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. [...]
[...] In some studies of older adults, pulse pressure (systolic blood pressure diastolic blood pressure) shows the strongest association. Early trials in severe hypertension unequivocally showed the benefits of reducing very high blood pressure levels, with a sharp reduction in morbidity and mortality from CVD. Meta-analyses of pharmacologic treatment of mild hypertension also showed benefit. Multiple classes of antihypertensive drugs are now available, and extensive research is needed to determine the optimal drug regimen for a given patient because some evidence suggests different drugs affect CVD outcomes differently despite similar reductions in blood pressure. [...]
[...] Clinical trials of alcohol for CVD end points have not and likely will not be conducted, however, owing to technical and ethical difficulties with study design. For nonatherosclerotic CVD, such as hemorrhagic stroke and cardiomyopathy, risk is increased by alcohol consumption. At higher levels of alcohol consumption (three or more drinks per day), blood pressure increases, arrhythmias may be induced, rebound hypercoagulability may develop, direct myocardial damage can occur, and total CVD risk is increased. Maximum overall benefit for alcohol is reached at a single drink per day, and consumption of more than two drinks per day is associated with increases in morbidity and mortality from total cardiovascular causes, cirrhosis, accidents and violence, and certain cancers. [...]
[...] Many patients do not experience symptoms or ignore warning symptoms, and their first presentation may be a severe or fatal MI or stroke. Risk Factors for Cardiovascular Disease TYPES OF STUDIES The epidemiology of CVD has been evaluated in many study designs including ecologic, case-control, cross-sectional survey, prospective cohort, and clinical trial designs. In general, the strength of the causal inference one can draw from a study increases along this continuum, with policy changes typically appropriate only when supported by solid evidence from clinical trials. [...]
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