Cardiovascular disease is a general umbrella term that refers to a group of disorders involving the heart and blood circulation systems, such as hypertension, stroke, congestive heart failure, cardiomyopathy, valvular heart disease, and coronary heart disease. Coronary heart disease refers to the narrowing or blockage of one or more coronary arteries by a gradual buildup of cholesterol within the artery wall (atherosclerosis), which reduces blood flow to the heart muscle. Coronary heart diseases include myocardial infarction and angina pectoris. Over 64 million Americans have some form of cardiovascular disease; coronary heart disease and stroke are the first and third leading causes of death in the United States, accounting for more than 40% of all deaths. Cardiovascular diseases also lead to high levels of premature and permanent disability.
Cardiovascular disease encompasses a broad range of specific disorders, and symptom presentations vary widely across these disorders. Among the most common cardiovascular diseases, some can be asymptomatic (e.g., hypertension) while others can cause acute pain and disability (e.g., angina pectoris, myocardial infarction). Symptoms of cardiovascular disease can include chest pain or radiating pain on the left side of the body and nausea (coronary heart disease), weakness or paralysis on one side of the body (stroke), and painful breathing, fluid retention, and fatigue (congestive heart failure).
Risk factors for cardiovascular disease include demographic factors, biological factors, and psychosocial factors.
Although cardiovascular disease occurs across the life span, the prevalence of most cardiovascular diseases increases with age. The prevalence of cardiovascular disease is slightly higher in women than in men, but the death rate for cardiovascular disease is substantially higher for women than for men. Women tend to experience some cardiovascular diseases, such as myocardial infarction, on average approximately 6 years later than do men. Rates for most cardiovascular diseases are higher for those of ethnic and racial minorities and those of lower socioeconomic status.
Biological factors that predispose individuals to cardiovascular disease include family history of cardiovascular disease, diabetes, high blood pressure, high blood cholesterol, and overweight/obesity.
A variety of psychosocial factors place individuals at higher risk for developing cardiovascular disease. One of the biggest risk factors is depression or depressive symptoms, which is prospectively related to the occurrence of cardiovascular disorders such as myocardial infarction. One particular aspect of depression, hopelessness, has been linked to sudden cardiac death as well as to the development of coronary heart disease. Other negative emotions, such as anxiety (both disorders such as panic disorder and more general anxiety symptoms such as worry) and vital exhaustion (a syndrome of fatigue, irritability, and demoralized feelings) also present significant risk for developing cardiovascular disorders.
Earlier investigations of type A personality (a behavior pattern characterized by competition, hostility, time urgency, and excessive focus on work) seemed to indicate that type A was a strong risk factor for developing cardiovascular disease. More recent research, however, indicates that rather than the entire constellation being predictive of cardiovascular disease, only certain of the type A traits serve as risk factors, particularly hostility. Hostility refers to a general negative orientation toward relationships with others and high levels of anger, cynicism, and mistrust. Hostility appears to be associated with the development and progression of cardiovascular disease, especially coronary heart disease. Recent research has identified anger as the most potent risk factor within hostility.
In addition to these psychosocial factors, lifestyle factors are strong predictors of cardiovascular disease. Tobacco use, physical inactivity, consumption of a high-fat, animal-based diet, excessive alcohol consumption, and poor stress management and coping skills are all risk factors for development and progression of cardiovascular disease.
Many of the identified psychosocial factors appear to contribute to cardiovascular disease through their influence on health behaviors. Negative emotions such as depression are related to higher levels of cigarette smoking, overeating, and increased alcohol use as well as lower levels of exercise and adherence with treatment. High levels of hostility are related to poorer interpersonal relationships and social isolation. In addition to these influences, many psychosocial factors exert their influence directly on physiological mechanisms, such as the neuroendocrine system, the hypothalamic–pituitary–adrenal axis, cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen, lipids, and glucose metabolism.
Prevention And Treatment
Prevention of cardiovascular disease can be greatly facilitated by the promotion of healthier lifestyles that involve higher levels of exercise and physical activity, maintenance of appropriate weight, consumption of a low-fat diet, and abstinence from tobacco products. Furthermore, regular medical checkups can lead to earlier interventions to treat underlying disease processes (e.g., diabetes, hypertension) and, when appropriate, prescription of medications such as beta-blockers and aspirin. Community interventions that promote healthier lifestyles such as more physical activity or reduced cigarette smoking may be particularly effective in reducing heart disease and stroke throughout entire communities.
Treatment of cardiovascular disease varies, depending on the particular disorder. For example, there are four basic ways to treat coronary heart disease: prescription of lifestyle changes, medication, minimally invasive interventional procedures, and surgery, all of which are designed to minimize symptoms and prevent myocardial infarction. Lifestyle changes involve increasing exercise, losing weight, eating a low-fat plant-based diet, and, if appropriate, making other changes (e.g., stopping smoking, keeping blood sugar under control). Medications that may be used to reduce coronary artery disease include cholesterol-lowering drugs, aspirin, beta-blockers, nitroglycerin, angiotensin converting enzyme inhibitors, and other drugs that lower blood pressure. Minimally invasive interventional procedures include stent implantation and percutaneous transluminal coronary angioplasty (PTCA). A common surgery for coronary artery disease is coronary artery bypass surgery (CABG).
- American Heart Association, http://www.americanheart.org
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- National Institutes of Health—National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov
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