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You've
seen the stories time and again: Exercise to prevent coronary artery
disease. Eat better to reduce your risk of coronary heart disease. Stop
smoking to stop heart disease. Lower your cholesterol to lower your
odds of developing cardiovascular disease.
Coronary artery
disease? Coronary heart disease? Heart disease? Cardiovascular disease?
What are all these things? And what's the difference, anyway?
Perhaps
you've been bombarded so often with warnings and advice about your
heart that you simply don't pay attention anymore. Or you don't know
what these conditions mean or exactly how destructive they can be to
your health.
Understanding the various terms and how
they're
often used — sometimes incorrectly — can help you sort through the
morass. And if you know more about the various types of cardiovascular
disease, and the havoc they can wreak on your body, you may be more
inclined to take steps to prevent them. You'll also know more about the
ways all of the different manifestations of cardiovascular disease
interact to affect your health, and you'll learn how you can best
control your risks.
| Defining
cardiovascular disease |
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First,
consider cardiovascular disease. Cardiovascular disease is a broad,
all-encompassing term. It's not a single condition or disorder in
itself. Rather, it's a collection of diseases and conditions. In fact,
some types of cardiovascular disease can even cause other types of
cardiovascular disease.
To get technical, cardiovascular disease
refers to any disorder in any of the various parts of your
cardiovascular system, which is made up of your heart and the blood
vessels throughout your body, explains Brooks Edwards, M.D., a
cardiologist at Mayo Clinic, Rochester, Minn., and medical editor in
chief of this site.
Cardiovascular disease, then, has two main
components:
- Diseases of the heart (cardio)
- Diseases of the blood vessels (vascular)
Although
you may hear a lot about preventing cardiovascular disease, sometimes
you can't prevent it. That's because some types of cardiovascular
disease are congenital — you're born with them. Other forms are
acquired — you develop them over the course of your lifetime. These
acquired conditions are the forms you can often help prevent by doing
such things as exercising regularly, eating a balanced diet or quitting
smoking. And they make up the vast majority of cardiovascular diseases.
So,
if you have something wrong with your heart, such as an abnormality of
the heart muscle (cardiomyopathy), that's a type of cardiovascular
disease. Likewise, an aneurysm, a bulging section of blood vessel, also
is a type of cardiovascular disease. And even varicose veins are
technically classified as a cardiovascular disease.
But what
about those news reports that say cardiovascular disease is the No. 1
killer of American men? What does that mean, really?
Are they
getting aneurysms? Dying of varicose veins? Did they have a congenital
heart defect that couldn't be successfully treated? Just what do those
reports mean? Adding to the confusion are the different ways that major
organizations and agencies, including the Centers for Disease Control
and Prevention and the American Heart Association, define
cardiovascular disease.
It's no wonder you're left scratching
your head. But to help sort through all of that and help you become a
health-savvy consumer the next time you read one of those reports,
here's a closer look at just what cardiovascular disease is.
The
heart consists of a muscle (myocardium) that pumps blood, arteries that
supply blood to the heart muscle, and valves to ensure that the blood
is pumped in the correct direction. At any point in the pumping
process, or in any part of the heart, something can go awry. The
diseases and conditions affecting the heart are collectively known as
heart disease.
Like
cardiovascular disease, the term heart disease is somewhat loose and
broad, and it's often used that way. You may see reports urging you to
avoid smoking so that you reduce your risk of heart disease, for
instance. And you can. Or that heart disease is the leading killer of
both men and women. And it is.
But neither exercise nor healthy
diet nor low cholesterol can protect you against all forms of heart
disease. There are many types of heart disease, and not all are the
consequences of unhealthy lifestyle habits. Some forms of
cardiomyopathy are caused by viruses, for instance. And some babies are
born with Ebstein's anomaly, a defect in one of the heart's valves that
causes blood to leak and prevents the heart from working at top
efficiency.
Most often, when you hear a report about
preventing
heart disease, it's really a call to prevent coronary artery disease or
coronary heart disease.
Coronary artery disease.
These are diseases of the arteries that supply the heart muscle with
blood. Sometimes known as CAD, coronary artery disease is the most
common form of heart disease in industrialized nations and far and away
the leading cause of heart attacks.
Coronary artery disease
generally means that blood flow through the arteries has become
impaired. The most common way such obstructions develop is through a
condition called atherosclerosis, a largely preventable type of
vascular disease.
The
actively contracting heart muscle needs a steady supply of oxygen and
nutrients to function. They're delivered by blood vessels known as
coronary arteries.
Over the course of your lifetime — actually
starting in early childhood — these arteries, whose inner lining is
normally smooth, can slowly become clogged with clumps of fats,
cholesterol and other material, called atherosclerotic plaques. You may
also know this as hardening or narrowing of the arteries. The inner
walls of arteries become narrow slowly because of a buildup of these
plaques, or suddenly by a rupture of a plaque and the formation of a
blood clot around the ruptured plaque.
As a result, the supply
of blood — with its oxygen and nutrients — going to the heart muscle is
choked off (myocardial ischemia). As less blood reaches the heart, it
can't function normally, and you begin experiencing the physical
consequences.
Chest pain (angina pectoris) occurs, for
instance,
when the oxygen demand of the heart muscle exceeds the oxygen supply
because of that narrowing in the coronary arteries. When the imbalance
of oxygen supply lasts for more then a few minutes, heart muscle can
begin to die, causing a heart attack (myocardial infarction). This may
occur without symptoms (silent heart attack), especially in people with
diabetes.
In addition, the lack of blood, even
briefly, can lead
to serious disorders of the heart rhythm, known as arrhythmias or
dysrhythmias. Coronary artery disease can even cause sudden death from
an arrhythmia without any prior warning.
These consequences of
coronary artery disease are also types of cardiovascular disease in
their own right and, in turn, can cause even more types of
cardiovascular disease — weaving a complex interplay of cause and
effect. A heart attack, for instance, can lead to congestive heart
failure, and both of these conditions are types of cardiovascular
disease.
There's another confusing twist to coronary
artery
disease: It's sometimes used synonymously with coronary heart disease.
But you can impress your cardiologist on the next visit — if not your
colleagues around the water cooler — if you know they're not
technically the same things.
Rather, coronary heart disease is a
more encompassing term that refers to diseases of the coronary arteries
and their resulting complications — angina, a heart attack and even
scar tissue caused by the heart attack. All are technically coronary
heart diseases. Remember, coronary artery disease is disease only of
the arteries.
Cardiomyopathy. These are
diseases of the heart muscle. Some forms of cardiomyopathy are genetic,
while others occur for reasons that are less well understood. The most
common type of cardiomyopathy in developed nations is ischemic
cardiomyopathy, which is caused by the loss of heart muscle from a
heart attack resulting from coronary artery disease. Some forms of
cardiomyopathy affect the contraction of the heart (systolic
dysfunction) while other forms affect the filling, or relaxation, phase
of the heart (diastolic dysfunction).
Valvular heart disease.
These are diseases of the valves within the heart. Blood flows in the
correct direction within the heart because of a series of valves. When
a valve is diseased, blood flow may become obstructed, a condition
known as valvular stenosis. Or a valve may leak, causing a condition
known as valvular insufficiency or valvular regurgitation. You may be
born with valvular disease, or the valves can become infected and
damaged by bacteria or other microorganisms, a condition known as
infectious endocarditis.
Pericardial disease.
These are diseases of the sac (pericardium) that encases the heart.
Diseases of the pericardial sac can secondarily affect the heart
itself. There are several types of pericardial disease, including
inflammation (pericarditis), fluid accumulation (pericardial effusion)
and stiffness (constrictive pericarditis). These forms can occur alone
or together. Causes and consequences vary. For instance, pericardial
effusion can occur after a heart attack and, as a result, prevent your
heart from working efficiently.
Congenital heart disease.
These are forms of heart disease that develop before birth
(congenital). Some may be apparent right at the time of birth, while
others may not be detected until later in life. Congenital heart
disease can affect the formation of the heart's chambers, muscle or
valves, and include such conditions as narrowing of a section of the
aorta (coarctation) and Ebstein's anomaly.
Congestive heart failure.
Congestive heart failure occurs when the heart no longer pumps
normally, although it does continue to work to some degree. With less
effective pumping, vital organs don't get enough blood, causing such
signs and symptoms as shortness of breath, fluid retention and fatigue.
This condition may develop suddenly or over many years. Congestive
heart failure occurs as a result of other cardiovascular conditions
that have damaged or weakened the heart. Among them are coronary artery
disease, cardiomyopathy, valvular heart disease, and some forms of
congenital heart disease.
| Diseases
of the blood vessels |
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High blood pressure.
High blood pressure (hypertension) is perhaps the most common form of
cardiovascular disease in the Western world, affecting about one in
four Americans. It's also one of the most preventable and treatable
types of cardiovascular disease.
But it's more than just a type
of cardiovascular disease. High blood pressure is also a cause of
cardiovascular disease and a risk factor for cardiovascular disease.
Blood
pressure is determined by how much blood your heart pumps out and how
narrow your arteries are. The more your heart pumps and the narrower
your arteries — say they're clogged from atherosclerosis — the higher
your blood pressure, and the harder your heart has to work to pump the
same amount of blood.
High
blood pressure has far-reaching and serious health consequences. For
one thing, it accelerates the development of atherosclerosis, which, in
turn, makes high blood pressure worse and further increases the risk of
other cardiovascular complications.
High blood pressure can also
lead to stroke. That happens when a bit of cholesterol or other clump
of arterial plaque breaks off and blocks blood flow to the brain. It
may also happen when a tiny blood vessel in the brain ruptures because
of damage sustained by high blood pressure. Stroke is sometimes
considered a type of cardiovascular disease. But technically, it's
actually a result of cardiovascular disease.
In addition, high
blood pressure can wreak havoc on the heart itself. It can cause
coronary artery disease, congestive heart failure and heart attack. And
the damage doesn't stop there: High blood pressure can also damage
other vital organs, such as your kidneys and eyes.
Aneurysms.
An aneurysm is a bulge or weakness in the wall of an artery or vein.
Aneurysms usually enlarge over time, and have the potential to rupture
and cause life-threatening bleeding. Aneurysms can occur in arteries in
any location in your body, but common sites include the abdominal aorta
and the arteries at the base of the brain.
The
vast majority of aneurysms occur when an artery wall becomes weak or
damaged by atherosclerosis. And that means in many cases, aneurysms are
another type of cardiovascular disease that's preventable. The usual
suspects in blood vessel damage are often to blame here, too — smoking,
high blood pressure, and unhealthy lifestyle habits that contribute to
atherosclerosis.
Brain aneurysms are a different matter and
often result from a congenital weakness in the arteries at the base of
the brain.
Claudication.
Strictly speaking, this is a symptom of the condition occlusive
arterial disease, but it's often referred to as a disease itself.
Symptoms develop when the arteries to the legs or arms become partially
obstructed, compromising blood flow — similar to how coronary artery
disease can cause angina. When the obstruction is mild, you may have
such symptoms as extremity pain during strenuous exercise. As the
disease progresses and arteries become more obstructed, you may notice
symptoms with minimal or no activity at all and develop ulcers of the
skin and soft tissue that don't heal.
As
with aneurysms, claudication is most often caused by preventable
atherosclerosis. Claudication isn't just a type of cardiovascular
disease. It's also a symptom of other cardiovascular disease — the pain
of claudication can be a symptom that you have atherosclerosis.
Vasculitis.
This is inflammation of the blood vessels. It usually involves the
arteries but may also affect small veins and capillaries. The
inflammation may damage the wall of the artery or vein and impair blood
flow to the region of the body supplied by that vessel. Sometimes
vasculitis occurs in the presence of a generalized disorder, such as
lupus or rheumatoid arthritis, but it sometimes occurs without an
associated disease.
Venous incompetence.
This is a condition in which blood actually flows the wrong way in
veins. Veins have tiny valves that are designed to promote blood flow
in a forward direction, back to the heart. But if you have such
conditions as infection, inflammation, abnormal blood clotting, or even
high-back pressure in pregnancy, the valves may become damaged and
incompetent. That allows blood to flow backward and pool in the
extremities when sitting or standing, causing a variety of
complications, such as prominent and painful varicose veins, skin
changes and ulcers.
Venous thrombosis. This is
the abnormal formation of a blood clot (thrombus) in a vein. This
condition may damage the vein and its valves. In addition, clots that
break off and travel in the bloodstream can lodge in the lungs, a
condition known as pulmonary embolism. In some cases, this type of clot
can also cause a stroke.
Varicose veins. This
is a condition in which veins become gnarled, twisted and enlarged.
They're usually located on the backs of the calves or on the inside of
the legs, from the groin to the ankle.
When
valves in your veins don't function properly, blood can accumulate in
your lower extremities, causing the veins to bulge and twist. The veins
appear blue because they contain less oxygen.
"Cardiovascular
disease is not a linear disease," Dr. Edwards says. "People don't
usually have only one of these conditions that make up cardiovascular
disease. Most of the time there's a complex interplay of the
conditions, and a primary disorder may cause a secondary disorder,
which can lead to other disorders and make all of them worse, including
the primary disorder."
Furthermore, he notes, one cardiovascular
disease can be a manifestation of another. Case in point: aneurysm. It
can be a sign that you have atherosclerosis.
All of this
underscores the complexity that is cardiovascular disease. But in the
end, the most common forms of cardiovascular disease are high blood
pressure and coronary artery disease, both of which are highly
preventable.
Some preventive measures you can take:
- Don't smoke or use other tobacco products
- Eat a varied diet, rich in fruits,
vegetables and low-fat foods
- Maintain a healthy weight
- Get at least 30 minutes of exercise
daily, most days of the week
- Keep your cholesterol levels in normal
ranges
- Control your blood sugar if you have
diabetes
- Control your blood pressure
You
have the power to greatly reduce your risk of cardiovascular disease,
whether it's heart disease, coronary artery disease or coronary heart
disease — or any of their numerous incarnations.
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