What Constitutes Cardiovascular Disease
Cardiovascular disease (CVD) is a broad term encompassing atherosclerotic conditions affecting the heart and blood vessels, including coronary heart disease (manifested by myocardial infarction), cerebrovascular disease (manifested by stroke), peripheral arterial disease, and heart failure. 1
Core Disease Categories
CVD comprises several distinct but related conditions:
Coronary heart disease (CHD): The most common clinical manifestation of atherosclerosis, accounting for the majority of CVD patients and presenting as sudden cardiac death, acute myocardial infarction, unstable angina, or exertional angina 1
Cerebrovascular disease: Ultimately manifested by ischemic or hemorrhagic stroke, with approximately 610,000 new cases annually in the United States 1
Peripheral arterial disease: Atherosclerotic involvement of peripheral arteries, strongly correlated with disease severity in other arterial territories 1
Heart failure: Affects 36% of patients with ischemic heart disease and represents a major manifestation of advanced CVD 2, 3
Pathophysiologic Foundation
The underlying pathogenesis of nearly all CVDs is predominantly atherosclerotic in origin:
Atherosclerosis is a specific type of arteriosclerosis characterized by intimal lesions (atheromata or fibrofatty plaques) and represents an inflammatory disease process beginning with lipid accumulation in the arterial wall 4, 5
Arteriosclerosis is the broader progressive condition involving increased arterial stiffness, measurable through pulse-wave velocity, and associated with increased systolic blood pressure and pulse pressure 4
Population-based autopsy studies demonstrate strong correlation between atherosclerosis severity in one arterial territory and involvement of other arterial beds, explaining why no distinction needs to be made between CHD and other forms of atherosclerosis for prevention purposes 1
Clinical Manifestations Beyond Atherosclerosis
While atherosclerosis dominates, CVD also includes:
Cardiomyopathies: Dilated, hypertrophic, restrictive, and arrhythmogenic forms, all observed in elderly populations 6
Valvular heart disease: Including rheumatic heart disease, aortic stenosis from dystrophic calcification, mitral valve prolapse, and degenerative valve disorders 7, 6
Cardiac arrhythmias: Atrial fibrillation, ventricular arrhythmias, and conduction system disease, often occurring as manifestations of hypertensive heart disease 8
Congenital heart defects: Structural abnormalities present from birth 7
Epidemiologic Impact
CVD represents the leading cause of morbidity and mortality:
Accounts for 1 of every 3 deaths among adults in the United States (approximately 38.5% of all deaths, totaling over 930,000 deaths annually) 1
Annual incidence includes 580,000 new myocardial infarctions and 610,000 new strokes 1
Prevalent cases exceed 64 million Americans with CVD 1
Total costs exceed $351.8 billion annually in direct and indirect expenses 1
Common Pitfall to Avoid
Do not confuse CVD with isolated risk factors—CVD refers to established disease manifestations (MI, stroke, heart failure, peripheral arterial disease), not simply the presence of risk factors like hypertension, diabetes, or dyslipidemia alone 1. Patients with only risk factors but no symptomatic disease are candidates for primary prevention, while those with established CVD require secondary prevention strategies 1.