Cardiovascular Disease

Cardiovascular diseases occur more frequently in people who smoke, who have high blood pressure, who have high blood cholesterol (especially high LDL-C), who are overweight, who do not exercise, and/or who have diabetes. Therefore, public health initiatives focus on decreasing CVD by encouraging people to:

• Follow a healthy diet
• Avoid smoking
• Exercise regularly
• If diabetic, maintain good control of blood glucose

In addition, there are some risk factors that cannot be controlled, including age, gender, and family history:

• CVD risk increases with age.
• Men are generally at higher risk of heart disease; however, women's risk increases to that of men's after menopause.
• Having a first-degree relative who had coronary heart disease or a stroke before age 55 for a male relative or before after 65 for a female relative increases the risk.

In November 2013, the American College of Cardiology and the American Heart Association released new guidelines for CVD risk assessment. The primary purposes of the recommendations were to better define what important factors are involved in determining CVD risk and to provide ways to reduce risk through treatment and lifestyle modifications. For example, included in one part of the recommendations is a new CV risk calculator, a downloadable companion tool that helps to predict 10-year and lifetime CVD risk levels. It is intended for people without heart disease between the ages of 40 and 79. Many factors are considered in the calculation, including age, gender, race, total cholesterol, high-density lipoprotein cholesterol (HDL-C), blood pressure, presence of diabetes, and smoking habit. Some experts have criticized the calculator's accuracy, however, saying that it overestimates patients' CVD risk and could lead to many more people being treated with preventive statins than is necessary. Proponents of the calculator's new formula say that it is still a valuable resource because it is better than previous risk calculators. The guidelines underscore the importance of discussing options and using judgment for both health practitioners and patients when making treatment decisions.

Some of the classifications of CVD include:

• Coronary heart disease (CHD) and coronary artery disease (CAD) – disease of the blood vessels supplying the heart that may lead to:
  • Angina
  • Heart attack
  • Congestive heart failure
• Cerebrovascular disease – disease of the blood vessels supplying the brain that may lead to:
  • Transient ischemic attacks (TIA) or "mini strokes"
  • Strokes
• Peripheral vascular disease – disease of blood vessels supplying the arms and legs that can lead to:
  • Claudication – obstructed blood flow in arteries, causing pain
  • Gangrene – death of tissues in legs due to poor circulation
  • Aneurysms

Other types of disease can also affect the heart and/or blood vessels. These are described in more detail in the Heart Disease and Vasculitis articles and include:

• Congenital heart disease – resulting from malformation of the heart structure during development (includes some valvular diseases)
• Valvular disease – defects in the structure or function of a heart valve; may be either congenital or acquired
• Cardiomyopathy – weakening of the heart muscle
• Myocarditis – inflammation or infection of the heart muscle
• Vasculitis – inflammation of blood vessels
• Blood clots that develop in the veins (thrombosis) and that detach and go to other organs (embolism)
• Atrial fibrillation – quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications

The World Health Organization estimates that cardiovascular diseases represent 30% of all global deaths. Over 80% of deaths from CVD occur in low- and middle-income countries, where there is increased exposure to risk factors and less access to preventive measures and adequate health care. As the leading cause of death worldwide, cardiovascular disease is a focus of international interest.