Cardiovascular diseases (ii)

Cardiovascular diseases are all those conditions that damage the heart or blood vessels.

In the World Health Organization's Global Health Statistics 2020, it states:

• "an estimated 41 million people worldwide died from noncommunicable diseases (NCDs) in 2016, equivalent to 71% of all deaths. The majority of these deaths were due to four noncommunicable diseases (NCDs) cardiovascular diseases (17.9 million deaths), cancer (9 million), chronic respiratory diseases (3.8 million) and diabetes (1.6 million)."
• "the underlying causes of major NCDs are complex. They include genetic predispositions as well as modifiable risk behaviors (such as tobacco use, harmful use of alcohol, physical inactivity and unhealthy diets) and environmental risks (such as air pollution), the prevalence of which varies by geographic location, income group and gender."

Most common cardiovascular diseases

Coronary artery disease: occurs when blood flow to the heart is impaired by plaque buildup in the wall of the coronary arteries. Coronary artery diseases include:

• Angina pectoris: a condition caused by insufficient blood (oxygen) supply to the heart muscle cells. It can cause pain in the retrosternal region. Angina pectoris is associated with an increased risk of fatal cardiovascular events.

• Acute myocardial infarction (cardiac arrest): this is caused by the death of cardiac cells due to a temporary or permanent decrease in blood flow (ischemia) resulting from an imbalance between the demand for and supply of blood flow through the coronary circulation. Acute myocardial infarction is the leading cause of death in men and women worldwide.

Peripheral vascular disease is the obstruction of large arteries supplying the arms and legs. It can be caused by arteriosclerosis, inflammatory processes, narrowing, embolism or thrombus formation. It causes lack of blood supply (ischemia) in acute or chronic form.

Cerebrovascular disease (including stroke): comprises a group of disorders of the cerebral blood vessels, which cause a temporary or permanent decrease in the function of a large region of the brain or of a small or focal area, for no apparent reason other than vascular origin. Cerebrovascular disease causes ischemia (lack of blood) or hemorrhage (stroke), with or without neurological symptoms or sequelae. The main risk factor for the occurrence of these disorders is arterial hypertension.

Renal artery stenosis: consists in the narrowing of the renal artery, a blood vessel that carries blood to the kidney. Its obstruction reduces blood flow to the kidney and causes renal insufficiency and arterial hypertension. Ninety percent of cases are caused by arteriosclerosis of the renal artery.

Aortic aneurysm: it is the dilatation in a specific area of the aorta artery, which causes a weakness in it. If left untreated, they tend to become larger and larger, constituting a serious health risk due to their potential rupture, which causes massive internal bleeding. The formation of aneurysms has been associated with arteriosclerosis, hypertension and smoking.

Cardiomyopathy: is the deterioration of heart muscle function for any reason. Cardiomyopathy often causes arrhythmias and is a risk factor for sudden or unexpected cardiac arrest.

Hypertensive heart disease: consists of pathological hypertrophy of the heart's cardiac cells. It tends to cause disturbances in myocardial function, congestive heart failure and sudden death. It also increases the risks of aneurysm and aggravation of arteriosclerosis.

Heart failure: is the inability of the heart to pump the necessary volumes of blood to the body's tissues. It is the main cause of hospitalization in people over 65 years of age. Heart failure is in most cases the end result of primary heart disease and deterioration of the heart.

Pulmonary heart disease (cor pulmonale): comprises a group of changes in the structure and function of the right ventricle, resulting from respiratory abnormalities that cause pulmonary hypertension. If left untreated, it can cause right heart failure and death. The most common symptom is shortness of breath.

Heart rhythm disorders: consist of the variation of the heart rate or rhythm, produced by the occurrence of disorders in the generation or propagation of the cardiac impulse, through the electrical conduction system of the heart or the combination of both. The normal heart rate for a patient at rest should be between 60 and 100 beats per minute. If it is above 100 beats per minute, it is considered accelerated and is called tachycardia; and if it is below 60 beats, it is considered decelerated and is called bradycardia.

Inflammatory heart disease:

• Endocarditis: is an inflammatory process located in the inner lining of the cardiac chambers and valves.

• Cardiomegaly: is the medical term that describes the abnormal enlargement of the heart or cardiac hypertrophy.

• Myocarditis: is the medical term describing inflammation of the myocardium. It usually occurs due to a viral or bacterial infection. Symptoms are chest pain, sudden heart failure and sudden death.

Valvulopathy: includes all those diseases that affect the heart valves. The most frequent causes of this disorder are rheumatic fever, age-related degenerative processes and congenital anomalies (valvular dysplasia).

Congenital heart disease: these are malformations of the heart structure, existing at birth.

Rheumatic fever: an inflammatory, non-suppurative, recurrent disease caused by the immune system response of certain individuals predisposed to the antigens of the group A beta-hemolytic streptococcus bacteria (streptococcus pyogenes).

Rheumatic fever can affect any part of the body, mainly the heart. It is the most common cause of heart disease in people between 5 and 30 years of age in underdeveloped countries, and is the leading cause of death from heart disease in people under 45 years of age.

Risk factors for cardiovascular disease

The origin of cardiovascular diseases depends on the complex interrelation of a group of non-modifiable factors, such as age, sex, heredity, and others that can be corrected, such as diet, consumption of toxic substances and levels of physical activity. This linkage between factors of such a diverse nature constitutes an obstacle to the design of strategies to reduce in the short term the large number of cardiovascular deaths that occur each year.

Despite the efforts of the world scientific community to reduce the number of patients and premature deaths caused by cardiovascular diseases, their incidence continues to be high, due to the constant presence of a group of environmental factors, particularly dietary factors, which favor their earlier onset and the increase in the number of cases and associated complications.

Non-modifiable risk factors:

• Age: age is the most significant risk factor in the development of cardiovascular disease. As the years go by, cardiac activity worsens, since the thickness of the heart walls increases and the arteries are less flexible. Also in older people, the negative effects of other factors have accumulated. It has been shown that atherosclerosis often begins at an early age, and can take 20 to 30 years to lead to blockage of the coronary arteries, capable of causing a heart attack. The negative effects of aging on the cardiovascular system are inevitable, but these effects can be reduced by adopting a healthy lifestyle.

• Genetic factors: individuals with a family history of heart attacks are considered to be at greater risk of developing cardiovascular disease prematurely, appearing in men before the age of 55 and in women before the age of 65. It is suspected that the increased risk is also due to the transmission of habits and lifestyles from parents to children, so it is recommended that people with a family history of cardiovascular disease adopt lifestyles that prevent, attenuate or delay the onset and development of these disorders.

• Gender: the male sex has a higher risk of suffering cardiovascular diseases than the female sex. This behavior is attributed to the supposed protective factor exerted by female sex hormones (estrogens). Coronary heart disease is 2 to 5 times more common among middle-aged men than among women.

Modifiable risk factors:

• Elevated total cholesterol and low-density lipoprotein (ldl or bad cholesterol) levels: elevated blood ldl and total cholesterol levels are associated with the onset and progression of atherosclerosis, a disorder that increases the risks of cardiovascular disease. Total cholesterol levels are usually higher in overweight or obese people, who consume large amounts of cholesterol, saturated fats (lard, butter, margarine, etc.) and do not engage in regular physical activity. LDL levels are also elevated in people suffering from hypothyroidism, diabetics and smokers.

• Elevated blood levels of high-density lipoprotein (hdl or good cholesterol) have also been shown to reduce the risk of cardiovascular disease.

Hypertension: when blood pressure remains elevated for a sustained period of time, the heart is forced to work harder, which can lead to an increase in its volume and deterioration of its functions (cardiac impairment). Higher than normal blood pressure values cause hardening of the blood vessels, decreasing the delivery of oxygen to organs and systems, such as the brain and the heart itself.To reduce the risk of hypertension, it is recommended to reduce salt consumption, and avoid overweight and obesity, practicing a healthy diet and performing daily physical activities. Smoking: is considered the modifiable factor that most favors the appearance of cardiovascular diseases. The risk caused by smoking increases proportionally to the number of cigarettes consumed daily and the number of years since starting to smoke. Tobacco smoke is also a risk factor for non-smokers who are exposed to second-hand smoke.It is estimated that in Europe smoking causes 1.2 million deaths each year, and is related to the appearance of 29 diseases. In Spain, more than 50,000 people die each year as a result of tobacco consumption.Quitting smoking at any age reduces the risk of death from coronary heart disease by half. Alcohol: the relationship between alcohol consumption and cardiovascular diseases is complex, since it has been proven that the consumption of moderate amounts of alcohol would reduce the risk of suffering some cardiovascular diseases and increase the risk of suffering others. The health risks of alcohol consumption outweigh any potential benefits, so regular consumption is not advisable. The level of physical activity: sedentary people or those with a low level of physical activity are at greater risk of developing cardiovascular disease. Regular physical activity appropriate to the age, sex and physical condition of the individual favors cardiovascular health by reporting the following benefits:

• » Strengthens the heart muscle.

• » It contributes to the maintenance of adequate body weight.

• » It favors the control of blood glucose levels, and increases insulin sensitivity.

• » Raises high-density lipoprotein concentrations (good cholesterol), which contributes to blood pressure control.

Obesity: obesity increases the workload of the heart, favoring the appearance of coronary heart disease, alterations in heart rhythm and ventricular function. It also leads to the development of hypertension, diabetes and hypercholesterolemia, factors that increase the risk of cardiovascular disease.When assessing the role of obesity in the development of cardiovascular diseases, we must take into account the level of fat accumulated in the abdominal region, since this constitutes an additional risk factor for the development of chronic degenerative diseases, as it is closely related to a higher prevalence of glucose intolerance, insulin resistance, increased blood pressure and increased blood lipids. Diet: when the diet is not complete, balanced, sufficient, varied and adequate, it increases the risk of cardiovascular disease. Among the foods that we should reduce their use to avoid these disorders we have:

• » Saturated fats (lard, cream, butter, fatty meats, coconut and palm oil) and trans fats (margarine).

• » Common salt.

• » Sugar and industrial soft drinks.

• » Processed meats (ham, chorizo, sausage, salami, etc.).

• » There are also foods that it is recommended to promote in diets due to their beneficial effects on the health of the cardiovascular system.

Examples:

• » The consumption of omega-3 fatty acids (ω-3), present in oily fish, seafood, nuts and in soybean and canola oils.
• » The consumption of dietary fiber contained in vegetables, fruits, bran from cereals and whole seeds from legumes.

Diabetes mellitus: the complications of undiagnosed or poorly treated diabetes mellitus significantly increase the risk of cardiovascular disease. Uncontrolled diabetes causes