Cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels.[3] 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.[3][4]
"Heart condition" redirects here. For other uses, see Heart condition (disambiguation).Cardiovascular disease
Heart failure, heart attack, stroke, aneurysm, peripheral artery disease, sudden cardiac arrest.[1]
Older adults[2]
Diabetes,[3] high blood lipids, excess weight, Smoking, excessive drug use, and excessive alcohol intake
Healthy eating, exercise, avoiding tobacco smoke, limited alcohol intake,[3] Overall lifestyle changes
Treating high blood pressure, high blood lipids, diabetes[3]
17.9 million / 32% (2015)[5]
The underlying mechanisms vary depending on the disease.[3] It is estimated that dietary risk factors are associated with 53% of CVD deaths.[6] Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis.[3] This may be caused by high blood pressure, smoking, diabetes mellitus, lack of exercise, obesity, high blood cholesterol, poor diet, excessive alcohol consumption,[3] and poor sleep,[7][8] 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%.[3] Rheumatic heart disease may follow untreated strep throat.[3]
It is estimated that up to 90% of CVD may be preventable.[9][10] Prevention of CVD involves improving risk factors through: healthy eating, exercise, avoidance of tobacco smoke and limiting alcohol intake.[3] Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial.[3] Treating people who have strep throat with antibiotics can decrease the risk of rheumatic heart disease.[11] The use of aspirin in people who are otherwise healthy is of unclear benefit.[12][13]
Cardiovascular diseases are the leading cause of death worldwide except Africa.[3] Together CVD resulted in 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990.[5][4] 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.[14][15] Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD deaths in females.[3] 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.[2] 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.[14] CVD is typically diagnosed seven to ten years earlier in men than in women.[3]: 48
There are many cardiovascular diseases involving the blood vessels. They are known as vascular diseases.
There are also many cardiovascular diseases that involve the heart.
Screening
Screening ECGs (either at rest or with exercise) are not recommended in those without symptoms who are at low risk.[84] This includes those who are young without risk factors.[85] In those at higher risk the evidence for screening with ECGs is inconclusive.[86] Additionally echocardiography, myocardial perfusion imaging, and cardiac stress testing is not recommended in those at low risk who do not have symptoms.[87] Some biomarkers may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the value of some biomarkers is questionable.[88][89] Ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP), and coronary artery calcium, are also of unclear benefit in those without symptoms as of 2018.[90]
The NIH recommends lipid testing in children beginning at the age of 2 if there is a family history of heart disease or lipid problems.[91] It is hoped that early testing will improve lifestyle factors in those at risk such as diet and exercise.[92]
Screening and selection for primary prevention interventions has traditionally been done through absolute risk using a variety of scores (ex. Framingham or Reynolds risk scores).[93] This stratification has separated people who receive the lifestyle interventions (generally lower and intermediate risk) from the medication (higher risk). The number and variety of risk scores available for use has multiplied, but their efficacy according to a 2016 review was unclear due to lack of external validation or impact analysis.[94] Risk stratification models often lack sensitivity for population groups and do not account for the large number of negative events among the intermediate and low risk groups.[93] As a result, future preventative screening appears to shift toward applying prevention according to randomized trial results of each intervention rather than large-scale risk assessment.
Management
Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.[3] Influenza may make heart attacks and strokes more likely and therefore influenza vaccination may decrease the chance of cardiovascular events and death in people with heart disease.[192]
Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle-income levels.[93] Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for quality-adjusted life-year (QALY) in regions of low and middle income. The costs for a single QALY for aspirin and atenolol were less than US$25, streptokinase was about $680, and t-PA was $16,000.[193] Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350.[193]
There are also surgical or procedural interventions that can save someone's life or prolong it. For heart valve problems, a person could have surgery to replace the valve. For arrhythmias, a pacemaker can be put in place to help reduce abnormal heart rhythms and for a heart attack, there are multiple options two of these are a coronary angioplasty and a coronary artery bypass surgery.[194]
There is probably no additional benefit in terms of mortality and serious adverse events when blood pressure targets were lowered to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg.[195]