What is cardiovascular disease?

What is Cardiovascular Disease?

Cardiovascular disease (CVD) is a broad term encompassing conditions that affect the heart and blood vessels, primarily caused by atherosclerotic processes that lead to coronary heart disease, cerebrovascular disease, and peripheral vascular disease, resulting in significant morbidity and mortality worldwide. 1

Definition and Scope

Cardiovascular disease includes several related conditions:

• Coronary artery disease (CAD): The most common clinical manifestation of atherosclerosis, presenting as:

  • Sudden cardiac death (often the first manifestation)
  • Acute myocardial infarction
  • Unstable angina
  • Exertional angina 1

• Cerebrovascular disease: Manifesting as:

  • Transient ischemic attacks
  • Ischemic stroke
  • Hemorrhagic stroke 1

• Peripheral vascular disease: Including:

  • Aneurysmal dilatation of the aorta
  • Aortic dissection
  • Progressive ischemia of lower limbs ("intermittent claudication") 1

Pathophysiology

The underlying pathogenesis of most CVDs is predominantly atherosclerotic in origin 2. This process involves:

1. Development of atherosclerotic plaques in arterial walls
2. Progressive narrowing of blood vessels
3. Potential plaque rupture leading to thrombosis
4. Obstruction of blood flow resulting in tissue ischemia and damage

In women, there is a higher proportion of acute coronary syndrome caused by plaque erosion, coronary microvascular dysfunction, coronary vasospasm, spontaneous coronary artery dissection, or Takotsubo cardiomyopathy compared to classical plaque rupture 1.

Epidemiology and Impact

CVD is the leading cause of morbidity and mortality globally:

• Accounts for 1 in 3 deaths among adults 1
• Approximately 80% of CVD-related deaths now occur in low- and middle-income countries 3
• Rising incidence in developing countries while declining in many industrialized nations 4
• Creates significant socioeconomic burden through healthcare costs and lost productivity 2

Risk Factors

Major modifiable risk factors for CVD include:

• Dyslipidemia (abnormal blood lipid levels)
• Hypertension
• Diabetes mellitus
• Smoking
• Obesity
• Physical inactivity 1, 2

These risk factors collectively represent more than 90% of CVD risks in epidemiological studies 2.

Clinical Presentation

CVD can present with various symptoms depending on the affected vascular territory:

• Coronary artery disease: Chest pain, dyspnea, fatigue

  • Women more often describe atypical symptoms such as indigestion, epigastric pain, shoulder/arm/back pain, or weakness 1

• Cerebrovascular disease: Neurological deficits, speech disturbances, visual changes, weakness

• Peripheral vascular disease: Claudication, pain with walking, tissue ischemia

Prevention and Management

The prevention and management of CVD involves:

1. Risk assessment: Using validated tools to estimate 10-year CVD risk 1

2. Lifestyle modifications:

   • Heart-healthy diet
   • Regular physical activity
   • Smoking cessation
   • Weight management 2

3. Pharmacological interventions:

   • Statins for dyslipidemia
   • Antihypertensive medications
   • Antiplatelet agents
   • Anticoagulants when indicated 5, 2

4. Surgical interventions: For advanced disease or acute events

Special Considerations

CVD in Women

Women may experience different presentations and outcomes:

• More atypical symptoms
• Higher mortality after myocardial infarction even after adjusting for baseline characteristics
• Less obstructive coronary artery disease on angiography but worse outcomes 1

Risk Continuum Approach

Prevention of CVD should be considered as a continuum from low to high risk:

• Highest risk: Patients with clinically manifest CVD
• Intermediate to high risk: Individuals with multiple risk factors
• Lower risk: Individuals with fewer risk factors but still requiring preventive measures 1

Comorbidities

The presence of comorbidities significantly impacts CVD management and outcomes, requiring tailored approaches to treatment 1.