What are the common cardiovascular disorders, including their pathogenesis, signs, symptoms, and risk factors?

From the Guidelines

The cardiovascular system is affected by several common disorders including coronary artery disease, heart failure, hypertension, and arrhythmias, with risk factors such as smoking, high cholesterol, hypertension, diabetes, obesity, and family history playing a crucial role in their development. Coronary artery disease develops through atherosclerosis, where cholesterol plaques build up in coronary arteries, restricting blood flow to the heart muscle. This process begins with endothelial damage, followed by lipid accumulation, inflammation, and eventual plaque formation, as noted in studies such as 1. Symptoms include chest pain (angina), shortness of breath, and potentially heart attack if an artery becomes completely blocked.

Heart failure occurs when the heart cannot pump efficiently, often resulting from long-standing hypertension, previous heart attacks, or valve disorders. The heart initially compensates through enlargement and increased muscle mass, but eventually these mechanisms fail. Patients experience fatigue, shortness of breath, edema, and reduced exercise tolerance. Hypertension involves chronically elevated blood pressure, damaging blood vessels and increasing workload on the heart. Initially asymptomatic, it can lead to headaches, vision changes, and eventually organ damage if untreated.

Some key points to consider in the management and prevention of these conditions include:

• The importance of lifestyle modifications, such as diet and exercise, in reducing the risk of cardiovascular disease, as highlighted in 1.
• The role of medications, such as statins, in managing conditions like high cholesterol and reducing the risk of cardiovascular events, as noted in 1.
• The need for early intervention and prevention, given the high burden of cardiovascular disease and its impact on morbidity, mortality, and quality of life, as discussed in 1 and 1.
• The significance of addressing modifiable risk factors, such as smoking, hypertension, and diabetes, to reduce the risk of cardiovascular disease, as emphasized in 1 and 1.

Management of these conditions typically involves a combination of lifestyle modifications, medications targeting specific pathophysiological mechanisms, and sometimes interventional procedures or surgery for advanced disease, with the goal of improving outcomes and reducing the burden of cardiovascular disease on individuals and society, as highlighted in studies such as 1 and 1.

From the FDA Drug Label

In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), the effect of atorvastatin calcium on fatal and non-fatal coronary heart disease was assessed in 10,305 patients with hypertension, 40 to 80 years of age (mean of 63 years; 19% female; 95% White, 3% Black or African American, 1% South Asian, 1% other), without a previous myocardial infarction and with total cholesterol (TC) levels ≤251 mg/dL Additionally, all patients had at least 3 of the following cardiovascular risk factors: male gender (81%), age >55 years (85%), smoking (33%), diabetes (24%), history of CHD in a first-degree relative (26%), TC:HDL >6 (14%), peripheral vascular disease (5%), left ventricular hypertrophy (14%), prior cerebrovascular event (10%), specific ECG abnormality (14%), proteinuria/albuminuria (62%) Atorvastatin calcium significantly reduced the rate of coronary events [either fatal coronary heart disease (46 events in the placebo group vs. 40 events in the atorvastatin calcium group) or non-fatal MI (108 events in the placebo group vs 60 events in the atorvastatin calcium group)] with a relative risk reduction of 36% [(based on incidences of 1.9% for atorvastatin calcium vs. 3% for placebo), p=0. 0005

The pathogenesis of cardiovascular disease involves the development of atherosclerosis, which is the buildup of plaque in the arteries, leading to their hardening and narrowing. This process is influenced by various risk factors, including:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Family history of heart disease
• Obesity
• Physical inactivity
• Unhealthy diet

The signs and symptoms of cardiovascular disease may include:

• Chest pain or discomfort
• Shortness of breath
• Pain or weakness in the arms or legs
• Fatigue
• Swelling in the legs or feet

The risk factors for cardiovascular disease are:

• Male gender
• Age >55 years
• Smoking
• Diabetes
• History of CHD in a first-degree relative
• High cholesterol
• High blood pressure
• Peripheral vascular disease
• Left ventricular hypertrophy
• Prior cerebrovascular event
• Specific ECG abnormality
• Proteinuria/albuminuria 2 2

From the Research

Common Disorders/Diseases Relating to the Cardiovascular System

• Cardiovascular diseases (CVDs) are the leading cause of premature death and disability in humans, with a substantial contribution to the escalating costs of health care 3.
• The underlying pathogenesis and progression associated with nearly all CVDs are predominantly of atherosclerotic origin, leading to the development of coronary artery disease, cerebrovascular disease, venous thromboembolism, and peripheral vascular disease 3.

Pathogenesis/Pathophysiology

• The aetiological risk factors leading to the onset of CVDs include hyperlipidaemia, hypertension, diabetes, obesity, smoking, and lack of physical activity, which collectively represent more than 90% of the CVD risks in all epidemiological studies 3.
• High blood pressure is a major modifiable risk factor for all clinical manifestations of coronary artery disease (CAD) 4.
• The pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion 4.

Signs and Symptoms

• The signs and symptoms of CVDs include myocardial infarction, cardiac arrhythmias, and stroke 3.
• The relationship between diastolic blood pressure and CAD is strongest in younger and middle-aged people, while pulse pressure shows the strongest direct relationship with CAD in people above 60 years of age 4.

Risk Factors

• Hyperlipidaemia is an independent predictor of many cardiovascular and cerebrovascular events, and its reduction can decrease the risk of vascular diseases 5.
• Alcohol consumption can have both harmful and beneficial effects on the cardiovascular system, with low-to-moderate consumption associated with a decrease in cardiovascular events and mortality, while high consumption increases the incidence of total and cardiovascular mortality, coronary and peripheral artery disease, heart failure, stroke, hypertension, dyslipidaemia, and diabetes mellitus 6.
• Other risk factors for CVDs include hypertension, diabetes, obesity, smoking, and lack of physical activity 3.