Cardiovascular

Heart disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system (as used in MeSH C14), it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions usually have similar causes, mechanisms, and treatments.

In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital.

Most countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer. In recent years, cardiovascular risk in women has been increasing and has killed more women than breast cancer. A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood.

By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and avoidance of smoking.

PATHOPHYSIOLOGY

Population based studies in the youth show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as childhood. The Pathobiological Determinants of Atherosclerosis in Youth 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. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.

This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with 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 are often linked to cardiovascular disease 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.

DIAGNOSIS
Associated diagnostic markers

Low-density lipoprotein
Lipoprotein(a)
Apolipoprotein A1
Apolipoprotein Bho

Trop 7
Trop I
HS Trop

SCREENING

Some biomarkers are thought to offer a more detailed risk of cardiovascular disease. However, the clinical value of these biomarkers is questionable.[10] Currently, biomarkers which may reflect a higher risk of cardiovascular disease include:

1. Higher fibrinogen and PAI-1 blood concentrations
2. Elevated homocysteine, or even upper half of normal
3. Elevated blood levels of asymmetric dimethylarginine
4. Inflammation as measured by C-reactive protein
5. Elevated blood levels of brain natriuretic peptide (also known as B-type) (BNP) [11]
6. Elevated levels of NT-proBNP

PREVENTION

Evidence shows that the Mediterranean diet improves cardiovascular outcomes. As of 2010 however vitamins have not been found to be effective at preventing cardiovascular disease.

Modifiable risk factors to improve or prevent atherosclerosis include: diet high in fibers from vegetables while low in saturated fat and cholesterol; tobacco cessation and avoidance of second-hand smoke; decreased alcohol consumption; lower blood pressures if elevated through the use of antihypertensive medications; strict diabetes management; decrease BMI if overweight or obese; increase daily activity to 30 minutes of moderate to vigorous exercise; and decrease emotional stress in day to day life.

MANAGEMENT

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions. Medication may also be useful for prevention.

RESEARCH

The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 1958. 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. A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease. These studies include those conducted by the Ryan Mackey Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular Health. Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with healthier menu options.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is an common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular disease. Also osteoprotegerin which involved with regulation of a key inflammatory transcription factor called NF-?B has been found to be a risk factor of cardiovascular disease and mortality.

Some areas currently being researched include possible links between infection with Chlamydophila pneumoniae and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.