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Cardiovascular Diseases
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Cardiovascular Diseases, Their Causes, Risk Factors and Interventions: A Review Based on Evidences from Follow-Up of Cohort Studies
What Are Cardiovascular Diseases?
Cardiovascular system comprises the heart, arteries, arterioles, capillaries, venules, and veins. The heart is a muscular organ, which has four chambers.
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The heart contracts 100,000 times per day to pump blood. There are two upper chambers of the heart namely the left atrium and the right atrium, and two lower chambers of the heart namely the left ventricle and the right ventricle. The heart has four valves namely the tricuspid valve, the mitral valve, the pulmonary valve, and aortic valve (or bicuspid aortic valve). The function of the heart is to pump blood to the body by alternative contraction and relaxation of its muscles.
Deoxygenated blood from the rest of the body enters the heart into right atrium. From the right atrium, the blood moves into the right ventricle, and gets pumped through the pulmonary artery to the lungs. Oxygenated blood from the lungs enters into the left
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atrium of the heart through the pulmonary vein. Blood from the left atrium is forced into the left ventricle. The left ventricle pumps blood through the aorta to various parts of the body.
Cardiovascular diseases are diseases that affect the heart and the vasculature namely the arteries, arterioles, capillaries, veins, and venules. The major types of cardiovascular diseases include atherosclerosis, coronary artery disease (CAD), or coronary heart disease (CHD) or ischemic heart disease (IHD), angina pectoris (chest pain), cardiac arrhythmias (irregular heart beat) congestive heart failure (CHF), congenital heart disease, rheumatic heart disease, and stroke.
How Serious Are Cardiovascular Diseases?
Cardiovascular disease (
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CVD) is the leading cause of death in the United States of America. Statistics showed that in 2005, CVD accounted for approximately 38 percent of all deaths in the United States. CVD has been the leading cause of death since 1900s, except for influenza in 1918. Reports suggest that more than 2,500 Americans die from cardiovascular disease each day. In today's world, most deaths are attributed to non-communicable diseases (35 million) and just over half of these deaths (17.5 million) are as a result of cardiovascular diseases. More than 1/3 of these deaths take place during middle age. In developed countries, stroke and heart disease is the 2nd leading cause of mortality for adult males and females. An estimated 17.3 million people died from CVDs in 2008. About 80% or more of the CVD deaths take place in low and middle income or developing countries. It is estimated that by 2030 more than 23 million people will have died annually from cardiovascular diseases. In the United States of America, CHD is the largest killer of men and women.
About 13.9 million have history of myocardial infarction (MI) and/or angina. The occurrence of myocardial infarction is being reported in 1.1 million people each year. About 370,000 die of myocardial infarction and at least 250,000 of them die within the first hour. By age 60, every 5th man and 17th woman develops CHD. The year 1998 estimated direct and indirect cost of heart diseases are $95.6 billion. About 53.3 million adults have elevated levels LDL-C and warrant intervention.
Why Do Cardiovascular Diseases Occur?
There are various risk factors that contribute to the occurrence
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of cardiovascular disease. Some people are born with congenital heart diseases that predispose them to cardiovascular diseases and
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stroke, but most people who develop cardiovascular disease in their adulthood do so because of a combination of life style choices such as unhealthy diet, lack of physical exercises, and smoking.
Many of the risk factors that lead to cardiovascular disease cause problems because they lead to atherosclerosis or arteriosclerosis. Atherosclerosis is the narrowing and thickening of arteries due to the formation or deposition of fat like material, cholesterol and other similar substances, that combine together to form what is known as plaques, in the walls of the arteries, over the years without causing symptoms. It can occur in any artery. If this thickening occurs in the coronary arteries, it is known as coronary artery disease.
The major risk factors leading to cardiovascular diseases are cigarette smoking, elevated levels of total or low density lipoprotein-cholesterol (LDL-C), hypertension, family history of pre-mature coronary heart disease, diabetes mellitus, chronic kidney disease, obesity, lack of regular physical activity, history of transient ischemic attack (TIA) or cerebrovascular accident (CVA), dyslipidemia, family history event in first degree relatives, diet not rich in vegetables, fruits and fiber, age higher than 45 in males, and higher than 55 in females and history of coronary artery disease or peripheral artery disease (Hemingway, 1999)
Framingham Heart Study
The Framingham Heart Study is an ongoing cardiovascular cohort study that has been conducted for a long period now, among the residents of the town of Framingham in Massachusetts, USA. The study began in 1948 with 5,209 adult subjects from Framingham (Hubert, et al., 1983). Follow-up studies of the original study are now being conducted among the people who are now the third generation of the original subjects. Prior to the Framingham heart study, there was almost no knowledge at all about the etiology of hypertensive or arteriosclerotic cardiovascular diseases. Much of the knowledge concerning heart disease, such as the effects of common medications such as aspirin, diet, exercise, and obesity, are based on this long-term longitudinal study, which is a project of the National Heart, Lung, and Blood Institute, in collaboration with Boston University since 1971.
Is Obesity a Major Risk Factor?
One of the major findings of the original Framingham heart study was the connection of obesity to cardiovascular diseases. It was a cohort study which involved 5,209 participants (Hubert, et al., 1983). A more recent study was done to re-examine the relationship between obesity levels and the occurrence of CVD or cardiovascular disease in the 5,209 men and women who were all a part of the initial Framingham participants. Scientist have observed that
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the occurrence of CVD over twenty-six years show that obesity, which is measured by "Metropolitan Relative Weight," was proven as a vital prediction for CVD for female participants. Evidences showed that "Metropolitan Relative Weight," showed a twenty-six-year occurrence of coronary disease (of angina and other coronary heart diseases), and congestive heart failure (CHF) among men, irrespective of whether or not factors such as age, systolic BP, cholesterol level, habit of smoking cigarettes, and glucose intolerance play a role. Relative weight in females was attributed to be independently and positively related with congestive failure, stroke, coronary heart
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disease, and coronary and cardio vascular disease death. Evidences from this study also suggest that weight gain after young age led to a high risk of CVD in both men and women, that could neither be attributed to the weight initially nor the amount of the predisposing factors that may have occurred due to the gain of weight. Interventions are necessary to check weight and obesity conditions (Hubert, et al., 1983).
Does Alcohol Consumption Play A Role In CVD?
There have been numerous studies which were investigating the effects of alcohol consumption on the occurrence of cardiovascular diseases, stroke, and related mortality. Moderate consumption of alcohol, particularly may protect against coronary heart disease, but whether this remains true for all types of alcohol or only for wine is not clear. On the other hand, there have been evidences suggesting the risk of mortality from stroke
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resulting in association with alcohol consumption. A 21-year follow-up study was conducted on 2,686 Scottish men; there were 1643 deaths, including 625 from coronary heart disease, 123 from stroke, 108 from alcohol-related causes. Thus indicating the significant relationship between alcohol consumption, for drinkers consuming more than 15 units
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of alcohol per week and mortality as a result of CHD (Sabino, 2014).
Questions to the Health Department on CVD mitigation
The Heath Department of any State or country plays a prominent role in assessing the impact of an epidemic or disease, and resolves to find ways to curb their incidence among its pollution. I put forward the following questions regarding
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CVD prevention to the health department of my State.
1. What are the policies that you have framed and the associated intervention programs implemented to help mitigate incidences of CVD?
2. Have you created any public health agencies and empowered them to spread awareness to the public regarding CVD prevention?
3. Have you provided training to the public agency personnel to help spread the word about caution of CVD?
4. Have data sources been enhanced and are key indicators to CVD being monitored to assess the increasing incidences of CVD?
5. Are you working with regional and global partners to enable sharing of knowledge and support for managing CVD? (CDC, nd)
Protocol to Mitigate CVD
Public health agencies should come to the fore and function in three domains or aspects to help mitigate CVD incidence. The three aspects include assessment, policy development, and assurance.
Assessment
Knowledge is key while combating an epidemic. For several years, public health agencies should embark on a mission to collect information about the disease, its spread, and risk factors involved. From the information garnered, further research trials can be conducted to help find to solutions to the endemic or disease condition, in this case, CVD (CDC, nd).
Policy Development
The knowledge accrued should pave way to the formulating of effective and applicable policies that would check the incidence of the disease.
Assurance
Public agencies should take every measure to check the occurrence of CVDs. However, this assurance is still not in place, as public health agencies are not adequately well-equipped to carry out this function.
Recommendations to my Organization to Prevent CVD
I would like the human resources team at the organization I work for to immediately take measures to combat incidences or occurrences of CVDs (CDC, nd).
The measures would include:
Anti-cigarette smoking laws and policies in the work environment should be laid;
Building a gym in the office premises to enable uptake of physical activity among employees;
Assessing stress levels among employees and managing them accordingly at regular intervals;
Early detection of risk parameters among employees that may predispose CVD;
Education and awareness on right nutrition and appropriate diet to help employees combat CVD;
Weight management techniques should be advocated to work force along with disease management (CDC, nd).
Conclusion
Follow-up studies suggest that there is no significant reduction in the occurrence of CVD over the years. Now that the awareness of risk factors
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causing CVD is well known, the measures to mitigate the effect of these factors have still not been proven to have reduced the rate of occurrence of cardio vascular diseases (Sytkowski et al., 1990). The occurrence and the mortality rates are still not completely reduced. Although the mortality rates have declined, the occurrence of cardiovascular diseases and the number of deaths that occur in the first hour of myocardial infarction make it very essential for extensive research to be conducted for facilitating more efficient methods of interventions so as to prevent mortality and reduce occurrence rates.
References
Bostom, A. G. et al., (1994), A prospective investigation of elevated lipoprotein (a)
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detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study. Circulation., 90, 1688-1695.
CDC (nd), A Public Health Action Plan to Prevent Heart Disease and Stroke, Retrieved from https://www.cdc.gov/dhdsp/action_plan/pdfs/action_plan_full.pdf
Hemingway , H. (1999), Psychosocial factors in the etiology
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and prognosis of coronary heart disease: systematic review of prospective cohort studies, BMJ. 318(7196), 1460-1467.
Hubert, H. H. et al., (1983), Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26-year
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Follow-up of Participants in the Framingham Heart Study, Circulation.
Sabino, (2014), Effect of
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chronic ethanol exposure on rat ventilatory responses to hypoxia and hypercapnia, Clinics, 360-366.
Sytkowski, et al., (1990), Changes in
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risk factors and the decline in mortality from cardiovascular disease - The
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Framingham Heart Study, N Engl J Med, 322, 1635-1641.
Plagiarism level
6.52%
Report generated:
Jan 26 2022 12:35 PM
Words scanned:
1934
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