What is cardiovascular disease and how common is it?

Cardiovascular disease (CVD) is a group of conditions that affect the heart and blood vessels. It is one of the leading causes of death worldwide. CVD includes coronary artery disease (CAD), heart failure, peripheral artery disease, and stroke, among others.

How is angina pain relieved with nitrates such as nitroglycerin?

Nitrate pills such as nitroglycerin are vasodilators that work by relaxing the blood vessels, particularly those in the heart. When taken during an episode of angina or chest pain, nitrate pills can help to increase blood flow to the heart, relieve symptoms of chest pain, and prevent further complications. Nitrate pills are often used as a part of the treatment plan for angina and other cardiovascular conditions.

The most common symptoms of CVD include chest pain or discomfort, shortness of breath, palpitations, weakness or fatigue, dizziness or lightheadedness, and swelling in the legs or ankles. In advanced stages, symptoms can include difficulty breathing, extreme fatigue, confusion, and chest pain at rest.

There are many genes that can affect cardiovascular health and contribute to cardiovascular disease. Some of the most well-known cardiogenic genes include:

1. ACE (angiotensin-converting enzyme) gene: This gene is involved in regulating blood pressure and the renin-angiotensin-aldosterone system. Variations in this gene can affect blood pressure regulation and increase the risk of hypertension and cardiovascular disease.
2. APOE (apolipoprotein E) gene: This gene is involved in cholesterol metabolism and can influence the development of atherosclerosis and cardiovascular disease. Variations in this gene can affect cholesterol levels and increase the risk of heart disease.
3. FTO (fat mass and obesity-associated) gene: This gene is involved in regulating energy balance and metabolism. Variations in this gene can increase the risk of obesity, which is a major risk factor for cardiovascular disease.
4. MTHFR (methylenetetrahydrofolate reductase) gene: This gene is involved in folate metabolism and can affect homocysteine levels in the blood. High levels of homocysteine are a risk factor for cardiovascular disease, and variations in this gene can affect homocysteine levels.
5. SCN5A (sodium channel, voltage-gated, type V, alpha subunit) gene: This gene is involved in regulating the electrical activity of the heart. Variations in this gene can affect the risk of arrhythmias and sudden cardiac death.
6. TNNT2 (troponin T type 2) gene: This gene is involved in muscle contraction in the heart. Variations in this gene can affect the risk of cardiomyopathy and heart failure.

There are many other genes that can affect cardiovascular health and contribute to cardiovascular disease, and researchers continue to identify new cardiogenic genes through genetic studies and genome-wide association studies.

Heart failure is a condition where the heart is unable to pump enough blood to meet the body’s needs. Symptoms include shortness of breath, fatigue, swelling in the legs, ankles, or abdomen, and persistent coughing or wheezing.

Ischemic heart disease is a type of heart disease that is caused by reduced blood flow to the heart. Myocardial infarction (MI), commonly known as a heart attack, is a type of ischemic heart disease. Symptoms of MI include chest pain or discomfort, shortness of breath, nausea or vomiting, cold sweat, and lightheadedness.

Advanced cardiovascular disease can affect different parts of the body and can cause a variety of symptoms. Some of the most common symptoms of advanced cardiovascular disease include:

1. Chest pain or angina: This can be a sign of reduced blood flow to the heart and is a common symptom of advanced coronary artery disease.
2. Shortness of breath: This can occur due to fluid buildup in the lungs or a weakened heart muscle, which are common in advanced heart failure.
3. Swelling in the legs and ankles: This can occur due to fluid buildup, which is a common symptom of advanced heart failure.
4. Fatigue: This can occur due to a decreased ability of the heart to pump blood to the body, which is common in advanced heart failure.
5. Irregular heartbeats or arrhythmias: This can be a sign of an electrical problem in the heart and is common in advanced cardiovascular disease.
6. Dizziness or lightheadedness: This can occur due to a decrease in blood flow to the brain, which is common in advanced cardiovascular disease.
7. Nausea or vomiting: This can occur due to the stress that advanced cardiovascular disease places on the body.

It is important to note that these symptoms can also be caused by other medical conditions, so it is important to see a healthcare provider for a proper diagnosis and treatment.

Hypertensive heart disease is a condition where high blood pressure causes damage to the heart muscle and blood vessels. Symptoms of hypertension may include headaches, shortness of breath, chest pain, and nosebleeds.

Hypotensive heart disease is a condition where low blood pressure causes damage to the heart muscle and blood vessels. Symptoms may include dizziness, fainting, blurred vision, and fatigue.

Atherosclerosis is a condition where plaque builds up in the arteries, causing them to become narrowed and hardened. Risk factors for atherosclerosis include high blood pressure, high cholesterol, smoking, diabetes, and a family history of heart disease.

The time it takes to develop a stroke after initial symptoms can vary, but it is important to seek immediate medical attention if you experience symptoms such as sudden weakness or numbness on one side of the body, difficulty speaking or understanding speech, sudden vision changes, dizziness or loss of balance, and severe headache.

Top 10 cardiovascular conditions with the highest mortality rate include coronary artery disease, stroke, heart failure, hypertensive heart disease, cardiomyopathy, aortic aneurysm, peripheral artery disease, rheumatic heart disease, pulmonary embolism, and endocarditis.

Top 10 cardiovascular conditions with a high cure rate include congenital heart disease, arrhythmia, valvular heart disease, Kawasaki disease, myocarditis, pericarditis, heart tumors, aortic valve stenosis, atrial septal defect, and ventricular septal defect.

Novel cardiovascular treatments include gene therapy, stem cell therapy, and new drug therapies, such as PCSK9 inhibitors.

Common treatments for CVD include lifestyle changes such as quitting smoking, eating a healthy diet, and getting regular exercise, as well as medications such as aspirin, statins, and blood pressure medications. In some cases, procedures such as angioplasty or bypass surgery may be necessary.

Novel drugs that can be used to prevent cardiovascular disease include PCSK9 inhibitors, which help to lower LDL cholesterol levels, and anticoagulant medications, which help to prevent blood clots.

Common screening tests used to early detect or diagnose cardiovascular disease include blood pressure measurements, cholesterol level tests, electrocardiograms, and stress tests.

Atherosclerosis occurs when the walls of arteries become thick and stiff due to the buildup of fatty deposits, cholesterol, and other substances called plaques. The exact cause of atherosclerosis is not known, but certain factors can contribute to its development, including high blood pressure, high cholesterol levels, smoking, diabetes, and a family history of the condition.

When the inner lining of an artery is damaged, white blood cells and other substances begin to accumulate at the site, forming a plaque. Over time, the plaque can grow, making the artery narrower and reducing blood flow to the affected area. In some cases, the plaque can rupture or break off, causing a blood clot to form that can block the artery and cause a heart attack or stroke.

Atherosclerosis can affect any artery in the body, but it is most commonly associated with the arteries that supply blood to the heart, brain, and legs.

Atherosclerosis is classified based on the location of the plaque buildup, such as coronary artery disease, carotid artery disease, or peripheral artery disease.

The treatment of atherosclerosis involves a combination of lifestyle changes, medications, and medical procedures. The goal of treatment is to prevent the progression of the disease, reduce the risk of complications, and improve symptoms.

Treatment for atherosclerosis may include lifestyle changes, such as quitting smoking, eating a healthy diet, and getting regular exercise, as well as medications to lower cholesterol levels or blood pressure.

1. Lifestyle changes: Lifestyle changes play a key role in the management of atherosclerosis. These include:

• Eating a healthy and balanced diet
• Engaging in regular physical activity
• Quitting smoking
• Maintaining a healthy weight
• Managing stress
• Controlling high blood pressure, high cholesterol, and diabetes

2. Medications: Several medications are used to manage atherosclerosis, including:

• Cholesterol-lowering medications (statins, bile acid sequestrants, niacin, fibrates, etc.)
• Blood pressure medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, etc.)
• Antiplatelet medications (aspirin, clopidogrel, etc.)
• Blood sugar-lowering medications (metformin, insulin, etc.)
• Medications to manage symptoms (nitroglycerin, calcium channel blockers, etc.)

3. Medical procedures: In some cases, medical procedures may be necessary to treat atherosclerosis. These include:

• Angioplasty and stenting: This involves using a balloon catheter to widen the narrowed artery and a stent to keep it open.
• Coronary artery bypass surgery: This involves creating a bypass around the blocked part of the artery using a blood vessel from another part of the body.
• Endarterectomy: This involves surgically removing the plaque from the artery.

The treatment of atherosclerosis is individualized and depends on several factors, including the severity and location of the disease, the presence of other medical conditions, and the overall health of the patient. It is important to work closely with a healthcare provider to develop an appropriate treatment plan.

PCSK9 is a protein that plays a key role in regulating the level of low-density lipoprotein (LDL) cholesterol in the bloodstream. It binds to the LDL receptor on liver cells, causing the receptor to be broken down and reducing the liver’s ability to remove LDL cholesterol from the bloodstream. This can lead to the buildup of LDL cholesterol in the arteries, which is a major risk factor for atherosclerosis and cardiovascular disease. Inhibiting the activity of PCSK9 can help to lower LDL cholesterol levels and reduce the risk of cardiovascular events.

Top 10 PCSK9 inhibitors:

1. Evolocumab (Repatha)
2. Alirocumab (Praluent)
3. Bococizumab (RN316)
4. LY3015014
5. Bococizumab (PF-04950615)
6. RG7652 (MPSK3169A), a fully human IgG1 monoclonal antibody against PCSK9
7. REGN-727 (Alirocumab), a human monoclonal antibody inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9)
8. SAR236553/REGN727
9. CSL-112

Common diuretics:

1. Furosemide (Lasix)
2. Hydrochlorothiazide (Microzide)
3. Chlorthalidone (Thalitone)
4. Spironolactone (Aldactone)
5. Bumetanide (Bumex)
6. Torsemide (Demadex)
7. Amiloride (Midamor)
8. Triamterene (Dyrenium)

Common proton pump inhibitors:

1. Omeprazole (Prilosec)
2. Lansoprazole (Prevacid)
3. Esomeprazole (Nexium)
4. Pantoprazole (Protonix)
5. Rabeprazole (Aciphex)
6. Dexlansoprazole (Dexilant)

Common alpha blockers:

1. Doxazosin (Cardura)
2. Terazosin (Hytrin)
3. Tamsulosin (Flomax)
4. Alfuzosin (Uroxatral)
5. Silodosin (Rapaflo)

Verified by: Rami Diab (May 5, 2023)

Citation: Rami Diab. (May 5, 2023). What is cardiovascular disease and how common is it. Medcoi Journal of Medicine, 9(2). urn:medcoi:article22243.