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Cardiovascular disease

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**Risk Factors for Cardiovascular Disease:**
– Age, sex, tobacco use, physical inactivity, non-alcoholic fatty liver disease, excessive alcohol consumption
– Unhealthy diet, obesity, genetic predisposition, family history of cardiovascular disease
– Raised blood pressure (hypertension), blood sugar (diabetes mellitus), blood cholesterol (hyperlipidemia)
– Undiagnosed celiac disease, psychosocial factors, poverty, low educational status, air pollution
– Poor sleep; contribution of risk factors varies but can be modified through lifestyle changes

**Genetics and Cardiovascular Disease:**
– Parental history increases risk by ~3 fold
– Over 40 inherited cardiovascular diseases are linked to single gene variants
– Common cardiovascular diseases are polygenic with hundreds of genetic variants
– Genetic factors play a key role in the development of cardiovascular diseases

**Prevention and Lifestyle Changes:**
– Healthy eating, exercise, avoiding tobacco smoke, limiting alcohol intake
– Prevention involves managing risk factors like high blood pressure, diabetes, high blood lipids
– Lifestyle changes are crucial for prevention of cardiovascular disease
– Antibiotics for strep throat can reduce rheumatic heart disease risk
– Unclear benefit of aspirin for healthy individuals

**Types and Impact of Cardiovascular Diseases:**
– Vascular diseases: coronary artery disease, peripheral arterial disease, cerebrovascular disease, renal artery stenosis, aortic aneurysm
– Heart diseases: cardiomyopathy, hypertensive heart disease, heart failure, pulmonary heart disease, cardiac dysrhythmias
– Inflammatory heart diseases: endocarditis, myocarditis, eosinophilic myocarditis
– Valvular heart disease, congenital heart disease, rheumatic heart disease
– Global impact: CVD is the leading cause of death worldwide, except in Africa

**Behavioral and Environmental Factors:**
– Tobacco: Cigarettes are the major form of smoked tobacco
– Physical inactivity: Insufficient physical activity is the fourth leading risk factor for mortality worldwide
– Diet: High intake of saturated fat, trans-fats, and salt, and low intake of fruits, vegetables, and fish are linked to cardiovascular risk
– Alcohol: The relationship between alcohol consumption and cardiovascular disease is complex
– Air pollution: Particulate matter under 2.5 micrometers affects cardiovascular disease

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

Cardiovascular disease
Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.
SymptomsChest pain, shortness of breath, fatigue, loss of consciousness
ComplicationsHeart failure, heart attack, stroke, aneurysm, peripheral artery disease, sudden cardiac arrest.
Usual onsetOlder adults
TypesCoronary artery diseases, stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, Arrhythmia
Risk factorsDiabetes, high blood lipids, excess weight, Smoking, excessive drug use, and excessive alcohol intake
PreventionHealthy eating, exercise, avoiding tobacco smoke, limited alcohol intake, Overall lifestyle changes
TreatmentTreating high blood pressure, high blood lipids, diabetes
MedicationAspirin, beta blockers, blood thinners
Deaths17.9 million / 32% (2015)

The underlying mechanisms vary depending on the disease. It is estimated that dietary risk factors are associated with 53% of CVD deaths. Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis. This may be caused by high blood pressure, smoking, diabetes mellitus, lack of exercise, obesity, high blood cholesterol, poor diet, excessive alcohol consumption, and poor sleep, among other things. 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.

It is estimated that up to 90% of CVD may be preventable. Prevention of CVD involves improving risk factors through: 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 antibiotics can decrease the risk of rheumatic heart disease. The use of aspirin in people who are otherwise healthy is of unclear benefit.

Cardiovascular diseases are the leading cause of death 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, while rates have declined in most of the developed world 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. CVD is typically diagnosed seven to ten years earlier in men than in women.

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