Cardiovascular disease is a medical condition that affects the cardiovascular system, which includes the heart and the blood vessels through which blood flows. More than 400 specific conditions are recognized under the general category of cardiovascular disease.
The human cardiovascular system has two major parts: the heart, which provides the pumping mechanism that moves blood through the body, and the system of blood vessels (arteries, veins, and capillaries), which provides the pathway that carries blood to every part of the body. Any structural, infectious, or other problem that interferes with the normal operation of the heart or the vascular system can result in a cardiovascular disease. As an example, infants are sometimes born with a defect of the heart anatomy that disrupts the normal flow of blood through the organ. Atrial septal defect is such a condition. Atrial septal defect occurs when the wall separating the two atria of the heart does not close properly during fetal development, resulting in a condition that allows blood to flow directly from one atrium to the other. Another rare cardiovascular disease is lupus vasculitis, an inflammation of the blood vessels that sometimes occurs in conjunction with the autoimmune disease known as lupus.
A number of events can follow. A narrowed lumen makes it more difficult for the heart to push blood through the artery, causing an increase in blood pressure, or hypertension, a condition commonly associated with many forms of cardiovascular disease. The plaque can become large enough to completely seal off the artery, causing a disruption in the flow of blood, a condition known as ischemia, the inadequate flow of blood to some part of the body. The increased stress placed on the heart in moving blood through the vascular system can cause angina, pain in the chest that might also be a warning sign for heart attack.
Another possible consequence of atherosclerosis is the development of a thrombus, commonly called a blood clot. If the fibrous cap of plaque ruptures, it can result in a clot within the arterial wall. The thrombus might develop in the specific location where the plaque ruptured. Alternately, it can develop in a different body part where the plaque traveled before it occluded the flow of blood in the vessel. A thrombus occurring in the heart disrupts normal blood flow to the heart, resulting in a heart attack, or myocardial infarction (MI). A thrombus occurring in the brain can cause a stroke, and a thrombus occurring in the lungs can produce a pulmonary embolism. All of these conditions are potentially life threatening.
Blood vessel blockage also can occur in veins. One of the most common of such events is called a deep vein thrombosis, which is a blood clot that occurs most often in the legs or thighs but also has been diagnosed in the arms. The condition is called deep vein because it occurs in veins that are buried relatively deeply within an extremity, in contrast to the superficial veins that are found closer to the surface of the arms and legs. A deep vein thrombosis begins when a blood clot forms on the wall of a vein. The clot might be caused by injury to the arm, leg, or thigh; by poor circulation; or by some other factor. The primary concern with deep vein thrombosis is that a portion of the clot may break off, travel to and then become lodged in the vasculature of the lungs, thus resulting in a pulmonary embolism.
According to the World Health Organization (WHO), cardiovascular disease is the number one cause of death in the world. In 2016, the most recent data from WHO listed 17.5 million deaths worldwide from cardiovascular disease, 31% of all deaths recorded that year. Of this number, an estimated 7.4 million people died of coronary heart disease, and an additional 6.7 million died of stroke. Cardiovascular disease occurs almost equally between men and women but is far more common in middle- and low-income countries—about four times as frequent—than in more developed nations.
The U.S. Centers for Disease Control and Prevention (CDC) reported in 2015 that about 610,000 people die annually of heart disease in the United States, accounting for about one-fourth of all deaths in the nation. More than half of all deaths recorded from heart disease were in men. More than 700,000 people in the United States have a heart attack each year. The highest rate of deaths from cardiovascular disease in the United States occurred among non-Hispanic blacks and non-Hispanic whites, at 23.8% each. The lowest rate was among American Indians or Alaska Natives (18.4%). Percentage of cardiovascular disease deaths was highest in people older than age 80 and second highest among people 60 to 79 years old. By age 80, the deaths among women are slightly higher than those among men.
The term cardiovascular disease covers a wide range of medical conditions that encompasses hundreds of causes, diagnoses, and treatments. In general, the causes of cardiovascular disease fall in two major categories: those over which individuals have some control, and those over which individuals have no control. The latter category comprises genetic conditions that are responsible for anatomical or physiological errors in the body that lead to malfunctions of the heart or vascular system, such as atrial septal defect. Surgery might be available to treat individuals who are born with such conditions, and prognosis is often good if the surgery is performed early enough. Moreover, cardiovascular diseases that occur as the result of an infection may be treated by antibiotics or other methods if they are diagnosed soon enough.
There is some genetic, or hereditary, component to risk for cardiovascular disease. Knowing that heart or blood vessel disease runs in one's family is important information to share with a physician. As researchers make strides in better understanding and mapping the human body's genes, they are learning more about how genetics affect risk for cardiovascular disease. For example, certain proteins and other DNA materials help regulate functions in the body and targeting treatment at these substances could improve care for patients with cardiovascular disease.
The direction of diagnosis for cardiovascular disease is determined to some extent by specific signs and symptoms patients have. For example, high blood pressure can be diagnosed using a series of blood pressure readings in the physician office. The range of conditions that fall under the category of cardiovascular disease is so large that a physician might need to begin with a general patient medical history and physical examination to look for general factors that could lead to a more specific diagnosis. Among the tests that are used for pinpointing the precise character of a cardiovascular disorder are the following:
Treatments are based on the specific heart or vascular disease. Infants born with anatomical errors in the cardiovascular system (such as atrial septal defect) can often be treated with surgery. Disorders resulting from infections can be treated with the use of various types of drugs, such as antibiotics. To treat disorders resulting from lifestyle choices, physicians help their patients make better choices that reduce the risk of developing a cardiovascular disease, such as stopping smoking, increasing exercise, and eating healthier foods while cutting back on foods likely to lead to coronary or vascular diseases (such as saturated and trans fats). The American Heart Association recommends that adults participate in at least 150 minutes per week of brisk walking or other moderate exercise or 75 minutes per week of more high-intensity exercise. In addition, a number of medications are available for reducing one's risk for serious cardiovascular events:
Some cardiovascular disorders might not get better with lifestyle changes or drug treatments and instead require surgical intervention. Some examples of these proceduresare as follows:
Given the wide range of conditions labeled as cardiovascular disease, the prognoses vary. Generally speaking, the earlier a condition is identified, the better the chance for successful treatment or management. In many cases, prognosis depends to a significant degree on a patient's willingness to make significant lifestyle changes (for example, changing dietary choices, becoming more active, or stopping smoking). Some patients are referred to cardiac rehabilitation programs that help them improve activity levels under health professional supervision and educate them on lifestyle and risk factors, which can improve their prognosis.
See also Cardiac rehabilitation .
ACSM's Guidelines for Exercise Testing and Prescription, 10th ed. Philadelphia: Wolters Kluwer, 2017.
Braunwald, Eugene, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed. Philadelphia: Elsevier Saunders, 2015.
Cavarretta, Elena, and Giacomo Frati. “MicroRNAs in Coronary Heart Disease: Ready to Enter the Clinical Arena?” Biomedical Research International. Published electronically September 25, 2016. doi: 10.1155/2016/2150763.
American Heart Association. “Heart Conditions.” (accessed November 29, 2016).
Centers for Disease Control and Prevention. “Heart Disease Facts.” https://www.cdc.gov/heartdisease/facts.htm (accessed November 29, 2016).
Intermountain Medical Center. “Cardiac Rehabilitation May Play Role in Reducing Risk for Death in Depressed Heart Patients after Surgery.” News-Medical.net . http://www.news-medical.net/news/20161114/Cardiacrehabilitation-may-play-role-in-reducing-risk-for-deathin-depressed-heart-patients-after-surgery.aspx (accessed November 28, 2016).
National Institutes of Health. “Targeting Cardiovascular Disease Risk Factors May Be Important across a Lifetime.” https://www.nih.gov/news-events/news-releases/targeting-cardiovascular-disease-risk-factors-may-beimportant-across-lifetime (accessed November 29, 2016).
World Health Organization. “Cardiovascular Disease.” http://www.who.int/cardiovascular_diseases/en/ (accessed November 29, 2016).
American Heart Association, 7272 Greenville Avenue, Dallas, TX, 75231, (301) 223-2307, (800) 242-8721, http://www.americanheart.org .
National Heart Blood and Lung Institute, PO Box 30105, Bethesda, MD, 20824-0105, (301) 592-8573, Fax: (240) 629-3246, email@example.com, http://www.nhlbi.nih.gov/index.htm .
David E. Newton, AB, MA, EdD
Revised by Teresa G. Odle, BA, ELS