form of vitamin B3, vitamin B3, an essential nutrient, essential human nutrient. It can be manufactured by plants and animals from the amino acid tryptophan. Niacin is obtaine ...

Niacin
,
fibrates In pharmacology, the fibrates are a class of amphipathic carboxylic acid A carboxylic acid is an organic acid that contains a carboxyl group (C(=O)OH) attached to an R-group. The general formula of a carboxylic acid is R−COOH or R−CO2H ...

fibrates
and
CETP Inhibitors A CETP inhibitor is a member of a class of drugs that inhibit cholesterylester transfer protein Cholesteryl ester transfer protein (CETP), also called plasma lipid transfer protein, is a plasma protein Proteins are large biomolecules or macro ...
, while they may increase
HDL cholesterol High-density lipoprotein (HDL) is one of the five major groups of lipoproteins. Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules ( lipids) around the body within the water outside cells. They are ...
do not affect the risk of cardiovascular disease in those who are already on statins. Fibrates lower the risk of cardiovascular and coronary events, but there is no evidence to suggest that they reduce all-cause mortality.
Anti-diabetic medication Drugs used in diabetes treat diabetes mellitus by altering the blood sugar level, glucose level in the blood. With the exceptions of Insulin (medication), insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus als ...
may reduce cardiovascular risk in people with Type 2 Diabetes, although evidence is not conclusive. A meta-analysis in 2009 including 27,049 participants and 2,370 major vascular events showed a 15%
relative risk reduction In epidemiology, the relative risk reduction (RRR) or efficacy is the relative decrease in the risk of an adverse event in the exposed group compared to an unexposed group. It is computed as (I_u - I_e) / I_u, where I_eis the incidence in the expo ...
in cardiovascular disease with more-intensive glucose lowering over an average follow-up period of 4.4 years, but an increased risk of major
hypoglycemia Hypoglycemia, also known as low blood sugar, is a fall in blood sugar The blood sugar level, blood sugar concentration, or blood glucose level is the concentration of glucose Glucose is a simple with the . Glucose is the most abundant , a ...

hypoglycemia
.
Aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication used to reduce pain, fever, or inflammation. Specific inflammatory conditions which aspirin is used to treat include Kawasaki disease, pericarditis, and rheumatic fever. Aspirin ...

Aspirin
has been found to be of only modest benefit in those at low risk of heart disease as the risk of serious bleeding is almost equal to the benefit with respect to cardiovascular problems. In those at very low risk, including those over the age of 70, it is not recommended. The
United States Preventive Services Task Force The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the Evidence-based medicine, evidence of effectiveness and develops recommendations for clinica ...
recommends against use of aspirin for prevention in women less than 55 and men less than 45 years old; however, in those who are older it is recommends in some individuals. The use of
vasoactive A vasoactive substance is an endogenous agent or pharmaceutical drug that has the effect of either increasing or decreasing blood pressure and/or heart rate through its vasoactivity, that is, vascular activity (effect on blood vessel The b ...
agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense.


Physical activity

Exercise-based cardiac rehabilitation following a heart attack reduces the risk of death from cardiovascular disease and leads to less hospitalizations. There have been few high quality studies of the benefits of exercise training in people with increased cardiovascular risk but no history of cardiovascular disease. A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide. The authors estimated that 121,000 deaths from coronary heart disease could have been averted in Europe in 2008, if physical inactivity had been removed. A Cochrane review found some evidence that yoga has beneficial effects on blood pressure and cholesterol, but studies included in this review were of low quality. Tentative evidence suggests that home-based exercise programs may be more efficient at improving exercise adherence.


Dietary supplements

While a
healthy diet A healthy diet is a diet Diet may refer to: Food * Diet (nutrition) In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for #Health, health or #We ...
is beneficial, the effect of
antioxidant Antioxidants are that inhibit , a that can produce and s that may damage the of organisms. Antioxidants such as s or (vitamin C) may act to inhibit these reactions. To balance , plants and animals maintain complex systems of overlapping an ...

antioxidant
supplementation (
vitamin E Vitamin E is a group of eight fat solubleLipophilicity (from Greek language, Greek λίπος "fat" and :wikt:φίλος, φίλος "friendly"), refers to the ability of a chemical compound to dissolve in fats, oils, lipids, and non-polar solven ...

vitamin E
,
vitamin C Vitamin C (also known as ascorbic acid and ascorbate) is a vitamin found in various foods and sold as a dietary supplement. It is used to prevent and treat scurvy. Vitamin C is an Nutrient#Essential nutrients, essential nutrient involved in t ...

vitamin C
, etc.) or vitamins has not been shown to protect against cardiovascular disease and in some cases may possibly result in harm. Mineral supplements have also not been found to be useful.
Niacin Niacin, also known as nicotinic acid, is an organic compound and a form of vitamin B3, vitamin B3, an essential nutrient, essential human nutrient. It can be manufactured by plants and animals from the amino acid tryptophan. Niacin is obtaine ...

Niacin
, a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk.
Magnesium Magnesium is a chemical element upright=1.0, 500px, The chemical elements ordered by link=Periodic table In chemistry Chemistry is the science, scientific study of the properties and behavior of matter. It is a natural science ...

Magnesium
supplementation lowers high blood pressure in a dose dependent manner. Magnesium therapy is recommended for people with ventricular
arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the is irregular, too fast, or too slow. The that is too fast – above 100 beats per minute in adults – is called , and a heart rate that i ...
associated with
torsades de pointes ''Torsades de pointes, torsade de pointes'' or ''torsades des pointes'' (TdP) (, , translated as "twisting of peaks") is a specific type of abnormal heart rhythm that can lead to sudden cardiac death. It is a polymorphic ventricular tachycardia ...
who present with
long QT syndrome Long QT syndrome (LQTS) is a condition in which repolarization of the heart after a Cardiac cycle, heartbeat is affected. It results in an increased risk of an cardiac arrhythmia, irregular heartbeat which can result in Syncope (medicine), faintin ...
as well as for the treatment of people with digoxin intoxication-induced arrhythmias. There is no evidence to support
omega-3 fatty acid Omega−3 fatty acids, also called Omega-3 oils, ω−3 fatty acids or ''n''−3 fatty acids, are polyunsaturated fatty acid Polyunsaturated fatty acids (PUFAs) are fatty acids that contain more than one double bond in their backbone. This ...
supplementation.


Management

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.
Influenza Influenza, commonly known as "the flu", is an infectious disease An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction of host (biology), ...

Influenza
may make heart attacks and strokes more likely and therefore influenza vaccination may decrease the chance of cardiovascular events and death in people with heart disease. Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle-income levels. Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for quality-adjusted life-year (QALY) in regions of low and middle income. The costs for a single QALY for aspirin and atenolol were less than $25, streptokinase was about $680, and t-PA was $16,000. Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350. A 2020 Cochrane review did not find any additional benefit in terms of mortality and serious adverse events when blood pressure targets were lowered to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg.


Epidemiology

Cardiovascular diseases are the leading cause of death worldwide and in all regions except Africa. In 2008, 30% of all global death was attributed to cardiovascular diseases. Death caused by cardiovascular diseases are also higher in low- and middle-income countries as over 80% of all global deaths caused by cardiovascular diseases occurred in those countries. It is also estimated that by 2030, over 23 million people will die from cardiovascular diseases each year. It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue.


Research

There is evidence that cardiovascular disease existed in pre-history, and research into cardiovascular disease dates from at least the 18th century. The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis. Recent areas of research include the link between inflammation and atherosclerosis the potential for novel therapeutic interventions, and the genetics of coronary heart disease.


References


External links

*
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)


MedicineNet Slides, photos, descriptions
Risk calculator
{{DEFAULTSORT:Cardiovascular Disease Cardiovascular diseases Wikipedia medicine articles ready to translate RTTEM