Reducing Your Risk of Cardiovascular Disease
This section of the book contains four chapters that deal with diseases. Although uninformed people claim that “there is nothing you can do to avoid disease,” ample evidence indicates that positive personal health choices can help reduce your risk of developing many diseases, from cardiovascular disease treatment to cancer to sexually transmitted diseases, including HIV and AIDS.
In this chapter, we will explain what you can do to reduce your risk of developing cardiovascular diseases. Prevention efforts are most effective when started in childhood, but it is never too late to adopt a wellness lifestyle.
Quitting smoking, becoming physically active, following a nutritious, (See effective formula tips discussed low-calorie chicken recipes), and controlling your blood pressure are important ways of reducing your risk of heart disease and improving your overall health.
Real Life Real choices
Straight from the Heart: One Kid’s Story
- Name: Greg Chulick
- Age: 10
- Occupation: Student, boy Scout, Little Leaguer
“Enjoy being a kid — you’ll be a grown-up soon enough!”
If Greg Chulick had a nickel for every time he’s heard those words from an older relative, he’d be a lot closer to affording that Duke snider card at the baseball bonanza store downtown.
He knows there are a lot of great things about being his age: like lazy afternoons fishing for carp in the Criders’ pond, playing first base on the Little League team, and going on overnights with his scout troop.
Greg Chulick History
As much as he has going for him, though, right now Greg is terrified. Why? Because for the last 3 days he’s had a sore throat, and this morning it isn’t any better. Like most kids, Greg ordinarily tells one of his parents when he isn’t feeling well. But not this time.
If Greg were somebody else, a sore throat would be no bigger deal than a scrap, a bruise, or a belly-flop in the Y pool. But Greg isn’t somebody else: he’s the former big brother of Joey a chunky spunky 5-year-old who 3 years ago woke up one morning with a sore throat and a month later was buried in All Saints Cemetery.
Joey’s sore throat turned out to have been caused by an infection that wasn’t treated in time to prevent him from developing the disease that killed him-rheumatic fever.
Greg never talks about his little brother, because who would understand the hole in his life Joey left when he died?
Who but Greg shared a room with him, treaded secrets and jokes and kid crimes, helped him climb out on the roof one August night so they could watch a meteor shower while the rest of the family slept?
And now it’s Greg’s turn. He’s got the sore throat that won’t go away, the sore throat that isn’t just any sore throat, except that’s what everyone thought Joey had…
As you study this chapter, think about what Greg is experiencing and prepare yourself to answer the question in Your Turn at the end of the chapter.
Great progress has been made with respect to CVD the focus of this chapter. Although heart disease continues to be the number one killer of Americans, between 1984 and 1994 the death rates from CVD declined 22.4 percent.
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Greg Chulick Treatment
The American Heart Association, in its 1997 Heart and Stroke Facts, credits this reduction to a combination of (a) prevention-oriented education programs that lead to lifestyle changes and (b) medical advances in the diagnosis and treatment of CVD. Interestingly, if all forms of cardiovascular disease were eliminated life expectancy in the U.S would increase by almost ten years.
This chapter provides material to help you understand how the heart works. Beyond this, it will help you identify your CVD risk factors and suggest ways you can alter certain lifestyle behaviors to reduce your risk of developing heart disease.
Prevalence of Cardiovascular Disease
Cardiovascular disease is directly related to more than 40 percent of deaths in the United States and indirectly related to a large percentage of additional deaths1. Fortunately, the rate of deaths from coronary heart disease has been falling. The decrease averaged 3 percent during the 1980s, but the decrease has slowed to 2.6 percent in the 1990s (Figure 10-1 and Table 10-1)3.
Normal Cardiovascular Function
The cardiovascular system, also called the circulatory system, uses a muscular pump to send a complex fluid on a continuous trip through a closed system of tubes. The pump is the heart, the fluid is blood, and the closed system of tubes is the network of blood vessels.
The Vascular System
The term vascular system refers to the body’s blood vessels. Although we might be familiar with the arteries (vessels that carry blood away from the heart) and the veins (vessels that carry blood to the heart), arterioles, capillaries, and venules are also part of the vascular system.
Arterioles are the further, smaller-diameter extensions of arteries. These arterioles lead eventually to capillaries, the smallest extensions of the vascular system.
After the blood leaves the capillaries and beings its return to the heart, it drains into small veins or venules. The blood in the venules flows into increasingly larger vessels called veins. Blood pressure is highest in arteries and lowest in veins, especially the largest veins, which empty into the right atrium of the heart.
|Cardiovascular Disease||Estimated Prevalence of Major|
|Coronary heart disease||11,200,000|
|Congenital heart disease||950,000|
|Rheumatic heart disease||1,350,000|
*58,920,000 people total. The sum of the individual estimates exceeds 58,920,000 because so many have more than one cardiovascular disorder.
The heart does not lie completely in the center of the chest. Rather, approximately two-thirds of the heart is to the left of the body midline and one third is to the right.4
Two upper chambers called atria, and two lower chambers, called ventricles, from the heart. Study Figure 10-2 and follow the flow of blood through the heart’s four chambers.
To function well, the heart muscle must receive adequate amounts of oxygen. The two main coronary arteries ( and their many branches) accomplish this. These arteries are located outside of the heart. If the coronary arteries are diseased and not functioning well, a heart attack is possible.
The heart contracts and relaxes through the delicate interplay of cardiac muscle tissue and cardiac electrical centers, called nodes.
Cardiovascular Pertaining to the heart (cardio) and blood vessels (vascular)
thorax the chest; the portion of the torso above the diaphragm and within the rib cage.
Coronary arteries vessels that supply oxygenated blood to heart muscle tissues.
Cardiac muscle specialized smooth muscle tissue that forms the middle (muscular) layer of the heart wall.
Figure 10-2 The heart functions as a complex double pump. The right side of the heart pumps deoxygenated blood to the lungs. The left side of the heart pumps oxygenated blood through the aorta to all parts of the body. Note the thickness of the walls of the ventricles. These are the primary pumping chambers.
The average-sized adult has approximate six quarts of blood in his or her circulatory system. Blood’s functions, which are performed continuously, are quite similar to the overall functions of the circulatory system and include the following:
- Transportation of nutrients, oxygen, wastes, hormones, and enzymes
- Regulation of water content of body cells and fluids
- Buffering to help maintain the appropriate pH balance of body fluids
- Regulation of body temperature: the water component in the blood absorbs heat and transfers it
- Prevention of blood loss; by coagulating or clotting, the blood can alter its form to prevent blood loss through injured vessels
- Protection against toxins and microorganisms, accomplished by chemical substances called antibodies and specialized cellular elements circulating in the bloodstream.
Cardiovascular Disease Risk Factors
As you have just read, the heart and blood vessels are among the most important structures in the human body. By protecting your cardiovascular system, you lay the groundwork for a more exciting, productive, and energetic life.
The best time to start protecting and improving your cardiovascular system is early in life when lifestyle patterns are developed and reinforced. Of course, it is difficult to move backward through time, so the second-best time to start protecting your heart is today.
Improvements in certain lifestyle activities can pay significant dividends as your life unfolds.
Complete the personal Assessment to estimate your risk for heart disease
The American Heart Association encourages people to protect and enhance their heart health by examining the ten cardiovascular risk factories that are related to various forms of heart disease.
A cardiovascular risk factor is an attribute that a person has or is exposed to that increases the likelihood that he or she will develop some forms of heart disease.
Three risk factors are ones you will be unable to change. An additional four risk factors are ones you can clearly change. Three final risk factors are ones that are thought to be contributing factors to heart disease. These risk factors are summarized in the Star Box on page 303. Let’s look at these three groups of risk factors separately.
Risk Factors That Cannot Be Changed
The three risk factors that you cannot change are increasing age, male gender, and heredity. Despite the fact that these risk factors cannot be changed, your knowledge that they might be an influence in your life should encourage you to make a more serious commitment to the risk factors you can change.
Prevention of Heart Disease Begins in Childhood
For many aspects of wellness, preventive behaviors are often best learned in childhood, where they can be repeated and reinforced by family members and caregivers.
This is especially true for behaviors to prevent heart disease. Although many problems related to heart disease are seen most frequently at midlife and beyond, the roots of heart disease start early in life.
For example, researchers studying children and using autopsies have found that hypertension, or high blood pressure, begins in early childhood. Intervention programs that target children have been shown to be effective in preventing hypertensive cardiovascular disease.28
Likewise, atherosclerotic cardiovascular disease, the type of disease that can result in heart attacks, reaches substantial levels in men beginning at age 45 and in women at age 55, but the disease has its onset in childhood.
The disease progresses according to each individual’s level of risk factors.
That is, the unhealthier the person’s lifestyle, with behaviors such as smoking, lack of exercise, or poor diet, the more quickly the disease develops.
So, we now know that efforts to promote cardiovascular health in childhood can have a dramatic effect after the child grows up. In response, experts have identified five major areas as targets for cardiovascular health promotion in childhood: obesity, cardiovascular fitness, hypertension, hypercholesterolemia (high blood levels of cholesterol), and smoking prevention.25
Get Started Prevent of Heart Disease
Sadly, the present state of health of America’s youth shows severe deficiencies in these areas. Children’s diets lack nutrient density and remain alarmingly high in overall fat. Teenage children are becoming increasingly overweight and obese.
Studies consistently show a deterioration in the amount of physical activity by today’s youth, as television and video games have become the after-school companions for large numbers of children. sadly, cigarette smoking continues to rise among schoolchildren, especially teenagers.
These unhealthy behaviors are lying the foundation for coronary artery disease, hypertension, and stroke in the future.
Programs that seek to instill healthy behaviors in children can have a real benefit. One study found that, of all children, those most at risk of cardiovascular disease also showed the greatest benefits from lifestyle intervention programs. The study found the greatest benefit in two types of programs: improving home nutrition and improving fitness.27
those of us who are parents must make better efforts to encourage our children to eat more nutritiously and be physically active. We can discourage cigarette use. Perhaps the best thing all adults can do for our youth is to set a good example by adopting our own heart-healthy behaviors. Following the Food Guide Pyramid and exercising regularly are excellent strategies that can be started early in life.
Physical inactivity and a poor diet can set the stage for heart disease later in life.
Heart disease tends to develop gradually over the course of one’s life. Although we may know of a person or two who experienced a heart attack in their thirties or forties, most of the serious consequences of heart disease become evident as we age. For example, nearly 85 percent of people who die from a heart attack are aged sixty-five and older.
Young men have a greater risk of heart disease than young women. Yet when women move through menopause (typically in their fifties), their rates of heart disease become similar to men’s rates. It is thought that women are somewhat more protected from heart disease than men because of their natural production of the hormone estrogen during their fertile years.
Obviously, you have no input in determining who your biological parents are. Like increasing age and male gender, this risk factor cannot be changed. By the luck of the draw, some people are born into families where heart disease has never been a serious problem, whereas others are born into families where heart disease is quite prevalent.
In this latter case, children are said to have a genetic predisposition (tendency) to develop heart disease as they grow and develop throughout their lives. These people have every reason to be highly motivated to reduce the risk factors they can control.
The race is also a consideration related to heart disease. African-Americans have moderately high blood pressure at rates twice that of whites and severe hypertension at rates three times higher than whites1 (for a detailed discussion of healthy high protein foods topic, see the Topics for today article).
Hypertension significantly increases the risk of both heart disease and stroke. Fortunately, as you will soon read, hypertension can be controlled through a variety of methods. It is especially important for African-Americans to take advantage of every opportunity to have their blood pressure measured so that preventive actions can be started immediately if necessary.
What Is Your Risk for Heart Disease
|Your serum cholesterol level is:||Your HDL cholesterol is:|
|0-190 or below||2 Over 60|
|+ 2 191 to 230||0 45 to 60|
|+ 6 131 to 289||+ 2 35 to 44|
|+ 16 Over 320||+ 6 29 to 34|
|+ 16 Over 320||+ 16 Below 23|
You smoke now or have in the past:
- Never smoked, or quit more than 5 years ago
- +1 Quit 2 to 4 years ago
- +3 Quit about 1 year ago
- +6 Quit during the past year
- You now smoke:
- +9 ½ to 1 pack a day
- +12 1 to 2 packs a day
- +15 More than 2 packs a day
The quality of the air you breath is;
- Unpolluted by smoke, exhaust, or industry at home and at work
- +2 Live or work with smokers in the unpolluted area
- +4 Live and work with smokers in the unpolluted area
- +6 Live or work with smokers and live or work in an air-polluted area
- +8 Live and work with smokers and live and work in an air-polluted area
Your blood pressure is:
- 120/75 or below
- +2 120/75 to 140/85
- +6 140/85 to 150/90
- +8 150/90 to 175/100
- +10 175/100 to 190/110
- +12 190/110 or above
Your exercise habits are:
- Exercise vigorously 4 or 5 times a week
- +2 Exercise moderately 4 or 5 times a week
- +4 Exercise only on weekends
- +6 Exercise occasionally
- +8 Little or no exercise
Your weight is:
- Always or near ideal weight
- +1 Now 10% overweight
- +2 Now 20% overweight
- +3 Now 30% or more overweight
- +4 Now 205 or more overweight and have been since before age 30
You feel overstressed :
- Rarely at work or at home
- +3 Somewhat at home but not at work
- +5 Somewhat at work but not at home
- +7 Somewhat at work and at home
- +9 Usually at work or at home
- +12 Usually at work and at home
Your diabetic history is:
- Blood sugar always normal
- +2 Blood glucose slightly high (prediabetic) or slightly low (hypoglycemic)
- +4 Diabetic beginning after age 40 requiring strict dietary or insulin control
- +5 Diabetic beginning before age 30 requiring strict dietary or insulin control
You drink alcohol beverages:
- Never or only socially, about once or twice a month, or only one 5-ounce glass of wine or 12-ounce glass of beer or ½ -ounce3 of hard liquor about 5 times a week
- +2 Two to three 5-ounce glasses of wine or 12-ounce glasses of beer or ½ -ounce cocktails about 5 times a week
- +4 More than three 1 ½ -ounce cocktails or more than tree 5-ounce glasses of wine or 12-ounce glasses or beer almost every day
Add all sources and check below
- 0 to 20: Low risk. Excellent family history and lifestyle habits.
- 21 to 50: Moderate risk. Family history or lifestyle habits put you at some risk. You might lower your risks and minimize your genetic predisposition if you change any poor habits.
- 51 to 74: High risk. Habits and family history indicate a high risk of heart disease. Change your habits now.
- Above 75: Very high risk. Family history and a lifetime of poor habits put you at very high risk of heart disease. Eliminate as many of the risk factors as you can.
To carry This Further. . . . .
Were you surprised by your score on this assessment? What were your most significant risk factors? Do you plan to make any changes in your lifestyle to reduce your cardiovascular risks? Why or why not?
Risk Factors for Cardiovascular Disease
Factors That Cannot Be Changed
- Increasing age
- Male gender
Factors That Can be Changed (“Big Four” Risk Factors)
- Physical inactivity
- High blood cholesterol level
- High blood pressure
- Individual response to stress
Risk factors That Can be Changed
Four cardiovascular risk factors are influenced, in large part, by our lifestyle choices. These risk factors are smoking, physical inactivity, high blood cholesterol levels, and high blood pressure. Healthful behavior changes you make concerning these four risk factors can help you protect and strengthen your cardiovascular system.
Although the other three controllable risk factors are important, this one may the most critical risk factor. Smokers have a heart attack risk that is more than twice that of nonsmokers. Smoking cigarettes is a major risk factor associated with sudden cardiac death.
In fact, smokers have two to four times the risk of dying from sudden cardiac arrest than nonsmokers. Smokers who experience a heart attack are more likely to die suddenly (within an hour) than those who don’t smoke.
Smoking also adversely affects nonsmokers who are exposed to environmental tobacco smoke. Studies suggest that the risk of death caused by heart disease is increased by about 30 percent in people exposed to secondhand smoke in the home.
The risk of death caused by heart disease may even be higher in people exposed to environmental tobacco smoke in work settings (for example, bars, casinos, enclosed offices, some bowling alleys and restaurants), since higher levels of smoking may be present at work than at home.
Because of the health threat to nonsmokers, restrictions on indoor smoking in public areas and business settings are increasing tremendously in every part of the country.
For years it was commonly believed that if you had smoked for many years, it was pointless to try to quit; the damage to one’s health could never be reversed.
however, the American Heart Association now indicates that by quitting smoking, regardless of how long or how much you have smoked, your risk of heart disease declines rapidly. For people who have smoked a pack or less of cigarettes per day, within three years after quitting smoking, their heart disease risk is virtually the same as those who never smoked.2
This news is exciting and should encourage people to quit smoking, regardless of how long they have smoked.
Of course, if you have started to smoke, the healthy approach would be to quit now. . . . before the nicotine controls your life and damages your heart.
Lack of exercise is a significant risk factor for heart disease. Regular aerobic exercise (discussed in physical fitness exercises) helps strengthen the heart muscle, maintain healthy blood vessels, and improve the ability of the vascular system to transfer blood and oxygen to all parts of the body.
In addition, physical activity helps lower overall blood cholesterol levels for most people, encourage weight loss and retention of lean muscle mass, and allows people to moderate the stress in their lives.
With all the benefits that come with physical activity, it amazes health professionals that so many Americans refuse to participate in regular exercise. Perhaps people feel that they do not have enough time or that they must work out strenuously.
However, you will recall from more also physical fitness programs that only twenty to sixty minutes of moderate aerobic activity three to five times each week is recommended. This is not a large price to pay for a lifetime of cardiovascular health. Find a partner and get started!
If you are middle-aged or older and have been inactive, you should consult with a physician before starting an exercise program. Also, if you have any known health condition that could be aggravated by physical activity, check with a physician first. Regular exercise helps strengthen the heart muscle and lower overall blood cholesterol.
Women and Heart Disease
Do you think heart disease is a problem just men? You might be surprised to discover that data from the American Heart Association indicate that 52 percent of all cardiovascular disease deaths are in women.
There are 20,800 women under age 65 who die from coronary artery disease who are under age 55. In addition, 44 percent of women who have a heart attack will die within I year, compared with 27 percent of men.
A total of 60 percent of the death from stroke and high blood pressure are in women, compared with 40 percent in men.
Women who smoke and also take oral contraceptives are 39 times more likely to have a heart attack and 22 times more likely to have a stroke than women who neither smoke nor use oral contraceptives6.
For many years, it was thought that men were at much greater risk than women for the development of cardiovascular problems. It is now known that younger men are more prone to heart disease than young women. Yet once women reach menopause (usually in their early to middle 50s), their rates of heart-related problems quickly equal those of men.
Among people having heart attacks, one study found the drug TPA to save 17 lives per 1,000 women and 7 per 1,000 men7. TPA benefits women more than men because women are at greater risk of dying from their attacks.
Best Women Heart Disease
The study also found that women delayed seeking treatment for their heart attack 18 minutes longer than men, and once they were in the hospital, doctors took longer to treat women. In both cases, the study suggested the reason may be that women may not recognize the symptoms of a heart attack.
Women often experience abdominal pain and fatigue with chest pain. For a look at the differences in the way women and men are diagnosed and treated in cases of cardiovascular disease, see diabetes in cardiovascular disease on amazon products.
The protective mechanism for young women seems to be the female hormone estrogen. Estrogen appears to help women maintain a beneficial profile of blood fats.
When the production of estrogen is severely reduced at menopause, this protective factor no longer exists. This is one of the reasons that the increasing number of physicians are prescribing estrogen replacement therapy (ERT) for many postmenopausal women.
Of course, young women should not rely solely on naturally produced estrogen to prevent heart disease.
The general recommendations for maintaining heart health through a good diet, adequate physical activity, monitoring blood pressure and cholesterol levels, controlling weight, avoiding smoking, and managing stress will benefit women at every stage of life.
Do Women Receive Equal Treatment in Cardiovascular Disease?
The short answer is no; women do not receive the same level of diagnosis or treatment for cardiovascular disorders as do men. In addition, the procedures and therapies we currently use were developed predominantly or completely for men.24
Researchers report that the history of medicine shows a disregard for women’s health problems that may prevail even today. Women are older and sicker when they have cardiovascular treatments such as angioplasty or bypass grafting, and they receive far fewer heart transplants.
These differences may be a result of the difference in the way women experience cardiac symptoms. For example, women often experience abdominal pain and fatigue with chest pain. Other possibilities are problems in the referrals women receive, or in the way women perceive themselves and their illness.
In response, the medical professional is now attempting to provide equitable health care for women and to conduct research that will describe women’s cardiac symptoms and their responses to cardiovascular treatments.
High Blood Cholesterol
The third controllable risk factor for heart disease is high blood cholesterol levels. Generally speaking, the higher the blood cholesterol level, the greater the risk for heart disease.
Fortunately, blood cholesterol levels are relatively easy to measure. Many campus health and wellness centers provide cholesterol screenings for employees and students.
These screenings help identify people whose cholesterol levels (or profiles) may be dangerous. Medical professionals have been unable to determine the link between a person’s diet and his or her cholesterol levels.
People with high blood cholesterol levels are encouraged to consume a heart-healthy diet (see prevent diabetes food) and to become physically active. In recent years, researchers have developed a variety of drugs that is very effective at lowering cholesterol levels.
Hormone Replacement Therapy Gains Popularity
Although coronary artery disease is the main cause of death and disease in both gender, fertile women enjoy a lower risk. This advantage mostly disappears when women move through menopause. Researchers believe that this relative advantage is due to the effects of women’s ovarian hormones.
As a result, physicians have prescribed hormone-replacement therapy to postmenopausal women over the past decade to attempt to continue this protection from cardiovascular disease.
The results strongly suggest that hormone-replacement therapy does, in fact, protect women against cardiovascular disease.22
We don’t know exactly how the hormone therapy works. The mechanism of action could be a reduction in lipid risk factors, that is, a decrease in blood levels of total and low-density lipoprotein cholesterol and increase in high-density lipoprotein cholesterol; an effect on blood vessel walls; or a reduction in the development of atherosclerosis, the accumulation of plaques on the interior of blood vessel walls.
Hormone Replacement Therapy
Researchers are studying the question. Besides reducing the risk of cardiovascular disease, hormone-replacement therapy has also been shown to reduce the risk of osteoporosis, improve quality of life, and increase life expectancy.23
Unfortunately, hormone-replacement might not be for all women. Experts disagree about the possible side effects of this therapy. In particular, women who have a history of estrogen-dependent gynecologic tumors or breast cancer must be evaluated on an individual basis, and these women must compare the potential benefits with the potential risks.
Of course, you should not consider hormone-replacement therapy a panacea for an unhealthy lifestyle. If you are a woman, you should also understand the benefits of exercise, weight control, breastfeeding, cessation of cigarette smoking, and moderation in the consumption of alcohol in reducing your risk of cancer, cardiovascular disease, and osteoporosis.
High Blood Pressure
The fourth of the four cardiovascular risk factors that can be changed is high blood pressure or hypertension.
High blood pressure can seriously damage a person’s heart and blood vessels. A high blood pressure diet causes the heart to work much harder eventually causing the heart to enlarge and weaken.
High blood pressure treatment increases the risk of stroke, heart attack, congestive heart failure, and kidney disease.
As you will soon see, this “silent killer” is easy to monitor and can be effectively controlled through a variety of approaches. This is a positive message about high blood pressure.
Other Risk Factors That Contribute to Heart Disease
The American Heart Association identifies three other risk factors that are associated with an increased risk of heart disease. These risk factors are diabetes, obesity, and individual response to stress.
Diabetes mellitus (discussed in detail in Chapter 12) is a debilitating chronic disease that has a significant effect on the human body. In addition to increasing the risk of developing kidney disease, blindness, and nerve damage, diabetes increases the likelihood of developing heart and blood vessel diseases. More than 80 percent of people with diabetes die of some type of heart or blood vessel disease.
With weight management, exercise, dietary changes, and drug therapy, diabetes can be relatively well controlled in most people. Despite careful management of this disease, diabetic patients remain quite susceptible to eventual heart and blood vessel damage.
Even if they have no other risk factors, obese people are more likely than nonobese people to develop heart disease and stroke. Obesity places considerable strain on the heart, and it tends to influence both blood pressure and blood cholesterol levels.
Also, obesity tends to trigger diabetes in predisposed people.2 maintaining body weight within a desirable range minimizes the chances of obesity ever happening. To accomplish this, you can elect to make a commitment to a reasonable sound diet and an active lifestyle.
Individual Response to Stress
Unresolved stress over a long period may be a contributing factor to the development of heart disease.
Certainly, people who are unable to cope with stressful life experiences are more likely to develop negative dependence behaviors ( for example, smoking, under activity, poor dietary practices) which can then lead to cardiovascular problems through changes in blood fat profiles, blood pressure, and heart workload.
Forms of Cardiovascular Disease
The American Heart Association describes the three major forms of CVD as coronary heart disease, hypertension, and stroke. These three diseases account for 70.7 percent of the deaths due to CVD.1 Additionally, many other disease can affect the heart and blood vessels, such as congenital heart disease, rheumatic heart disease, peripheral artery disease, congestive heart failure, and arrhythmias.
A person may have just one of these three diseases or a combination of forms at the same time. Each form exists in varying degrees of severity. All forms are capable of causing secondary damage to other body organs and systems.
Coronary Heart Disease
This form of CVD, also known as coronary artery disease, involves damage to the vessels that supply blood to the heart muscle.
Any damage to these important vessels can cause a reduction of blood flow (with its vital oxygen and nutrients) to specific areas of the heart muscle. The ultimate result of inadequate blood supply is an attack.
The principal cause of coronary heart disease is atherosclerosis. Atherosclerosis produces a narrowing of the long-term buildup of fatty deposits, called plaque, on the inner walls of the arteries.
This buildup reduces the blood supply to specific portions of the heart. Some arteries of the heart can become so blocked (occluded) that all blood supply is stopped.
Heart muscle tissue begins to die when it is deprived of oxygen and nutrients. This damage is known as myocardial infarction. Inlay terms, this event is called a heart attack. The health action guide formula on muscular endurance fitness explains how to recognize the signs of a heart attack and what to do next.
Cholesterol and Lipoproteins
For many years, scientists have known that atherosclerosis is a complicated disease that has many causes.
Some 52 percent of American adults aged twenty and older exceeds the “borderline high” 200 mg/ dl cholesterol level.
Experts estimate that nearly 40 percent of American youth aged nineteen and under have: borderline high” cholesterol levels of 170 mg/dl or above. Twenty percent of American adults have “high” blood cholesterol levels, that is, 240 mg/dl or greater.1
Initially, most people can help lower their serum cholesterol levels by adopting three dietary changes: lowering the intake of saturated fats, lowering caloric intake to a level that does not exceed body requirements.
The aim is to reduce excess fat, cholesterol, and calories in our diet while promoting sound nutrition.
By carefully following such a diet, people with elevated serum cholesterol levels are typically able to reduce their cholesterol levels by 30 to 55 mg/ dl.8 However, dietary changes do not affect people equally; some will not respond at all to dietary changes and may need to take cholesterol-lowering medications and increase physical activity.
HDLS & LDLS
Lipoproteins are particles that circulate in the blood and transport lipids (including cholesterol).2 The two major classes of lipoproteins are low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs).
After much study, researchers have determined that high levels of LDL are a significant cause of atherosclerosis. This makes sense because LDLs carry the greatest percentage of cholesterol in the bloodstream. LDLs are more likely to deposit excess cholesterol into the artery walls.
This contributes to plaque formation. For this reason, LDLs are often called “bad cholesterol.”1 High LDL levels are determined partly by inheritance, but they are also clearly associated with smoking, poor dietary patterns, obesity, and lack of exercise.
On the other hand, high levels of HDLs are related to a decrease in the development of atherosclerosis. HDLs are thought to transport cholesterol out of the bloodstream.
High-Density Lipoproteins & Low-Density Lipoproteins
Reducing total serum cholesterol levels is a significant step in reducing the risk of death from coronary heart disease.
For people with elevated cholesterol levels, a 1 percent reduction in serum cholesterol level yields about a 2 percent reduction in the risk of death from heart disease, Thus a 10 percent to 15 percent cholesterol reduction can reduce risk by 20 percent to 30 percent.9 Study Table 10-2 for cholesterol classifications and currently recommended follow-up.
Atherosclerosis the buildup of plaque on the inner walls of arteries.
myocardial infarction heart attack; the death of part the heart muscle as a result of a blockage in one of the coronary arteries.
Figure 10-3 Progression of atherosclerosis. How plaque deposits gradually accumulate to narrow the lumen (interior space) of an artery. Although enlarged here, coronary arteries are only as wide as a pencil lead.
When coronary arteries become narrowed, chest pain, or angina pectoris, is often felt. This pain is caused by a reduced supply of oxygen to heart muscle tissue. Usually, a patient feels angina when he or she becomes stressed or exercises too strenuously.
Angina reportedly can range from a feeling of mild indigestion to severe viselike pressure in the chest. The pain may extend from the center of the chest to the arms and even up to the jaw.
Some cardiac patients relieve angina with the drug nitroglycerin, a powerful blood vessel dilator. This prescription drug, available in slow-release transdermal patches or small pills that are placed under the patient’s tongue, causes the coronary arteries to dilate and allow a greater flow of blood into heart muscle tissue. Other cardiac patients may be prescribed drugs such as calcium channel blockers or beta-blockers.
Emergency response to Heart Crises
Heart attacks are not always fatal. The consequences of any heart attack depend on the location of the damage to the heart, the extent to which heart muscle is damaged, and the speed with which adequate circulation is restored. Injury to the ventricles may very well prove fatal unless medical countermeasures are immediately undertaken. Recognizing a heart attack is critically important (See Amazon product on heart attack).
Cardiopulmonary resuscitation (CPR) is one of the most important immediate countermeasures that trained people can use when confronted with a person having a heart attack.
Public education programs sponsored by the American Red Cross and the American Heart Association teach people how to recognize, evaluate, and manage heart attack emergencies.
Frequently, colleges offer CPR classes through health science or physical education departments. We encourage each student to enroll in a CPR course.
|Total Cholesterol Level||Classification||Recommended Follow-up|
|<200 mg/dl||Desirable blood cholesterol level||Repeat test within 5 years|
|200-239 mg/dl||Borderline-high blood cholesterol level||Without definite CVD or two other CHD risk factors(one of which may be male gender): dietary modification and annual retesting|
With definite CHD or two other CHD risk factors: lipoprotein analysis; further action based on LDL-cholesterol level
|<240 mg/dl||High blood cholesterol level||Lipoprotein analysis; further action based on LDL-cholesterol level|
After a person’s vital signs have stabilized, further diagnostic examinations can reveal the type and extent of damage to the heart muscle. Initially, an ECG might be taken. This test analyzes the electrical activity of the heart.
Heart catheterizations, also called coronary arteriography, is a minor surgical procedure that starts by placing a thin plastic tube into an arm or leg artery. This tube, called a catheter, is guided through the artery until it reaches the coronary circulation, where a radiopaque dye is then released.-ray pictures called angiograms then record the progress of the dye through the coronary arteries. Areas of blockage are relatively easily identified.
Recently, researchers have greatly expanded the use of magnetic resonance imaging (MRI) in cardiovascular diagnosis. In the past, MRI has been used to illustrate the cardiac anatomy, congenital malformations, thrombi, and masses.
Best Diagnosis MRI
Now MRI is also used to illustrate the anatomy of coronary arteries and the function of the heart, enabling physicians to evaluate such problems as valvular disease and cardiac shunts. 10 MRI is combined with electrocardiogram (ECG) studies to illustrate the function of the left ventricle.
Nuclear medicine is another important tool in the diagnosis of cardiac disease. Nuclear medicine uses radiopharmaceuticals such as Thallium-201 to map blood flow and perfusion of tissues. Physicians use such tools to study the function of the heart and diagnose cardiac problems. Other radiopharmaceuticals are used to reveal metabolic disorders, hypoxia, and disturbances in the function of the myocardium of the heart.11
After the extent of damage has been determined, a physician or team of physicians can decide on a medical course of action. Treatments can be divided into two broad categories: surgical and nonsurgical.
Surgical Treatments Currently popular is an extensive form of surgery called coronary artery bypass surgery. About 400,000 bypass surgeries are performed each year.
The purpose of such surgery is to detour (bypass) areas of coronary artery obstruction by using a section of a vein from the patient’s leg (often the saphenous vein) or an artery from the patient’s chest (the internal mammary artery) and grafting it from the aorta to a location just beyond the area of obstruction. Multiple areas of obstruction result in double, triple. or quadruple bypasses. In 1992 the average cost of coronary bypass surgery was $44,200.1
More Also Treatment
Surgeons have recently begun performing heart bypass surgery through a three-inch incision in the rib cage, along with two to four small incisions in the patient’s chest, rather than the traditional large, twelve-to fifteen-inch incision.
Physicians manipulate the coronary arteries through the small ports, and they view their work through a fiber-optic camera called a thoracoscope. This new technique results in much less pain and blood loss, a shorter hospital stay, and a quicker recovery for the patient.
Angioplasty. Angioplasty, an alternative to bypass surgery, involves the surgical insertion of a doughnut-shaped “balloon” directly into the narrowed coronary artery (Figure 10-4).
These balloons usually remain within the artery for lass than an hour. Rear-rowing of the artery will occur in about one-quarter of angioplasty patients.2 Each year, about 400,000 people with heart disease undergo angioplasty. The decision of whether to have angioplasty or bypass surgery can be a difficult one to make.12
In 1990 the EDA approved a new device for clearing heart and leg arteries. This device is called a motorized scraper. Inserted through a leg artery and held in place by a tiny inflated balloon, this motor-driven cutter shaves off plaque deposits from inside the artery.
The use of laser beams to dissolve plaque that blocks arteries has been slowly evolving. The FDA has approved three laser devices for use in clogged leg arteries. In February 1992 the FDA approved the use of an excimer laser for use in coronary arteries.13
Heart transplants and artificial hearts. For approximately thirty years, surgeons have been able to surgically replace a person’s damaged heart with that of another human being.
Although very risky, these transplant operations have added years to the lives of a number of patients who otherwise would have lived only a short time. In 1995,2,361 heart transplants were performed in the United States.1 Eighty-two percent of heart transplant patients survive for one year, 78 percent survive for two years, 75 percent survive three years, and 71 percent survive for four years.1
Artificial hearts have also been developed and implanted in humans. These mechanical devices have extended the lives of patients and have also served as temporary hearts while patients wait for a suitable donor heart.
One of the important difficulties with artificial heart implantation has been the control of blood clots that may form, especially around the artificial valves.
Figure 10-4 Angioplasty. , A “balloon” is surgically inserted into the narrowed coronary artery. B, The balloon is inflated, compressing the plaque and fatty deposits against the artery walls.
This new class of drugs has been shown to prevent the formation of blood clots, a major cause of heart attacks, chest pain, and artery tightening after angioplasty.
One study found that the IIa/IIIb inhibitors reduce heart attacks in patients with unstable angina, or severe chest pain, by about half.14 Observers say this new class of drugs will have a tremendous effect on the treatment of heart problems.
Aspirin and Clopidogrel
Studies released in the late 1980s highlighted the role of aspirin in reducing the risk of a heart attack in men who had no history of previous attacks.
Specifically, the elevated cholesterol levels, or both, taking one aspirin per day was a significant factor in reducing their risk of a heart attack. Aspirin works by making the blood less able to clot, which reduces the likelihood of blood vessel blockages.
Experts currently disagree about the age at which this preventive action should begin.
Alcohol. For years, scientists have been uncertain about the extent to which alcohol consumption is related to a reduced risk of heart disease. The current thinking is that moderate drinking (defined as no more than two drinks per day for men and one drink per day for women) is related to a lower heart disease risk (see also more amazon product on heart disease guideline.
However, the benefits are much as stopping than proven risk reduction behavior, such as stopping smoking, reducing cholesterol level, lowering blood pressure, and increasing physical activity. Experts caution that heavy drinking increases cardiovascular risks and that nondrinkers should not start to drink just to reduce heart disease risk.
Can Alcohol Be Good for Your Heart?
You have probably seen the controversial headlines over the past couple of years, starting that moderate consumption of alcohol may actually reduce your risk of coronary heart disease. Such research is controversial because experts fear they may encourage problem drinking of turn abstainers into problem drinkers.
Nevertheless, the evidence is strong that drinking alcohol in moderate amounts indeed reduces the risk of heart attack and death from coronary heart disease, according to a recent report. cardiologist Arthur Klatsky reports that the best evidence comes from population studies that show a 30 percent reduction in coronary risk among moderate drinkers when compared with abstainers.
The results are similar in both men and women, and among various ethnic groups.
Klatsky identifies two possible explanations for the cardiovascular benefits: (1) that alcohol raises the level of protective high-density lipoprotein (HDL) cholesterol in the blood, making atherosclerosis less likely, and (2) that alcohol inhibits blood clotting by helping to dissolve clots in blood vessels.
One study reported that having two drinks a day reduces by a third the risk of developing clogged arteries in the legs.21
Alcohol and Heart Health
This effect is also probably related to alcohol’s tendency to raise the level of HDL in the blood, the study’s authors reported.
Researchers are looking at specific types of alcohol, such as red wine, but the results are not yet strong enough to justify recommending that people switch to wine from beer or liquor. It appears that the benefits come from any type of alcohol product.
Grape juice, the dark purple kind, may convey the same cardiovascular benefits as alcohol. A new study of both humans and monkeys demonstrated that compounds called “flavonoids” in purple grape juice reduce the activity of platelets, the blood cells that stick together to form clots.20
These are the same compounds that are at least partly responsible for the apparent health effect of red wine. Purple grape juice, of course, would be a safer alternative, since it does not carry the risk of alcohol abuse that must be considered when drinking alcohol.
Because of the risk of serious health problems from heavy drinking greatly outweighs possible cardiovascular benefits, experts do not recommend that abstainers begin drinking. In addition, heavy drinkers should curtail their alcohol intake or abstain.
Just as your car’s water pump recirculates water and maintains water pressure, your heart recirculates blood and maintains blood pressure. When the heart contracts, blood is forced through your arteries and veins. Your blood pressure is a measure of the force that your circulating blood exerts against the interior walls of your arteries and veins.
Blood pressure is measured with a sphygmomanometer. A sphygmomanometer is attached to an arm-cuff device that can be inflated to stop the flow of blood temporarily in the brachial artery. This artery is a major supplier of blood to the lower arm. It is located on the inside of the upper arm, between the biceps and triceps muscles.
Two pressure measurements are recorded: The systolic pressure is the blood pressure the diastolic pressure is the blood pressure against the vessel walls when the heart relaxes (between heartbeats).
Because blood pressure drops when the heart relaxes, the diastolic pressure is always lower than the systolic pressure.
Although many people still consider 120/80 as a “normal” or safe blood pressure for a young adult, variations from this figure do not necessarily indicate a medical problem.
In fact, many young college women of average weight display blood pressures that seem to be relatively low (100/60, for example), yet these lowered blood pressure are quite “normal” for them.
Hypertension refers to consistently elevated blood pressure. Generally, concern about a young adult’s high blood pressure begins when he or she has a systolic reading of 140 or above or a diastolic reading of 90 or above.2 Approximately 50 million American adults and children have hypertension.
American Heart Association Reports
The American Heart Association reports that African-American adults have significantly higher rates (28.4%) of high blood pressure than white Americans (24.7%). Nearly 19 percent of Cuban-Americans, 15 percent of Mexican-American Indian/Alaska Natives (12%), however, have significantly lower rates of hypertension.
Throughout the body, hypertension makes arteries and arterioles become less elastic and thus incapable of dilating under a heavy workload. Brittle, calcified blood vessels can burst unexpectedly and produce serious strikes (brain accidents), kidney failure (renal accidents), or eye damage (retinal hemorrhage). Thus hypertension can be a cause of heart attacks. Clearly, hypertension is a potential killer.
People with this disorder cannot feel the sensation of high blood pressure. The condition does not produce dizziness, headaches, or memory loss unless one is experiencing a medical crisis.
Only a small percentage (21%) of people who have hypertension control it adequately, generally through dietary control, supervised fitness, relaxation training, and drug therapy.
Hypertension is not thought of as a curable disease; rather, it is a controllable disease. As a responsible adult, you should use every opportunity you can to measure your blood pressure regularly.
systolic pressure (sis told ick) blood pressure against blood vessel walls when the heart contracts.
diastolic pressure (dye uh sol ick) blood pressure against blood vessel walls when the heart relaxes.
Prevention and Treatment
For overweight or obese people, a reduction in body weight may produce a significant drop in blood pressure.
Physical activity helps lower blood pressure by expending calories (which leads to weight loss) and improving overall circulation. Reducing alcohol consumption to less than two ounces daily helps reduce blood pressure in some people.
The restriction of sodium (salt) in the diet also helps some people reduce hypertension.
Reducing salt intake would have little effect on the blood pressure of the rest of the population. Nevertheless, because our daily intake of salt vastly exceeds our need for salt, the general recommendation to curb salt intake still makes good sense.
In recent years, behavioral scientists have reported the success of meditation, biofeedback, controlled breathing, and muscle relaxation exercises in reducing hypertension. Look for further research findings in these areas in the years to come.
Disease and Its Prevention
Diuretic drugs work by forcing fluid from the bloodstream, thereby reducing blood volume. Vasodilators relax the muscles in the walls of blood vessels (especially the arterioles), allowing the vessels to dilate (widen).
Also used are calcium channel blockers, beta-blockers, and other drugs that work in various ways to relax blood vessels. The most disturbing aspect of drug therapy for hypertension is that many patients refuse to take their medication on a consistent basis, probably because of the mistaken notion that “you must feel sick to be sick”.
Some people taking these medications report uncomfortable side effects, including depression, reduced libido (sex drive), muscle weakness, impotence, dizziness, and fainting.
Thus the treatment’s side effects may seem worse than the disease. Because of the poor record of patient compliance with hypertension drug therapy, many television and radio public service announcements are geared to the hypertensive patient. Nutritional supplements, such as calcium, magnesium, potassium, and fish oil, are not effective in lowering blood pressure.
Learning From Our Diversity
Dancing Their Hearts Out: African-American and Hispanic-American Adolescents Improve Cardiovascular Fitness
Try telling a teenager that he or she is at risk for cardiovascular disease, and you’ll probably get a reaction ranging from polite skepticism to a burst of laughter.
Kids have always seen themselves as immortal: immune to the ailments that plague their elders, and magically shielded from the consequences of unhealthful behaviors like smoking, drinking, eating junk food, and being a couch spud instead of an exercise buff.
The bad news is that cardiovascular disease (CVD) doesn’t suddenly appear when we get old. It starts early in life when habits of eating and exercise are learned.
Particularly at risk are African-American and Hispanic-American adolescents, in whom low levels of fitness and increased body mass index are common.29 Not surprisingly, cardiovascular disease is the major cause of death among Hispanic-Americans and African-Americans in the United States.
Improve Cardiovascularly Fitness
A key to preventing or delaying the onset of CVD is regular physical activity, and school physical education programs can encourage students to participate by making activities appealing and enjoyable.
That was the rationale behind Dance for Health, an intervention program designed to provide an enjoyable aerobic routine for low-income African-American and Hispanic-American adolescents. In the first year of the intervention, some 110 boys and girls ages ten to thirteen took part in the aerobic dance pilot program for twelve weeks.
The next year, a culturally sensitive health education class twice a week and went to a dance-oriented physical education class three times a week. Meanwhile, another group of students took part in the school’s usual playground-based activity.
The students who participated in the intervention program experienced a significantly greater decrease in body mass index and resting heart rate than did the students who engaged only in playground activities.
Program participants also learned culturally appropriate information about nutrition, exercise, obesity and unhealthy weight regulation practices, smoking, prevention, substance abuse, stress management, and peer pressure.29
The bottom line?
Efforts aimed at preventing cardiovascular disease can’t begin too early, especially among high-risk populations- and a great way to get started is to offer kids the chance to have fun while getting healthy.
Do you have a favorite aerobic activity? Why do you like it, and how often do you do it?
The third major CVD is a stroke. Stroke is a general term for a wide variety of crises (sometimes called cerebrovascular accidents [CV As] or brain attacks) that result from blood vessel damage in the brain.
African-Americana have a 60 percent greater likelihood of having hypertension than white Americans. About a half-million people suffer a stroke in the United States each year, and of these, about a third die. A total of 154,350 Americans died of a stroke in 1994.1 Just as the heart muscle needs an adequate blood supply, so does the brain.
Any disturbance in the proper supply of oxygen and nutrients to the brain can pose a threat.
Perhaps the most common form of stroke results from the blockage of a cerebral (brain) artery. Similar to coronary occlusions, cerebrovascular occlusions can be started by a clot that forms within an artery, called a thrombus, or by a clot that travels from another part of the body to the brain, called an embolus (Figure 10-5 A and B).
The resultant accidents (cerebral thrombosis or cerebral embolism) cause 70 percent to 80 percent of all strokes. The portion of the brain deprived of oxygen and nutrients can literally die.
The third type of stroke can result from an artery that bursts to produce a crisis called cerebral hemorrhage (Figure 10-5C). Damaged, brittle arteries can be especially susceptible to bursting when a person has hypertension.
The fourth form of stroke is a cerebral aneurysm. An aneurysm is a ballooning or outpouching on a weakened area of an artery (Figure 10-5 D). Aneurysms may occur in various locations of the body and are not always life-threatening.
The developing of aneurysms is not fully understood, although there seems to be a relationship between aneurysms and hypertension. It is quite possible that many aneurysms are congenital defects. In any case, when a cerebral aneurysms bursts, a stroke results.
retinal hemorrhage uncontrolled bleeding from arteries within the eye’s retina.
the salt-sensitive term used to describe people whose bodies overreact to the presence of sodium by retaining fluid, thus
cerebrovascular occlusions (ser ee bro vas Kyou lar) blockages to arteries supplying blood to the cerebral cortex of the brain; strokes.
A person who reports any warning signs of stroke or any small stroke, called a transient ischemic attack (TIA), is given a battery of diagnostic tests, which could include a physical examination, a search for possible brain tumors, tests to identify areas of the brain affected, electroencephalogram, cerebral arteriography, and CAT (computerized axial tomography) scan or MRI (magnetic resonance imaging) scan. Many other tests can also be used.
Researchers recently made a breakthrough in the treatment of stroke, with the discovery that the clot-dissolving drug TPA and the cell-rebuilding drug citicoline could reduce the severity of strokes.
In the past, physicians essentially waited for a stroke to end before assessing damage and beginning rehabilitation. Now, experts find that TPA can actually reduce the severity of a stroke as it is occurring.
TPA was previously used to dissolve clots in the treatment of heart attacks. This same effect, applied during a stroke, can help prevent brain cells from “starving” to death because of a lack of blood supply.17
As a result, experts are reclassifying stroke as a medical emergency that must be treated as quickly as possible. To be effective, TPA must be administered in the first 3 hours of the stroke.
After that time, brain cells have been damaged and TPA can worsen the damage. In addition, TPA is useful only for ischemic stroke, which occurs when arteries clog (embolism or thrombosis), the most common type. Because 500,000 people suffer strokes and about one-third of these die each year, TPA has the potential to save thousands of lives a year.
More recently, researchers have found that the drug citicoline, administered within twenty-four hours of a stroke, appears to help injured brain cell membranes repair themselves.18 This limits the number of brain cell deaths and enables the brain to repair damaged circuits or create new ones. In addition, citicoline can be given with both ischemic strokes and other types of strokes.
Another treatment after a stroke depends on the nature and extent of the damage the patient has suffered. Some patients require surgery (to repair vessels and relieve pressure) and acute care in the hospital.
The advances made in the rehabilitation of stroke patients are amazing. Although some severely affected patients have little hope of improvement, our continuing advances in the application of computer technology to such disciplines as speech and physical therapy offer encouraging signs for stroke patients and their families.
Congenital Heart Disease
A congenital defect is one that is patent at birth. The American Heart Association estimates that each year about 32,000 babies are born with a congenital heart defect. In 1993,5,388 children (mostly infants) died of congenital heart disease.1
A variety of abnormalities may be produced by congenital heart disease, including valve damage, holes in the walls of the septum, blood vessel transposition, and underdevelopment of the left side of the heart.
All of these problems ultimately prevent a newborn baby from receiving adequate oxygenation of tissues throughout the body. A bluish skin color (cyanosis) is seen in some infants with such congenital heart defects.
The cause of congenital heart defects is not clearly understood, although one cause, rubella, has been identified. The fetuses of mothers who contract the rubella virus during the first three months of pregnancy are at great risk of developing congenital rubella syndrome (CRS), a catch-all term for a wide variety of congenital defects, including hearts defects, deafness, cataracts, and mental retardation.
Other Heart Disease
Other hypotheses about the development of congenital heart disease implicate environmental pollutants, maternal use of drugs, including alcohol, during pregnancy, and unknown genetic factors.
Treatment of congenital defects usually requires surgery, although some conditions may respond well to drug therapy. Defective blood vessels and certain malformations of the heart can be surgically repaired. This surgery is so successful that many children respond quickly to increased circulation and oxygenation. Many are able to lead normal, active lives.
transient ischemic attack (TIA) (trans see ent its key mick) stroke-like symptoms caused by temporary spasm of cerebral blood vessels.
CAT scan computerized axial tomography scan; an x-ray procedure designed to illustrate structures within the body that would not normally be seen through conventional x-ray procedures.
MRI scan magnetic resonance imaging scan; an imaging procedure that uses a giant magnet to generate an image of body tissue.
Rheumatic Heart Disease
Rheumatic heart disease is the final stage in a series of complications started by a streptococcal infection of the throat. This bacterial infection, if untreated, can result in an inflammatory disease called rheumatic fever ( and a related condition, scarlet fever).
Rheumatic fever is a whole-body (systemic) reaction that can produce fever, joint pain, skin rashes, and possible brain and heart damage. A person who has had a rheumatic fever is more susceptible to subsequent attacks. Rheumatic fever tends to run in families. The number of Americans who died from rheumatic fever and rheumatic heart disease in 1994 was 5,540.1
Damage from rheumatic fever centers on the heart’s valves. For some reason, the bacteria tend to proliferate in the heart valves. Defective heart valves nay fail either to open fully (stenosis) or to close fully (insufficiency).
A physician initially might diagnose valve damage when she hears backwashing or backflow of blood ( a murmur). Further tests, including chest x rays, cardiac catheterization, and echocardiography, can reveal the extent of valve damage.
Peripheral Artery Disease
Peripheral artery disease (PAD), also called peripheral vascular disease (PVD), is a blood vessel disease characterized by pathological changes to the arteries and arterioles in the extremities.
These changes result from years of damage to the peripheral blood vessels. Important causes of PAD are cigarette smoking, high-fat diet, obesity, and sedentary occupations.
PAD severely restricts blood flow to the extremities. The reduction in blood flow is responsible for leg pain or cramping during exercise, numbness, tingling, coldness, and loss of hair on the affected limb. The most serious consequence of PAD is the increased likelihood of developing ulcerations and tissue death. These conditions can lead to gangrene and may eventually necessitate amputation.
Improve blood lipid levels (through diet, exercise, or drug therapy), reduce hypertension, reduce body weight, and to eliminate smoking. Blood vessel surgery may be a possibility.
Congestive Heart Failure
Congestive heart failure is a condition in which the heart lacks the strength to continue to circulate blood normally throughout the body. During congestive heart failure, the heart continues to work, but it cannot function well enough to maintain appropriate circulation.
Venous blood flow starts to “back up”. Swelling occurs, especially in the legs and ankles. Fluid can collect in the lungs and cause breathing difficulties and shortness of breath, and kidney function may be damaged.5
Congestive heart failure can result from heart damage caused by congenital heart defects, lung disease, rheumatic fever, heart attack, atherosclerosis, or high blood pressure. Without medical care, congestive heart failure can be fatal.19
Arrhythmias are disorders of the heart’s normal sequence of electrical activity. They result in an irregular beating pattern of the heart. Arrhythmias can be so brief that they do not affect the overall heart rate.
Some arrhythmias, however, can last for long periods of time and cause the heart to beat either too slowly or too fast.
Hearts that beat too slowly are unable to pump a sufficient amount of blood throughout the body. The body becomes starved of oxygen, and loss of consciousness and even death can occur. The heart that beats too rapidly does not allow the ventricles to fill sufficiently.
When this happens, the heart cannot pump enough blood throughout the body. The heart becomes, in effect, a very inefficient machine. It beats rapidly but cannot pump much blood from its ventricles.
This pattern may lead to fibrillation, which is the life-threatening, rapid uncoordinated contractions of the heart. Interestingly, whether the heart pumps too slowly or too rapidly, the result is the same: inadequate blood flow throughout the body.
The person most prone to arrhythmia is a person with some form of heart disease, including atherosclerosis, hypertension, or inflammatory or degenerative conditions.2
The prevalence of arrhythmia tends to increase with age
Certain congenital defects may make a person more likely to have an arrhythmia. Some chemical agents, including high or low levels of minerals (potassium, magnesium, and calcium) in the blood, addictive substances (alcohol, tobacco, other drugs), and various cardiac medications can all provoke arrhythmias.
Arrhythmias are most frequently diagnosed through an ECG, which records the electrical activity of the heart. After diagnosis, a range of therapeutic approaches can be used, including simple monitoring (if the problem is relatively minor), drug therapy, use of a pacemaker, or the use of implantable defibrillators.
rheumatic heart disease chronic damage to the heart (especially the heart valves) resulting from a streptococcal infection within the heart; complications of rheumatic fever.
murmur an atypical heart sound that suggests backwashing of blood into a chamber of the heart from which it has just left.
peripheral artery disease (PAD) damage resulting from restricted blood flow to the extremities, especially the legs and feet.
congestive heart failure inability of the heart to pump out all the blood that returns to it; can lead to dangerous fluid accumulations in veins, lungs, and kidneys.
bradycardia slowness of the heartbeat, as evidenced by a resting pulse rate of less than 60.
tachycardia excessive rapid heartbeat, as evidenced by a resting pulse rate of greater than 100.
Related Cardiovascular Conditions
Besides the cardiovascular disease already discussed, the heart and blood vessels are also subject to other pathological conditions. Tumors of the heart, although rare, occur.
Infections conditions involving the pericardial sac that surrounds the heart (pericarditis) and the innermost layer of the heart are more commonly seen. Some people develop serious diseases of the heart valves. In addition, inflammation of the veins (phlebitis) is troublesome to some people.
And Now, Your Choices. . . .
- If you were one of Greg’s parents, how could you encourage Greg to tell you when he got a sore throat without adding to his fears arising from his brother’s death?
- Cardiovascular diseases are responsible for more disabilities and deaths than any other disease.
- The cardiovascular system consists of the heart, blood, and blood vessels.
- The vascular system comprises the body’s blood vessels, including arteries, veins, arterioles, capillaries, and venules.
- The blood continuously performs many functions, including the transportation of nutrients and oxygen.
- The “big four” risk factors are smoking, high blood pressure, high blood cholesterol level, and physical inactivity. These are controllable risk factors.
- Smokers have a heart attack risk that is more than twice that of nonsmokers. However, the risk of heart disease declines rapidly if the smoker quits.
- Regular aerobic exercise helps strengthen the heart muscle, maintain healthy blood vessels, and improve the vascular system’s ability to transport blood and oxygen to the body. Physical activity can also help lower blood cholesterol, encourage weight loss and retention of lean muscle mass, and allow people to moderate stress.
- People with high blood cholesterol should eat a heart-healthy diet and become physically active.
- Heredity, being male, and increasing age are risk factors that cannot be controlled.
- Contributing risk factors for heart disease are diabetes, obesity, and individual response stress.
- The three most significant and common forms of heart disease are coronary artery disease, high blood pressure, and stroke.
- Each form of heart disease develops in a unique way and requires specialized treatment that may be surgical, such as coronary artery bypass surgery, or nonsurgical, such as the use of aspirin or other drugs.
- Moderate alcohol consumption may be related to a lower risk of heart disease. However, heavy drinking increases cardiovascular disease risk.
- Hypertension is the condition can produce strokes, kidney failure, eye damage, and other serious problems
- There are four types of strokes: cerebral thrombosis, cerebral embolism, cerebral hemorrhage, and cerebral aneurysm.
- The new clot-dissolving drug TPA can reduce the severity of a stroke as it occurs.
- Other heart diseases include congenital heart disease, rheumatic heart disease, peripheral artery disease, congestive heart failure, and heart arrhythmias.
Hypertension in Africa-Americans: Targeting Prevention
The development of the disease is an area in which each societal group is disadvantaged in one way or another. Practically every group has a tendency to develop one or more afflictions at a higher rate than the general population. For the African-American community, one particular problem is hypertension.
The existing data show that hypertension is more common in Africa-Americans.1,2 Whereas one on four adults in the general population has hypertension, the proportion rises to one in there among African-Americans. This disease is also more aggressive and less well managed in African-Americans than in whites.
Hypertension in Africa-Americans
African-Americans also have higher rates of morbidity and mortality from disease related to high blood pressure, such as stroke and renal (kidney) failure. The natural nocturnal fall in blood pressure is less pronounced in African-Americans, and their systolic blood pressure while awake is higher than in people of other races.1
The exact causes of these differences have not been pinpointed, but research seems to be focused in two general areas. Some research suggests that certain physical and genetic factories contribute to increased incidence of hypertension in African-Americans, whereas other studies have shown that hypertension in African-Americans is related to environmental stress. This debate involves not just medical data but socioeconomic factories as well. In short, it is a nature versus nurture debate, and supporting data exist for both arguments.
Nature versus Nurture
Studies have shown that environmental stress may contribute to increased hypertension in African-Americans. A study conducted by Dr. Norman Anderson of Duke University3 shows that chronic stress may lead to an increase in the release of the hormone norepinephrine to the bloodstream. Norepinephrine reduces the amount of salt eliminated from the kidneys, and the resulting increase in blood salt content can lead to increased blood pressure.
This chain reaction has been shown to occur in animal studies. The high rate of chronic exposure to stress in many African-American communities has been well documented3. If these studies hold true for humans, it would lend credence to the idea that certain stressful factories found in some African-American communities could cause hypertension. Stress such as poverty, unemployment, the threat of violence, and racial discrimination could be shown to cause kidneys to reduce the elimination of salt and thus may also increase the risk of hypertension3.
Anger in response to racism may be a significant contributing factor in increased hypertension in African-Americans. A study conducted jointly at the University of Tennessee and Saint Louis University showed that blood pressure in African-Americans increased significantly when they were shown film clips of racially motivated violence4.
Hypertension African American
The responses of African-Americans to these scenes of racial discrimination were more pronounced than their responses to viewing scenes that were anger-provoking but had no racial component5. The increase in blood pressure was not into the hypertension range, but researchers believe that over time, such continued elevation of blood pressure could become dangerous.
Such conclusions seem to suggest that socioeconomic factories are the main cause of hypertension among African-Americans. A study performed on twenty-six African-American women on strict low-fat diets seems to support this.
The data showed that women of higher socioeconomic status had more excretion of salt than those of lower statues3. Since proportionately more African-Americans are in lower socioeconomic classes than whites, increased stress from lower statues could be the main factor behind the inflated rate of hypertension among the African-American population.
Another link between socioeconomic status and hypertension has recently been discovered. Babies born to mothers of low socioeconomic status are typically small for their age because of intrauterine growth retardation. Because their kidneys do not develop adequately, they retain excess sodium.
Sodium draws fluid into the blood vessels. Many groups of these small babies, the majority of whom are African-American, were followed by researchers over a period of years and confirmed to be more likely to have hypertension in adulthood than their more developed counterparts of any race6.
But is it all due to the environment?
Perhaps not. Other groups of traditionally lower socioeconomic status, such as Hispanics, Asians, and Native Americans, have been found to have the same incidence of hypertension as whites1. African-American children have been found to have higher blood pressure in general than white children’1 it is not known whether stress plays a significant role in affecting the blood pressure of these children so early in life.
Some evidence also shows that African-Americans may be predisposed to hypertension at the cellular level. Microscopic studies of blood vessels in African-Americans with severe hypertension revealed that renal arterioles were thickened and had reduced flow. This thickening, not found in the renal arterioles of hypertensive whites, was caused by hypertrophy ( excess growth) of smooth muscle cells in the muscle walls of the arterioles.
This thickening reduced the size of the lumen (inside opening) of the vessels, and the resulting reduced blood flow may have caused increased blood pressure. The smooth muscle cells were thought to be responding abnormally to growth factors, which caused the hypertrophy to occur2. The reason behind this abnormal reaction was not determined, however.
High Blood Pressure in African American
The best explanation of why African-Americans are more prone to develop hypertension may not involve environment of genetics alone, but a combination of the two. Stress factors unique to the African-American community may serve to aggravate or intensify an existing physical predisposition toward hypertension.
It has already been shown that the tendency toward developing hypertension can be passed from parents to their children. Add several unique stress factors to a population already predisposed to high blood pressure, and the potential exists for high numbers of people to develop hypertension.
Commenting on the UT-SLU study, Dr. Elijah Saunders agreed that” racism and Black rage are emotional stressors that could worsen a physiological tendency towards hypertension”4. A combination of genetic factors and stress may be responsible for the high incidence of hypertension among African-Americans.
Treatment of Hypertension in African-Americans
The good news is that African-Americans respond to medical treatment in a similar manner to whites. The treatment regimen for African-Americans may be somewhat different, however, since they do not respond as well to some hypertension medications as people of other races.
For unknown reasons, drugs such as beta-blockers and ACE (angiotensin-converting enzyme) inhibitors do not work as well in African-Americans and may need to be supplemented by other medications, such as diuretics1.
Lifestyle changes may also be needed and maybe a more effective tool in lowering blood pressure in African-Americans than in people of other races1. An effort should be made to exercise and lose weight if needed since excess weight can be a contributing factor in hypertension.
African-American women may need to make a strong effort to control their weight since data suggest that African-American women have a greater tendency to become overweight7,8.
African American with Hypertension
Thirty-five percent of all adult women African-American women are between 38 percent and 48.6 percent9,10. This may be due in part to the higher percentage of African-American women (68%) than white women (56%) with sedentary lifestyles.
Hypertensive African-Americans tend to have lower intakes of potassium and calcium, so diet changes should be made to ensure that these minerals are inadequate to supply. A reduction in sodium may also be desirable since research suggest that African-Americans may be more sensitive to the effects of sodium on the cardiovascular system1.
Although African-Americans are more likely to develop high blood pressure, prevention and treatment can help keep hypertension from becoming a deadly affliction. Proper diagnosis is essential, so people at risk should see their doctors determine whether they have hypertension or are at risk for developing it.
By recommending lifestyle modifications, prescribing medications, or both, a physician can help manage this condition or help prevent its inset. The keys to living with hypertension are awareness, treatment, and control.
Suggested Lifestyle Modifications to Control or Reduce the Risk of Hypertension 6.10
A first heart attack convinces many people to quit smoking, but don’t wait-you may not get a second chance.
Lose weight if you are overweight or obese
Losing 5% to 10% of your body weight drastically reduces your disease risk factors
Reduce sodium intake
Consume <2,400mg of sodium per day. Excess sodium raises blood pressure in salt-sensitive people.
Moderate alcohol intake
Intake of alcohol above moderate levels increases blood pressure Men should have no more than two drinks a day, and women should have no more than one drink a day.
Sedentary people have a 50% greater chance of developing hypertension. One simple plan for increasing your physical activity is to walk briskly 30 to 45 minutes three to five times per week.
Increase potassium intake
Potassium works to control blood volume and therefore blood pressure. Eat at least five servings of fruits and vegetables a day. Good sources of potassium are potatoes, tomatoes, and orange juice.
Maintain an adequate intake of calcium and magnesium
These minerals are important to blood pressure regulation. Eat two to three portions of low-fat milk or cheese per day.
Seek appropriate prenatal care during pregnancy
Prenatal visits help to ensure the delivery of healthy babies whose kidneys are adequately developed.
Take prescribed medication as directed
Hypertension is called the “silent killer” because people who have it don’t feel sick. It is critical to take your medication no matter how good you feel.
Consult your physician regularly
He or she can help you comply with and personalize your hypertension control program.
For Discussion . . . .
Were you aware of how serious hypertension can be? Even if you’re not in particularly high-risk groups, would you consider adopting some of the suggested lifestyle modifications to improve your general health? Which ones would be the easiest to follow? The most difficult?