cardiovascular disease (CVD)
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Introduction
Disease of the cardiovascular system:
Generally in collective reference to:
Etiology
Epidemiology
- leading cause on death in the United States
- among people > 75, more than twice as many die from cardiovascular disease than from cancer & related causes
- mortality from cardiovascular disease in the U.S.
- mortality due to cardiovascular deaths continues to increase globally despite improvments in prevention & treatment[7]
- 48% of U.S. adults with cardiovascular disease (CVD) in 2016
- prevalence largely driven new AHA/ACC definition of hypertension (>= 130/80 mm Hg)
- 46% of adults with hypertension, compared with 32% under the older threshold of (>= 140/90 mm Hg)*
- excluding hypertension, ~9% of U.S. adults with CVD in 2016.
- coronary heart disease mortality declined 32% 2006 to 2016
- 40% of adults & 19% of youth were obese 2015-2016
- increase in economic prosperity in U.S. associated with small decrease in cardiovascular mortality[16]
* it is significant that not all medical organizations have bought into the new AHA/ACC guidelines & financial incentives for tighter blood pressure control have not received enough attention
Pathology
- see more specific cardiovascular disease
- see age-associated changes in cardiovascular function
Clinical manifestations
- see more specific cardiovascular disease
- see dermatologic manifestations of cardiovascular disease
Laboratory
Complications
- disease interaction of hearing loss with cardiovascular disease
- disease interaction(s) of chronic obstructive pulmonary disease with cardiovascular disease
- disease interaction(s) of diabetes mellitus type 2 with cardiovascular disease
- interaction(s) of breast cancer with cardiovascular disease
- disease interaction(s) of cardiovascular disease with depression
Management
- see cardiovascular risk factor
- lipid-lowering for secondary prevention much more effective than primary prevention[3]
- high-intensity statin (atorvastatin 40 mg QD) for patients with known cardiovascular disease
- dose to achieve > 50% reduction in LDL cholesterol
- add ezetimibe as needed & then a PCSK9 inhibitor for high-risk patients with LDL cholesterol > 70 mg/dL[12]
- moderate intensity statin + ezetimibe as effective as high-intensity statin & better tolerated[17]
- high-intensity statin (atorvastatin 40 mg QD) for patients with known cardiovascular disease
- anti-platelet agent for secondary prevention
- lifetime duration of therapy[4]
- influenza vaccine to reduce risk of cardiovascular events[3]
Notes
- lower cardiovascular mortality at top-ranked hospitals, but not lower hospital readmission[11]
- American College of Cardiology & American Heart Association guidelines are largely based on expert opinion
- little improvement is seen in the evidence base from 2008-2018[14]
- younger patients less likely to comply with medications than older patients[15]
More general terms
More specific terms
- abnormal cardiovascular sound
- cardiovascular disease in women
- cardiovascular-kidney-metabolic (CKM) syndrome
- genetic disease of the cardiovascular system
- heart disease (cardiac disease)
- hypertension (HTN, high blood pressure, HBP)
- hypotension
- syncope
- vascular disease (vasculopathy)
Additional terms
- age-associated changes in cardiovascular function
- cardiopulmonary resuscitation (CPR)
- cardiovascular risk factor
- cardiovascular system
- dermatologic manifestations of cardiovascular disease
- secondary prevention in patients with cardiovascular disease
- sexual activity & cardiovascular disease
References
- ↑ The American Heart Association Guideline for the Prevention of Cardiovascular Disease in Women Prescriber's Letter 11(3):16 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200315&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Smith SC et al, AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update Circulation 2006; 113:2363 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16702489 <Internet> http://circ.ahajournals.org/cgi/content/full/113/19/2363
Smith SC et al, AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update J Am Coll Cardiol 2006; 47:2130 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16697342 - ↑ 3.0 3.1 3.2 3.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
- ↑ 4.0 4.1 Garcia Rodriguez LA et al Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care BMJ 2011; 343:d4094 http://www.bmj.com/content/343/bmj.d4094.full
- ↑ 5.0 5.1 ARUP Consult: Cardiovascular Disease (Traditional Risk Markers)
Risk Markers CVD (Traditional) deprecated reference
ARUP Consult: Cardiovascular Disease (Non-traditional Risk Markers) - Risk Markers - CVD (Non-traditional) deprecated reference - ↑ Go AS et al Heart Disease and Stroke Statistics - 2014 Update. A report for the American Heart Association http://newsroom.heart.org/pr/aha/document/FINAL_DRAFT-AHA_Statistical_Update.pdf
Lloyd-Jones D, Adams RJ, Brown TM et al Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010 Feb 23;121(7):948-54 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20177011 - ↑ 7.0 7.1 Roth GA et al Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality. N Engl J Med 2015; 372:1333-1341. April 2, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25830423 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1406656
- ↑ Dhawan SS, Quyyumi AA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep. 2008 Apr;10(2):128-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18417067
- ↑ Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001 Dec 4;104(23):2855-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11733407
- ↑ 10.0 10.1 Rodriguez F, Maron DJ, Knowles JW et al Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online November 9, 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829091
Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829079 - ↑ 11.0 11.1 Wang DE, Wadhera RK, Bhatt DL. Association of Rankings With Cardiovascular Outcomes at Top- Ranked Hospitals vs Nonranked Hospitals in the United States. JAMA Cardiol. Published online November 28, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30484836 https://jamanetwork.com/journals/jamacardiology/article-abstract/2716297
- ↑ 12.0 12.1 Grundy SM, Stone NJ, Bailey AL 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423391
Grundy SM, Stone NJ, Bailey AL et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 Nov 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423393 https://www.sciencedirect.com/science/article/pii/S073510971839034X - ↑ Benjamin EJ, Muntner P, Alonso A et al Heart Disease and Stroke Statistics - 2019 Update: A Report From the American Heart Association. Circulation. Jan 2019 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659
- ↑ 14.0 14.1 Fanaroff AC, Califf RM, Windecker S, Smith SC Jr, Lopes RD. Levels of evidence supporting American College of Cardiology/American Heart Association and European Society of Cardiology guidelines, 2008-2018. JAMA 2019 Mar 19; 321:1069-1080 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30874755 https://jamanetwork.com/journals/jama/fullarticle/2728486
Bonow RO, Braunwald E. The evidence supporting cardiovascular guidelines: Is there evidence of progress in the last decade? JAMA 2019 Mar 19; 321:1053=1054 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30874738 https://jamanetwork.com/journals/jama/fullarticle/2728466 - ↑ 15.0 15.1 Mahtta D et al. Evaluation of aspirin and statin therapy use and adherence in patients with premature atherosclerotic cardiovascular disease. JAMA Netw Open 2020 Aug 3; 3:e2011051 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32816031 PMCID: PMC7441361 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769571
- ↑ 16.0 16.1 Khatana SAM, Venkataramani AS, Nathan AS et al Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults. JAMA. 2021;325(5):445-453 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33528535 https://jamanetwork.com/journals/jama/fullarticle/2775712
- ↑ 17.0 17.1 Kim BK, Hong SJ, Lee YJ et al. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): A randomised, open-label, non-inferiority trial. Lancet 2022 Jul 30; 400:380 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35863366 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00916-3/fulltext
- ↑ Damluji AA, Ramireddy A, Otalvaro L, Forman DE. Secondary cardiovascular prevention in older adults: an evidence based review. J Geriatr Cardiol. 2015 Sep;12(5):459-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26512234 PMCID: PMC4605938 Free PMC article.