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What is Heart Disease?
Heart disease is a general term used to describe the varying conditions and diseases related to the heart and cardiovascular system. These diseases range in specificity, addressing heart rhythm problems (arrhythmias), valve disorders, congenital (birth) heart defects and diseases of the blood vessels. Heart disease is the number one killer of both men and women in the United States and the world.1
The phrase “heart disease” is often used interchangeably with “cardiovascular disease.” While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments.
Atherosclerosis, also called coronary artery disease or coronary heart disease, plays a significant role as the precursor in the development of cardiovascular disease. This condition refers to the hardening of arterial walls and the buildup of plaque. Damage to the arterial wall, caused by such risk factors as smoking or high blood pressure, triggers the body’s innate immune response: inflammation. Circulating immune complexes, including C-reactive proteins and macrophages, as well as fibrin, travel to the affected site to try and repair the artery, forming clumps. Overtime, plaques can develop on these clumps, consisting of cholesterol, fatty deposits and other cellular waste traveling in the blood. These plaques harden the arteries and narrow the passageway by which blood reaches other organs and tissues.2
Recent evidence from clinical and population studies now suggests that inflammation is an important factor in the severity of atherosclerosis and the likeliness of developing other cardiovascular diseases. Blood flow to vital organs is limited as the vessels narrow. Plaques can then become imbedded in the artery wall, signaling for counter-acting immune responses (i.e. inflammation). When these responses are unable to break up the plaque, the buildup can burst and send clotting particles circulating in the blood. Blood clots can lead to much more serious complications and even be fatal.3,4
Heart Disease Causes and Risk Factors
Cardiovascular disease, as brought on by atherosclerosis, is associated with a number of factors which put someone at risk. These include:
- Age: as we get older, arteries become weaker and more susceptible to damage, promoting clotting
- Gender: men are at greater risk than women; risk in women increases after menopause
- Smoking: nicotine constricts blood vessels, and carbon monoxide damages their inner lining
- Poor diet: high fat, cholesterol and sodium in the diet can be plaque-forming and affect blood pressure
- Physical inactivity
- Excessive alcohol or caffeine intake
- High stress
- Poor hygiene
- High C-reactive protein levels
- High blood pressure
- High blood cholesterol levels: low density lipoproteins (LDLs) accumulate in the form of plaque
- Family history of heart disease
Heart Disease Symptoms
Atherosclerosis is slowly progressive. The blood vessels are gradually narrowed, blocked or stiffened, making it so the heart, brain or other organs do not receive enough blood to function. Cardiovascular disease is not usually diagnosed until atherosclerosis is so severe that it creates serious problems like heart attack, stroke, heart failure or cardiac arrest. Important symptoms to pay attention to and inform your doctor of are:
- Chest pain (angina)
- Shortness of breath
- Pain, weakness, numbness or coldness in your extremities
Heart Disease Complications and Prognosis
Early detection of cardiovascular disease typically results in a better outcome, but everyone recovers differently. While lifestyle changes may help some, medications and surgical procedures may be necessary for others. Worsening disease states can cause ischemic problems that lead to life-threatening complications, including:
- Heart attack: blood clot blocks blood flow through the coronary artery
- Heart failure: the heart cannot pump enough blood to meet body’s needs
- Stroke: arteries to the brain are narrowed or blocked and too little blood reaches the brain
- Aneurysm: bulge of the wall of an artery anywhere in the body
- Peripheral artery disease: atherosclerosis of arteries in the extremities
- Sudden cardiac arrest
Heart Disease Treatment
Cardiovascular disease can be brought on by a number of contributing factors, thus a number of medications may be prescribed to help treat symptoms and prevent disease progression. The types of treatment vary from person to person and depend on severity of the disease. Certain laboratory goals are usually established in order to monitor progress. These typically include:
- Blood LDL cholesterol < 100 mg/dL
- Glycosylated hemoglobin (HbA1c) < 7%
- Blood pressure < 120/80 mmHg
The first and most important part of treatment for anyone with cardiovascular disease is changes in lifestyle to promote a healthy heart. This includes eating a heart healthy diet low in saturated fat, cholesterol and sodium, exercising at least 30 minutes most days of the week, quitting smoking and limiting alcohol consumption.
A number of medications are prescribed to help control heart disease including:
- ACE inhibitors to lower blood pressure
- Aspirin for blood thinning
- Beta-blockers to lower heart rate, blood pressure and oxygen used by the heart
- Calcium channel blockers to relax arteries and lower blood pressure
- Diuretics to lower blood pressure and treat congestive heart failure
- Nitrates to stop chest pain and improve blood supply to the heart
- Statins to lower cholesterol
- Warfarin for blood thinning
If medications aren’t enough, surgery may be recommended to clear blockages. These include angioplasty and stent placement, coronary artery bypass surgery and minimally invasive heart surgery.
- AHA Writing Group Members et al. Circulation: Heart Disease and Stroke Statistics 2008 Update. J Am Heart A. 2008; 117 (4): e25.
- Kuller LH, Tracy RP. The Role of Inflammation in Cardiovascular Disease. Arter Throm Vasc Bio. 2000; 20:901.
- Gorman C, Park A, Dell K. Health: The Fires Within. Time Magazine. 2004; 163(8):7-12.
- Ridker PM, Hennekens CH, Buring JE, Rifai N. C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women. N Engl J Med. 2000; 342:836-843.
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