THE BURDEN OF CARDIVASCULAR DISEASE AS REPORTED BY AMERICA HEART ASSOCIATION

WHAT IS CARDIOVASCULAR DISEASE?

Cardiovascular disease (CVD) refers to a group of diseases that target the heart and blood vessels and is the result of complex interactions between multiple inherited traits and environmental issues including diet, body weight, blood pressure, and lifestyle habits. This means that cardiovascular disease is largely preventable and, when diagnosed early, disease symptoms and risk factors can often be mitigated with lifestyle change and medication. Common forms of CVD include high blood pressure, coronary heart disease, stroke, and congestive heart failure.

A major cause of CVD is atherosclerosis, a general term for the thickening and hardening of the arteries. It is characterized by deposits of fatty substances, cholesterol, and cellular debris in the inner lining of an artery. The resulting buildup is called plaque, which can partially or completely occlude a vessel and may lead to heart attack or stroke. The most prevalent forms of heart disease and stroke, in which narrowed or blocked arteries result in decreased blood supply to the heart or brain, are referred to as ischemic heart disease and ischemic stroke.

Progress is being recorded in some countries where capacity has been built and developed to tackle the scourge of CVD, while countries, states and local communities in Africa still wallow in the grip of the menace of CVD. Factors affecting this decline in other parts of the world include more effective medical treatment and more emphasis on reducing controllable risk factors.

While CVD mortality rates have declined most developed countries of the world, the financial burden from CVD continues to rise. Together, heart disease and stroke remain the number one drain on health care resources. According to the American Heart association (AHA), the estimated direct and indirect cost of CVD in the US in 2008 will be $448.5 billion. In 2006, hospitalization charges for CVD and stroke in Texas were over $10 billion. Ischemic heart disease alone accounted for 60 percent of these charges.

Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.

Globally, cardiovascular diseases are the number one cause of death and is projected to remain so. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million due to stroke. About 80% of these deaths occurred in low- and middle-income countries. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).

PRIMARY CAUSES OF CARDIOVASCULAR DISEASE

High Blood Pressure: The relationship between blood pressure and risk for cardiovascular disease is well established and independent of other risk factors. High blood pressure is a factor in 67% of heart attacks, 77% of strokes, and 74% of heart failures. The higher the blood pressure becomes, the greater the risk for heart attack and heart failure. The presence of pre-hypertension signals the need for increased education and lifestyle modification to prevent or reduce the onset of hypertension. Recommended lifestyle changes include weight reduction, adoption of a good eating plan, sodium reduction, physical activity, and moderation of alcohol consumption. Combinations of lifestyle modifications can achieve optimum results.

High Blood Cholesterol: Reducing risk associated with high blood cholesterol involves reducing lifestyle risk factors such as obesity, physical inactivity, a diet high in saturated fats, excess alcohol consumption, and tobacco use. A diet high in carbohydrates (more than 60% of energy intake), certain diseases, certain drugs, and genetic causes are also associated with abnormal lipoprotein levels.

Diabetes: Diabetes, a major risk factor for cardiovascular disease, is a group of diseases marked by high levels of blood glucose and includes type 1, type 2, gestational, and other types resulting from specific genetic conditions. People with type 1 diabetes must monitor and control their blood glucose level by self administration of insulin. Those with type 2 diabetes can often control their blood glucose through diet, exercise, and oral medication. Diabetes self-management education is integral to effective medical care. According to the American Diabetes Association, it is important for patients and their providers to “make the link” between diabetes, heart disease, and stroke. Diabetes management involves not only control of blood glucose but also of blood pressure and cholesterol levels.

Tobacco use and exposure to second hand smoke: Tobacco remains the single most preventable cause of death and disease in the United States today. Tobacco use is a major risk factor for heart disease and stroke. Between 1997 and 2001, smoking resulted in an estimated annual average of 137,979 deaths in the US from cardiovascular disease. In 1998, smoking-related health care expenditures in the US were estimated at $75.5 billion. Tobacco-related health disparities are reflected in unequal treatment of tobacco use, incidence, morbidity, mortality, burden of illness, and access to resources. Racial/ethnic minorities, people with low socioeconomic status, and people with lower levels of education are at higher risk for tobacco use and exposure to second hand smoke, and they experience more tobacco related illness and death.

Overweight and Obesity: Premature death, heart disease, diabetes, cancer, respiratory problems, arthritis, and reproductive complications are among the health consequences of overweight and obesity. The incidence of heart disease, high blood pressure, and high cholesterol are higher in people who are overweight and obese. Risk factors for heart disease such as high cholesterol and high blood pressure are more prevalent in children and adolescents who are overweight.

Recent studies suggest that obesity, independent of other risk factors such as keeping active and not smoking, increases risk for acute coronary syndrome (symptoms associated with myocardial ischemia). Overweight and obesity classifications are determined by body mass index (BMI), a ratio of body weight (kg) to height (m)2. Overweight is defined, in adults, as a BMI between 25 and 29.9, while obesity in adults is defined as a BMI of 30 or higher.

Unhealthy eating: Nutrition plays an important role in an in¬dividual’s overall health and quality of life. A diet high in calories, saturated fat, and cholesterol and high in sodium or sugar is a major contributor to poor health. For reducing risk of CVD and stroke, the American Heart Association encourages people to know their daily caloric intake to help ensure calories eaten do not exceed calories burned through daily physical activity and consume nutrient rich foods that are high in vitamins, minerals, fiber, and other nutrients but low in calories. A diet high in fruits and vegetables is as¬sociated with better weight management and a reduced risk of chronic disease.

Lack of physical activities: Regular physical activity is associated with reduced risk for chronic disease and a healthier, longer life. Cardiovascular ben¬efits of regular physical activity include lower risk for heart disease, high blood pressure, stroke, abnormal blood choles¬terol and triglycer¬ides, type 2 diabetes, obesity and a second heart attack.