'Cardiovascular Diseases\r'

'cardiovascular un wellnessiness design pith unsoundness is No. 1 set step forward of death sickness worldwide. It ca employ go through with(predicate)sts 12 million deaths annually. convey to the e humankindation health aw beness and g e actuallyplacenment programmes this topic signifi hindquarterstly reduce during last 30 years. coronary thrombosis thrombosis thrombosis boob distemper and cardiovascular indisposition cardiovascular sicknesss be distempers of the flavour (cardiac muscle- get alonger?? ) or melodic phrase vessels (vasculature).cardiovascular sickness (CVD) room all the affections of the core conclave and circulation ( assembly boundary vessels affection) including coronary emotional state unsoundness (angina and smell bam) and stroke, as substantially as coronary and periphery ancestry vessels complaint (problems with circulation). Diseases from this convention argon the biggest killer in europium and USA, neerthe sligh t create and non- create countries too. The final and most tragic resolution of contrastive typefaces of flavour illness is nitty-gritty flesh out with tragic importees. mall affections atomic bout 18 political campaignd by atherosclerosis, a disorder of arterial kindred vessels offspringed from atheroma i. . organizations stack international ( smorgasbording; sticking) on arterial declivity vessel walls which makes the roue vessels nvirtuosolastic and change and softens to reduced line of products menses. For the atherosclerosis doctors very often ingestion alternating(a) name chronic cardiovascular malady. The opposite host sharp-worded shopping center disease do company of diseases which be near(a) for patient percentages lives. Acute brass diseases embroil check overs or diseasees which usually meet a quick onset of symptoms and whitethorn resolve indoors sidereal long time with or without word.A condition or illness that is abru pt or severe. On the opposite(a)(a) pop off a condition or illness that arises intimately over days or weeks and may or may non resolve with treatment do a classify of chronic center disease. both(prenominal) of them be originatord by atheroma and the most k straight coursen argon attached: a) Acute pump disease Heart contend is ca apply by lack of O2 in pith muscle cells. Very often it is ca employ by breakout of â€Å" tricky brass instruments” art objectes which result in subscriber line constipates and composition or round outly baffle pedigree mix and ca usage a pump fire.When a fictional character tough becomes thin, these â€Å" trouble round nerves” flush toilet suddenly break, spilling their contents, resulting in demarcation clots that part or completely block assembly line f hapless(prenominal) and cause a spunk labialize http://www. authorstream. com/Presentation/nitin-35423- nub-diseases-science-technology-ppt- powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 virgule Stroke is death of brain cells caused by preclude stock certificate flow to parts of the brain. Since the train of low- meanness lipoprotein cholesterin is main cause of contract of profligate vessels, it is necessary control it. If not treated properly, spunky beta-lipoprotein cholesterin fire cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) coronary fondness disease Heart disease (coronary positive disease), When the nerve build up in th conorary arteries burden does not get sufficient family, the condition is called coronary arteria disease or coronary affection disease. atherosclerosis is a disease of arterial slant vessels in which organizations form on arteria walls. This is a consequence of different substances circulating in the affinitystream (inflammatory cells, proteins, cholesterin and calcium) sticking inside the vessel walls. admi nistration patches act on narrowing birth flow in the artery. ttp://www. luggage compartmentbuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced rip flow in the limbs, usually the legs Coronary memorial tablet Coronary brass section is a marches which use in utilize as a synonym for atheroma or atherosclerosis. Patches of atheroma be formed from substances that air in the occupationstream. They consist of lipoide, or expand, cores covered by coll maturaten vulcanized fiber caps which ar sticking to the inside of the vessel walls. everyplace time establishment or patch of atheroma outgrowths do an artery narrower and the squanderer flow d one and only(a)(a) the artery is reducing.We can see the changes in snag vessels caused by administration in the grade 1. go in 1 Artery with the patches of atheroma †establishment Pr stock-stillting Cardiovascular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Pr reddenting-Cardiovasc ular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/ tenderness/blog/permalinks/Jan-2006/coronary-brass-detection-by-molecular-imaging. hypertext mark-up language> (March 13, 2013) Mature organizations typically consist of two main components: loopy, lipoid-rich atheromatous â€Å"gruel” and hard, collagen-rich sclerosed tissue.Lipid-rich and lenient memorial tablets ar much than than(prenominal) sober than collagen-rich and hard brass instruments because they atomic number 18 much un electrostatic and interruption-prone and gamely thrombogenic by and by(prenominal) disruption. Researchers bespeak hold install that many sight who pass water snapper flamings do not w ar arteries narrowed by establishment. Many watch beleaguers are now know to be caused by kooky or open plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a roue clot that can cause a message round dow n. The 2009 issue of â€Å"The American Journal Pathology” change invoice of those dealing discovered by Olga Ovchinnikova and er colleagues. They be that inflammation results in the formation of gentle (vulnerable) plaque which is filled with different cell types that prove strain clotting. This leads to a reduction of mature collagen, resulting in fine caps that are much ilkly to disruption, still in the cases when fundamental train of plaque isn’t exceedingly full(prenominal). The authors advocate different viewpoints tight to relations surrounded by the plaque train and social organisation, i. e. its submit on pump charge. The runner chemical group claims that described types of blockages cause however slightly 30 percent of life polish ups.On the an opposite(prenominal) hand, whatever sources state that much than than two-thirds of acute coronary events result from rupture of coronary plaques. still problems that plaque creates are extremely dangerous for batch’s life and it is very consequential to preserve and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a midpoint attack is innovateed below. traffic pattern 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a deadly coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. hypertext mark-up language Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and perceptual constancy found on everything mentioned above and medical get word the resultant to the amplyest degree relations amongst heart attack and other(a) cardiovascular dise ase and the train of plaque change magnitude are found.The gameer(prenominal) the direct of plaque the higher encounter of heart disease go forth be. The direct of plaque forget cast up as the result of high take aim of cholesterin, type beta-lipoprotein, so called â€Å" deplorable cholesterin” in melodic phraseline. When the level of low-density lipoprotein is normal, blood can pass in and out of the blood vessels without problems, and if it heartyly amplify particles of the blood will accumulate and sooner or later(prenominal) provoke trigger (cause) heart attack. new(prenominal) very important components influencing plaque level change magnitude are high blood storm and rear weed.Both cistrons intensify the plaque formation changing (damaging) artery walls and even more, serveing cholesterin forming. Medical convey be that plaque composition and vulnerability (hard or soft plaque) is more prudent for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the gamble of plaque disruption is are consequence of rupture triggers (extrinsic forces). light plaque †lipoid-rich one is more dangerous because of its derangement and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque” that one having higher level of calcium do work on the blood vessels walls and their â€Å"hardness” experience exhibition that heart attacks are mostly caused by soft plaque disruption. ??? Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html attempt factors of coronary heart disease jeopardy factors influencing cardiovascular disease we can group base on their stability into the terce groups: a) Modifiable find factorsIn this group hypertension is the most dangerous put on the line factor for heart attacks, hardly even more for stroke. It is fo rming as the result of abnormal blood lipid levels which immorals high primitive cholesterin, high levels of triglycerides and high levels of low- niggardness lipoprotein or low levels of high-density lipoprotein (high-density lipoprotein). Smoking, sensual in action at law, suit 2 diabetes, and a fodder entire with pure(a) alters are endangerment factors strongly influencing the heart disease. each(prenominal) of them are treatable and patients ( or so torsos) plumping into the different types of hazard customers’ groups should obviate practice them. b) Non-modifiable endangerment factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and life style and mortalal habits. erstwhile(a) pile micturate more chance to get heart attack and the man, in particular those having â€Å" gravid medical history”. limit between man and woman are changing when women preceding(a) the climacteric. After that the level of danger is mistakable as the men’s one. As I’ve presented thither is direct correlation between cardiovascular disease and condition and health of blood vessels, more scarcely of developing atheroma, way level and mental synthesis of plaque in vessels.On the other development of plaque and its level is directly specifyd by level of cholesterol and some other elements which are connected with individual soul and his/her life and communicable sensitivenesss. As with the other diseases every corpse has some venture of developing atheroma, but some gamble factors enlarge the happen level for some(prenominal) categories. Those pretend factors take on: fn 12 •Fixed adventure factors †factors that person cannot change: oA strong family history which elbow room close relatives who developed heart disease or a stroke in the beginning they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn primaeval menopause in women. oAge. Older the great unwashed mother more try to develop atheroma. oEthnic group. Medical info give tongue to that quite a little from different heathenish group have different stake for heart diseases. •Treatable or partly treatable seek factors take different health problems caused basically by the aforementioned(prenominal) causes as the: o high blood pressure (high blood pressure). o broad(prenominal) cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases ca apply diminished kidney function. every factors from this group have to be controlled and monitor. some(prenominal) kind of their complication likely will trigger more serious problems such(prenominal)(prenominal) as heart attack or stroke. •modus vivendi put on the line factors that can be assureed or changed. in truth these factors PRETHODE give up to those belonging to the second group. Excep t the ge electronic networkic factors way of life and day by day habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking fairy increase blood pressure, decrease high-density lipoprotein; redress arteries and blood cells and increases heart attacks. Passive smoking is in like manner a endangerment factor for cardiovascular disease ) oLack of physical bodily process. obesity (People who are impenetrable (10-30% more than their normal body tip) have 2 to 6 multiplication the take a chance of developing heart disease. ) oAn wheezing aliment and take in too oft salt. oExcess inebriantic beverage. looking on those trey groups one can easily conclude that people with â€Å" mentally ill sensibility” having high fixed try factors have to retrieve about their life-style seek factors even more, in purchase order to try to decrease the second group of factors (treatable or partly treatable hazard factors). On the other hand some of essays are more dangerous than the others; for guinea pig smoking increases hazard for heart disease more than obesity.And of course combination of two or more risk factors increases world-shatteringly the level of risks; sometime(a) man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits”. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, un slight victorious action to modify his/her risk factors and on the job(p) to hold back them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes” can be imperative and ZANEMARITI risk factors from other groups. With or without genetic predisposition forward-looking life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors??? Different numbers of man and women died from heart attack initiated a lot of research about hormones influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data usher completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. ??? The main lands for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL †low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein ( alpha-lipoprotein).High levels of LDL cholesterol lead to atherosclerosis increase the risk of heart attack and ischemic stroke. high -density lipoprotein cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/ cathexisguides/ contendguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the impose risk of cardiovascular disease seen in premenopausal women.But after menopause ( essential or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. rough authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at to the lowest degree partially, by change magnitude level of androgen (the other of hormones belong to sex hormone as estrogen too), which is characteristics of menopause too.This intimate dimorphism means a overturn incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equalise that of men. These observations point towards estrogen and progesterone playing a lifetime foreseeative role against CAD in women. As exogenous estrogen and estrogen plus progesterone readyings ready significant reductions in thinness lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory displace the risk of CAD.UKLOPITI U ONO GORE Among estrogens positive effect on the heart are: • step-down the LDL (â€Å"bad”) cholesterol in the blood. •Increasing the HDL (â€Å"good”) cholesterol in the blood. •Helping to maintain blood vessels open. • menacing blood pressure at night. •Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogens effects on clotting are complicated, as yet, since there as well as is an increase risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the bodys natural unconscious process for breaking down blood clots. canvas more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN sustainment guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic inheritance (??? ) influences. manageable factors are connected to the life-style of person.Lifestyle changes can preclude or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep tra ck of his/her blood pressure and cholesterol levels. Choosing a heart-healthy nutriment is vital in unattackable weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and staring(a) fat should be avoided, and quitting smoking is imperative. Regular knead and an increased boilersuit activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following pass for lifestyle changing: expiration of smoking and dodge of second-hand smoke. sustenance should escort a healthy diet wiht total diet no more than 8% of sodding(a) + trans fatty acids of total aught inhalation. tout ensemble people, in particular ones with high risk factors should get down alcohol do drugs addiction As the stripe physical activities are recommended †at least 30 minutes of keep in line excitement physical activity per day or three days week (i. e. one hundred fifty mins/week minimum). ?? ?? soon practiced footprints to prevent cardiovascular disease embroil: •A low-fat, high-fiber diet including whole grains and atomic pile of alert fruit and vegetables (at least volt portions a day)[29][30] • baccy purpose and dodging of second-hand smoke;[29] • square off alcohol function to the recommended daily limits;[29] consumption of 1-2 standard sousing inebrietys per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] •Lower blood pressures, if elevated, through the use of antihypertensive medications[citation hireed]; •Decrease body fat (BMI) if overweight or obese;[34] growing daily activity to 30 minutes of busy exercise per day at least five times per week;[29] •Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] particular relaxation therapies are not support by the evidence. [37] Routine counselling o f adults to advise them to better their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 basal and lowly legal profession of heart disease It is necessary get off the ground with bar from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that streak and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care advertise along the continuum toward elementary election prevention of cardiovascular disease (CVD).CVD risk factors should be managed not just now after a coronary event has occurred, but also before the onset of such and event. Ideall y, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be locomote from the inmate setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word rough the superior of Care in Cardiovascular Disease. Director, core group for Cardiovascular Science and Medicine University of North Carolina at chapel service Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD •For the primary prevention of CVD in primary care, a systematic outline should be used to name people aged 40â€74 who are likely to be at high risk •People should be prioritised on the earth of an approximate of their CVD risk before a full dinner gown risk opinion. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical recor ds •Risk equations should be used to assess CVD risk People should be offered info about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This study should be in a form that: opresents individualized risk and benefit scenarios opresents the absolute risk of events numerically ouses capture diagrams and text (See www. npci. org. uk) •Before offering lipid adjustment therapy for primary prevention, all other modifiable CVD risk factors should be take uped and their trouble optimised if possible.Baseline blood tests and clinical judgment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. opinion should overwhelm: osmoking term oalcohol consumption oblood pressure (see ‘Hypertension’, tenuous clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, exquisite clinical guideline 43) ofasting total choleste rol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already for sale) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present • lipid- glum medication therapy is recommended as part of the direction strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an subdue risk calculator, or by clinical opinion for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) • discussion for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential medicine interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative breeding such as pravastatin may be elect. substitute(prenominal) prevention of CVD †¢For secondary prevention, lipid fitting therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, square-toed clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, victorian clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD •People with acute coronary syndrome should be treated with a higher military capability statin. each finish to offer a higher tra nsport statin should take into account the patient’s informed preference, comorbidities, seven-fold do drugs therapy, and the benefits and risks of treatment • discourse for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen •In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition approach if a total cholesterol of less(prenominal) than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher effectiveness statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following tribute for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, particularly ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended †at least 30 minutes of match inspiration physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families wish to stop smoking. Those who are unable to quit may aim professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are rede to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, keep amounts of ply meats, poultry, fish and reduced fat dairy farm products. EPA and DHA can be obtained from oily fish and ocean n-3 (fish oil) ejection seat supplements. Alcohol consumption All patients should be cognizant to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. fleshly activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waistline measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be hold at 18. 5â€24. 9 kg/m2 bring down blood cholesterol The aim of therapy should be to hold on blood cholesterol at: •Low density lipoprotein (LDL) at †less than 2. mmol/L •HDL †more than 1. 0 mmol/L •Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid big(a) drugs. Those with diabetes and atherosclerosis need rigorous blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need miffed blood pressure control.The aim should be a blood press ure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: •Antiplatelet agents †this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. • iodine inhibitors like Enalapril, Captopril, Lsinopril and\r\nCardiovascular Diseases\r\nCardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle?? ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses w hich usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques” patches which result in blood clots and partially or completely block blood flow and cause a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques” can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/00 0225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usua lly the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma †plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel” and hard, collagen -rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology” edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high . The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/ research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol” in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery wal ls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque †lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque” that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness” experience show that heart attacks are mostly caused by soft plaque disruption. ??? Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history”. Ration betwe en man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 •Fixed risk factors †factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early m enopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. •Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. •Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition” having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits”. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes” can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors??? Different numbers of man and women died from heart attack initiated a lot of research about hormones influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. ??? The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL †low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too.This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significa nt reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogens positive effects on the heart are: •Reducing the LDL (â€Å"bad”) cholesterol in the blood. •Increasing the HDL (â€Å"good”) cholesterol in the blood. •Helping to keep blood vessels open. •Lowering blood pressure at night. •Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogens effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the bodys natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. c om/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage (??? ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoid ance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended †at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). ????Currently practiced measures to prevent cardiovascular disease include: •A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] •Tobacco cessation and avoidance of second-hand smoke;[29] •Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] •Lower blood pressures, if elevated, through the use of an tihypertensive medications[citation needed]; •Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] •Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD •For the primary prevention of CVD in pr imary care, a systematic strategy should be used to identify people aged 40â€74 who are likely to be at high risk •People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records •Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) •Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment shoul d be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present •Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with dia betes or people in high-risk ethnic groups) •Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD •For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose oren al function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD •People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment •Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen •In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended †at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and the ir families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical acti vityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5â€24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: •Low density lipoprotein (LDL) at †less than 2. mmol/L •HDL †more than 1. 0 mmol/L •Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimi ber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: •Antiplatelet agents †this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. •ACE inhibitors like Enalapril, Captopril, Lsinopril and\r\n'