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Epidemiology of Cardiovacular Disease

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  1. Introduction
  2. Importance of cardiovascular disease
  3. Disease impact
  4. Secular trends
  5. Economic impact
  6. Risk Factors for cardiovascular disease
  7. Unmodifiable cardiovascular disease risk factors
  8. Dyslipidemia
  9. Hypertension
  10. Physical inactivity
  11. Obesity
  12. Thrombotic and fibrinolytic factors
  13. Synergy of risk factors
  14. Subclinical cardiovascular disease
  15. Conclusions
  16. Bibliography

The three major clinical manifestations of atherosclerotic cardiovascular disease (CVD) are coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). Atherosclerosis also can be found in other arterial beds, especially the renal arteries, where it causes about two thirds of cases of renal artery stenosis. More than 60 million Americans are estimated to have some form of CVD: 50 million have hypertension, 12.4 million have CHD, and 4.5 million have had a stroke. More than one in five Americans currently have some form of CVD. CVD accounts for about 950,000 deaths annually in the United States and constitutes more than 40% of all deaths. About 35% of CVD deaths occur prematurely (i.e., in persons <75 years old).

[...] UNMODIFIABLE CARDIOVASCULAR DISEASE RISK FACTORS Several CVD risk factors are essentially immutable, including older age, male gender, and a family history of CVD. Nonetheless, these risk factors are important to consider in evaluating risk in an individual patient. CIGARETTE SMOKING Cigarette smoking, along with dyslipidemia and hypertension, is considered one of the three major risk factors for CHD, thromboembolic stroke, and PAD. Event rates are three to four times higher in regular smokers, with a dose-response relationship. In contrast to most other CVD risk factors, cigarette smoking can be eliminated entirely, but not easily. [...]

[...] GENDER ISSUES The epidemiology of CVD in women and men is similar. Except for gonadal hormones, risk factors produce similar relative risks in men and women. The major gender difference is the greater absolute age-specific CVD risk of men, particularly at younger ages. Because absolute CVD risk is lower overall in women, the incremental risk produced by a given risk factor tends to be less except for diabetes, in which the relative and the incremental risks for heart disease are greater in women. [...]

[...] Angiotensin-converting enzyme inhibitors can reduce the risk of progressive renal disease and CHD events in patients with existing diabetes mellitus. OBESITY Obesity has increased dramatically in recent years in the United States for unclear reasons. Possible causes include the automobile, television, the Internet, a decrease in school-based physical activity programs, fast food, and large portion sizes. Obesity contributes to increased CVD risk by aggravating known CVD risk factors, including hypertension, insulin resistance, low HDL cholesterol, and hypertriglyceridemia. Even adjusting for these risk factors, obesity seems to contribute independently to CVD risk. [...]

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