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Cardiovascular Diseases
Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet. Globally, cardiovascular diseases are the number one cause of death and is projected to remain so. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million due to stroke.

About 80% of these deaths occurred in low- and middle-income countries. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).
Heart attacks and strokes are mainly caused by a blockage that prevents blood from flowing to the heart or the brain. The most common cause is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. The blood vessels become narrower and less flexible, also known as atherosclerosis (or hardening of the arteries). The blood vessels are then more likely to become blocked by blood clots. When this happens, the blocked vessels cannot supply blood to the heart and brain, which then become damaged.

Atherosclerosis in the coronary arteries causes angina, myocardial infarction, ischemic heart disease and sudden cardiac arrest. This is how it happens
Phase 1 is an asymptomatic phase consists of fatty streaks in people younger than 30. They have been observed in children as young as 3 yrs old. Fatty streaks are non obstructive, lipid filled cells (macrophages and smooth muscle cell) that form at bends in the artery in response to chronic injury to the arterial endothelium. Not all fatty streaks progress to lesions.

Phase 2 is characterized by plaque with a high lipid content that may be prone to rupture. The lipid is derived from plasma LDL that enters the injured endothelial wall. As these intermediate lesions are unstable

Phase 3 consists of acute, complicated lesions that rupture and cause nonocclusive thrombus.

Phase 4 is associated with angina, myocardial infarction and sudden death.

Phase 5, Any complicated lesion can progress to phase 5 which has fibrotic or occlusive lesions with similar clinical outcomes
A number of health-related behaviors practiced by people every day contribute markedly to cardiovascular disease. There are three main reasons for fatty build-up, all controllable:
Smoking and other tobacco use

Smokers have twice the risk of heart attack as nonsmokers. One-fifth of the annual 1,000,000 deaths from CVD are attributable to smoking. Surveillance data indicate that an estimated 1,000,000 young people become "regular" smokers each year.
Unhealthy diet

Between 20% and 30% of the nation’s adults (some 58 million people) are obese and thus have a higher risk for heart disease, high blood pressure, high cholesterol, and other chronic diseases and conditions such as diabetes. Only 27% of women and 19% of men report eating the recommended five servings of fruits and vegetables each day.
Physical Inactivity

People who are sedentary have twice the risk of heart disease as those who are physically active. Despite these risks, America remains a predominantly sedentary society. Surveys show that more than half of American adults do not practice the recommended level of physical activity, and more than one-fourth are completely sedentary.

All the above factors are removable by intervention and some other are not.
Category 1
Factors which on intervention  are proven to lower CVD risk
Category 2
Factors which on intervention  are likely lower CVD risk
Category 3
Factors if modified might lower CVD risk
Category 4
Non modifiable factors

  • Smoking
  • LDL – C
  • High fat/ cholesterol diet
  • Hypertension
  • Left ventricular hypertrophy
  • Thrombogenic factors

  • Diabetes Mellitus
  • Physical Inactivity
  • HDL – C
  • Triglycerides, Small dense LDL
  • Obesity
  • Post menopausal status

  • Psychological factors
  • Lipoprotein (A)
  • Homocysteine
  • Oxidative stress
  • Alcohol consumption

  • Age
  • Sex
  • Family history
 
 
 
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