Cardiovascular disease

Cardiovascular disease (CVD) encompasses a range of conditions affecting the heart and blood vessels. It includes coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, and carditis. Atherosclerosis, a common underlying mechanism, is often driven by risk factors such as high blood pressure, smoking, diabetes, obesity, poor diet, and excessive alcohol consumption.

Overview

The symptoms of CVD can vary depending on the specific condition but commonly include chest pain, shortness of breath, fatigue, and loss of consciousness. Complications can lead to heart failure, heart attack, stroke, aneurysm, peripheral artery disease, and sudden cardiac arrest.

Diagnosis

The diagnosis of CVD often involves a combination of medical history, physical examination, and diagnostic tests. These tests can include electrocardiograms (ECGs), echocardiography, cardiac stress testing, and blood tests for biomarkers such as high-sensitivity C-reactive protein (hs-CRP).

Risk Factors

Key risk factors for CVD include age, sex, tobacco use, physical inactivity, poor diet, obesity, high blood pressure, diabetes, high cholesterol, and genetic predisposition. Additional factors such as socioeconomic disadvantage, air pollution, poor sleep, and certain occupational exposures also contribute to increased risk.

Genetics and Age

Genetics play a significant role in CVD risk, with familial history increasing the risk by approximately three-fold. Age is the most very important risk factor, with the likelihood of developing CVD tripling with each decade of life.

Sex Differences

Men are generally at a higher risk of heart disease compared to pre-menopausal women. However, post-menopausal women with diabetes have a higher risk of developing heart disease compared to their male counterparts.

Prevention

Preventive measures for CVD are highly effective, with up to 90% of cases being preventable through lifestyle modifications. These include maintaining a healthy diet, regular physical activity, avoiding tobacco, and limiting alcohol intake. Managing high blood pressure, cholesterol, and diabetes is also very important.

Treatment

Treatment strategies for CVD focus on both lifestyle changes and medical interventions. Medications such as aspirin, beta blockers, and blood thinners are commonly used. For those with high blood pressure or cholesterol, specific drugs to manage these conditions are essential.

Surgical Interventions

In some cases, surgical procedures may be necessary, such as coronary artery bypass surgery, valve replacement, and pacemaker implantation for arrhythmias.

Epidemiology

Cardiovascular diseases are the leading cause of death worldwide, accounting for 17.9 million deaths in 2015. The prevalence is higher in low- and middle-income countries, contributing to over 80% of global CVD deaths.

Pathophysiology

Atherosclerosis, the major precursor of cardiovascular disease, begins in childhood and is influenced by factors such as obesity, diabetes mellitus, and chronic kidney disease.

Screening

Routine ECGs for low-risk individuals are not recommended. However, lipid testing in children with a family history of heart disease is advised. Risk stratification models such as the Framingham or Reynolds risk scores are commonly used to guide preventive interventions.

Research

Current research focuses on the link between inflammation and atherosclerosis, novel therapeutic interventions, and the genetics of coronary heart disease.

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Self-assessment MCQs (single best answer)

Which of the following is NOT a common condition encompassed by cardiovascular diseases (CVD)?

What is the primary underlying mechanism common in many cardiovascular diseases?

Which symptom is NOT commonly associated with cardiovascular disease?

What diagnostic test measures electrical activity of the heart?

Which of the following is the most very important risk factor for developing cardiovascular disease?

Which lifestyle modification is NOT recommended for preventing cardiovascular disease?

Which medication is NOT commonly used in the treatment of cardiovascular disease?

Which surgical procedure is used to improve blood flow to the heart?

Which global statistic is true about cardiovascular diseases?

Routine ECGs are recommended for: