whiteeportfolio.files.wordpress.com€¦ · Web viewCardiovascular disease, also known as heart disease, is an epidemic throughout the world. It is the leading cause of death in the

Running head: CARDIOVASCULAR DISEASE 1

Cardiovascular Disease

Vincent White

Northern Arizona University

CARDIOVASCULAR DISEASE 2

Abstract

Cardiovascular disease, also known as heart disease, is an epidemic throughout the world. It is

the leading cause of death in the world. More people die from CVD every year than from any

other cause (World Health Organization, 2013). According to the World Health Organization

“An estimated 17.3 million people died from CVDs in 2008.” With Cardiovascular disease being

such a relevant disease in today’s day and age, much education needs to be distributed to help

reverse the problem. According to the World Health Organization “The number of people who

die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3 million by

2030 (1,3). CVDs are projected to remain the single leading cause of death (3)”. If we refuse to

address this problem on the global stage soon, millions of needless deaths will continue.



Person, Place, Time inside the U.S.


Specific disease/condition information.

Cardiovascular disease is a generalized term that can refer to any disease pertaining to the heart.

Heart disease is a general term that describes many different types cardiovascular issue.

Coronary Artery Disease is one of these cardiovascular issues and is most common in the United

States. It has the ability to cause heart attack, angina, heart failure, and arrhythmias, which can

lead to a cause of death in related, yet different ways (Center for Disease Control, 2014)

Background general investigation. Generally speaking, when referring to

cardiovascular disease most people are referring to coronary artery disease, as it is the most

common in the U.S. (Center for Disease Control, 2014). “Coronary artery disease occurs when a

substance called plaque builds up in the arteries that supply blood to the heart (called coronary

arteries). Plaque is made up of cholesterol deposits, which can accumulate in your arteries. When

this happens, your arteries can narrow over time. This process is called atherosclerosis” (Center

for Disease Control, 2014). The narrowing of these arteries and plaque buildup can lead to pain

called angina or even a myocardial infarction, more commonly known as a heart attack (Center

for Disease Control, 2014).

Disease Condition Specifics

Stage of susceptibility. Obesity is the most common stage of susceptibility for

developing cardiovascular disease. “Multiple logistic regression analyses showed that

Metropolitan Relative Weight, or percentage of desirable weight, on initial examination


predicted 26-year incidence of coronary disease (both angina and coronary disease other than

angina), coronary death and congestive heart failure in men independent of age, cholesterol,

systolic blood pressure, cigarettes, left ventricular hypertrophy and glucose intolerance” (Hubert,

Feinleib, & Mcnamara, 1983). The other risk factors listed also pose significant susceptibility to

developing cardiovascular disease.

Stage of presymptomatic disease. There are many presymptomatic factors of

cardiovascular disease. Patients are most likely in a stage of presymptomatic disease for years

before ever being diagnosed with cardiovascular disease. “Among the identified precursors of

cardiovascular disease, hypertension plays a dominant role. Also, once an attack occurs, it is

more likely to be fatal in the hypertensive. Although generally high, the excess cardiovascular

risk in the hypertensive is not uniform. The factors influencing its impact on cardiovascular

disease include the height of the blood pressure, ECG-LVH, serum cholesterol value,

carbohydrate tolerance, the cigarette habit, and heart size on x-ray, among others” (Kannel,

1974). Patients who opt to get these tests early may be able to prevent further damage and

effectively prevent a progression of cardiovascular disease.

Stage of clinical disease. Cardiovascular disease has a relatively long clinical stage and

can result in death if not treated properly. People who have coronary artery disease are likely to

have a myocardial infarction resulting in cardiac muscle death. And the worst part is that people

who experience a myocardial infarction are more likely to have another cardiac episode in the

future. “Independent predictors of future cardiovascular events were LVEF for patients with a

recent MI and WMA, inducible perfusion defects, LVEF and presence of infarction for patients

with suspected or known CAD ” (El, et al., 2014). In essence, cardiac disease leads to more


cardiac disease and eventually death; holding true the axiom that prevention is better than

reaction.

Stage of recovery, disability, or death. Recovery is quite possible and even common

with modern medicine today depending on how long it takes the patient to seek treatment and

how much heart muscle the patient has lost. The main determinant of the patients recovery seems

to come down to how well the left ventricle functions after the myocardial infarction.

“Impairment of left ventricular function is the major predictor of mortality after acute myocardial

infarction, but it is not known whether this is best described by ejection fraction or by end-

systolic or end-diastolic volume (White, et al., 1987). People usually have to attend rehab and/or

physical therapy after a myocardial infarction depending on the extent of the injury to their

cardiac muscle.

Data & Measures Used

Epidemiological measures used for tracking. In cardiovascular disease, a number of

coefficients are used to track the disease, mostly comprised of risk factors. “In the literature,

tracking coefficients were reported for biologic coronary heart disease risk factors such as serum

cholesterol, blood pressure, and body fatness (1-4), as well as for lifestyle coronary heart disease

risk factors such as dietary intake, physical activity, smoking behavior, and alcohol consumption

(5-8). However, the magnitude of the tracking coefficients depends on the initial age of the

subjects, the number of repeated measurements, the time period(s) between the measurements,

the length of the total time period under consideration, and the methodology used to assess

tracking” (Twisk, Kemper, Mechelen, & Post, 1997).

Incidence rate (a measure of morbidity) worldwide. Here are a few key facts from the

World Health Organization:


- “The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths,

or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases,

including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million). Diabetes

caused an additional 1.3 million deaths.” (World Health Organization, 2013)

- “Low- and middle-income countries are disproportionally affected: over 80% of CVD deaths

take place in low- and middle-income countries and occur almost equally in men and women

(1)” (World Health Organization, 2013).

-“The number of people who die from CVDs, mainly from heart disease and stroke, will increase

to reach 23.3 million by 2030 (1,3). CVDs are projected to remain the single leading cause of

death (3)” (World Health Organization, 2013).

Prevalence rate (number of current/existing cases) worldwide. In order to determine

how many people have cardiovascular disease worldwide we must first narrow our search to a

more specific type of cardiovascular disease such as hypertension. “Hypertension is one of the

primary risk factors for heart disease and stroke, the leading causes of death worldwide. Recent

analyses have shown that as of the year 2000, there were 972 million people living with

hypertension worldwide, and it is estimated that this number will escalate to more than 1.56

billion by the year 2025” (Chockalingam, Campbell, & Fodor, 2006). Reducing the amount of

hypertensive patients could help prevent a lot of cardiovascular related deaths each year.

Mortality rate (number of deaths) worldwide. According to the World Health

Organization “An estimated 17.3 million people died from CVDs in 2008” (World Health

Organization, 2013).


Patterns of Disease in the United States

Particular factors.

Overall current and year 2010 prevalence rate of CVD for the United States. According

to the CDC in 2010, “Percent of non-institutionalized adults ages 20 and over with hypertension:

31.9%” (Center for Disease Control, 2010). According to the AHA the current prevalence rate

now is: “In the United States, about 77.9 million (1 out of every 3) adults have high blood

pressure” (American Heart Association, 2013).

Current and year 2010 prevalence rate of CVD for the United States by gender

Current. “Among adults age 20 and older in the United States, the following have high

blood pressure:

- For non-Hispanic whites, 33.4 percent of men and 30.7 percent of women.

- For non-Hispanic blacks, 42.6 percent of men and 47.0 percent of women.

- For Mexican Americans, 30.1 percent of men and 28.8 percent of women” (American Heart

Association, 2013).

2010. “In 2009 to 2010, the prevalence of hypertension was 30.5% among men and

28.5% among women” (Guo, Di, Zhang, & Walton, 2012).

Current and year 2010 prevalence rate of CVD for the United States by race/ethnicity.

Current. “Among adults age 20 and older in the United States, the following have high

blood pressure:

- For non-Hispanic whites, 33.4 percent of men and 30.7 percent of women.

- For non-Hispanic blacks, 42.6 percent of men and 47.0 percent of women.

- For Mexican Americans, 30.1 percent of men and 28.8 percent of women” (American Heart

Association, 2013).


2010. “The prevalence of preHTN was associated with age and black race (62.9% in

blacks compared to 54.1% in whites)” (Glasser, et al., 2011).

Current and year 2010 prevalence rate of CVD for the United States by age

Current. According to the Center for Disease Control (2013) here is the age prevalence

breakdown

-Men and women in the 20-34 years of age group: 11.1%, 6.8%.





-Men and women in the 75 years of age and older: 66.7%, 78.5%.

-Men and women in all age groups: 34.1%, 32.7%, respectively.

2010. “Throughout 1999 to 2010, the 60+ years group had an almost 9-fold higher

hypertension prevalence than the 20- to 39-year-old group (about 60% vs 6%)” (Guo, Di, Zhang,

& Walton, 2012).

Prevalence rate of CVD for the United States by geographic location. Although a small

amount of information is known about geographical locations effect on hypertension, there are a

few studies with significant evidence. For example: “Blacks born in southern states were 1.11

(95% confidence interval (CI): 1.02, 1.23) times more likely to be hypertensive than non-

southern states after adjusting for age and sex. Findings were similar, though not statistically

significant, for Whites (prevalence ratio (PR): 1.15, 95% CI: 0.98, 1.35). Blacks and Whites

living in Forsyth (Blacks, PR: 1.23, 95% CI: 1.07, 1.42; Whites, PR: 1.32, 95% CI: 1.09, 1.60)


and Baltimore (Blacks, PR: 1.14, 95% CI: 1.00, 1.31; Whites, PR: 1.24, 95% CI: 1.05, 1.47)

were also significantly more likely to be hypertensive than those living in Chicago after adjusting

for age and sex. Among Blacks, those living in New York were also significantly more likely to

be hypertensive. Geographic heterogeneity was partially explained by socioeconomic indicators,

neighborhood characteristics or hypertension risk factors. There was also evidence of substantial

heterogeneity in Black-White differences depending on which geographic groups were compared

(ranging from 82% to 13% higher prevalence in Blacks compared with Whites)” (Kershaw, et

al., 2010).

Person, Place, Time outside the U.S.

Patterns of Cardiovascular Disease outside the U.S.

Cardiovascular disease devastates other countries epidemically just as much as the United

States. Countries such as Belarus, Ukraine, The Republic of Moldova and Azerbaijan all have a

death rate over 400 per 100,000 due to coronary artery disease. (Kim & Johnston, 2011)

Noticeably, these countries are all a part of the European Union, which makes Europe another

interesting location for study pertaining to cardiovascular disease.

Particular factors of cardiovascular disease in Europe. Cardiovascular disease is the

leading cause of death in Europe, killing more than 4 million people each year. Coronary Heart

Disease and stroke account for the main forms of CVD; around half are from CHD and a third is

from stroke (Nichols, Townsend, Scarborough, & Raynes, European Cardiovascular Disease

Statistics 4th edition 2012: EuroHeart II, 2012). Below is information on cardiovascular disease

in Europe. Such as its prevalence and broken down by gender, race, and age. The rate between

the E.U. and Europe itself is negligible.


Overall current and year 2010 prevalence rate of CVD for the Europe.

In 2013, Cardiovascular Disease resulted in 46% of deaths in the Europe (Nichols,

Townsend, Scarborough, & Rayner, Cardiovascular disease in Europe: epidemiological update,

2013); whereas in 2010 it resulted in 47% of deaths. (Nichols, Townsend, Scarborough, &

Raynes, European Cardiovascular Disease Statistics 4th edition 2012: EuroHeart II, 2012).

Current and year 2010 prevalence rate of CVD for Europe by gender.

Current.

20% of men die from CHD, 10% die from stoke, and 12% die from another form of

CVD.

21% of women die from CHD, 15% die from stroke, and 15% die from another form of

CVD (Nichols, Townsend, Scarborough, & Rayner, Cardiovascular disease in Europe:

epidemiological update, 2013).

2010.

20% of men die from CHD, 10% die from stoke, and 12% die from another form of

CVD.

22% of women die from CHD, 15% die from stroke, and 15% die from another form of

CVD (Nichols, Townsend, Scarborough, & Raynes, European Cardiovascular Disease

Statistics 4th edition 2012: EuroHeart II, 2012).

Current and year 2010 prevalence rate of CVD for Europe by race/ethnicity. Unfortunately,

there is not much information on cardiovascular disease broken down by ethnicity for all of

Europe, and for the information that is available, it is usually only for specific areas of Europe.


That being said, there is at least an interesting rate of CVD deaths by race in the England and

Wales jurisdiction, which gives perspective of what other countries in Europe may look like,

depending on if they are as ethnically diverse.

The following is a breakdown of deaths due to CVD by ethnicity.

Black 11%

Indian 11%

Pakistani 12%

Bangladeshi 6%

Chinese 5%

Irish 15%

General Population 14%

Some ethnicities are omitted and grouped as the general population (Scarborough, et al., 2010).

Current and year 2010 prevalence rate of CVD for the United States by age.

Current: Below age 75, CVD results in 37% of the deaths in Europe. Below age 65, CVD

results in 30% deaths in Europe (Nichols, Townsend, Scarborough, & Rayner, Cardiovascular

disease in Europe: epidemiological update, 2013).

2010: Below age 75, CVD results in 36.5% of the deaths in Europe. Below age 65 CVD

results in 28.5 deaths in Europe (Nichols, Townsend, Scarborough, & Raynes, European

Cardiovascular Disease Statistics 4th edition 2012: EuroHeart II, 2012).

Prevalence rate of CVD in Europe by geographic location. Currently, Central and

Eastern Europe have the highest risk for stroke in both men and women and a slightly higher

chance in developing CHD than other areas of Europe. CVD as a whole is decreasing in those

areas despite a quick surge in CVD related deaths until the 21st century. (Nichols, Townsend,

Scarborough, & Raynes, European Cardiovascular Disease Statistics 4th edition 2012: EuroHeart


II, 2012) The higher risk of CVD in Central and Eastern Europe may be from Europeans being

significantly less active in those areas, especially women. (Nichols, Townsend, Scarborough, &

Rayner, Cardiovascular disease in Europe: epidemiological update, 2013)

Other Prevalence Date in Europe. Europe has high rates of obesity all across the

continent. The most likely cause is the intake of fat by Europeans. However, recently, they have

begun to eat more fruits and vegetables, while the fat intake is about the same. (Nichols,

Townsend, Scarborough, & Raynes, European Cardiovascular Disease Statistics 4th edition

2012: EuroHeart II, 2012)

Summary & Conclusion

In both the Unites States and Europe, there is a noticeable high rate of premature deaths

due to CVD. This is mainly due to obesity, inactivity, tobacco use and unhealthy diet. For

healthcare providers and alike, preventing premature deaths is the highest priority. Therefore,

promoting awareness of the causes of premature CVD deaths is the most effective action that can

be done to prevent CVD deaths in general. Europe addresses the issue of CVD through

legislation on tobacco control; public health programs; the European Platform for Diet, Physical

Activity and Health; as well as the development of more indicators (European Commision,

2014). The United States takes a similar approach with Center for Disease Control’s ABCS

initiatives. ABCS involves aspirin therapy, blood pressure control, cholesterol control, and

smoking cessation. (Center for Disease Control, 2011)

Globalization of cardiovascular disease. Since cardiovascular disease is non-

communicable, time is spent researching the globalization of food patterns, as well as lifestyle

changes. Evidence shows that the drastic change of diet that countries undergo when food from


animal products and fast food becomes popular directly relates to an increase in cardiovascular

disease (Hu, 2008).

Economic impact of cardiovascular disease. CVD is not only deadly, it is expensive. It

costs Europeans €196 billion a year (Nichols, Townsend, Scarborough, & Raynes, European

Cardiovascular Disease Statistics 4th edition 2012: EuroHeart II, 2012) and Americans $312.6

billion a year (Million Hearts, 2014). Of the €196 billion that Europeans pay, 54% is healthcare

costs, 24% is productivity losses, and 22% is because of informal treatment of those with CVD

(Nichols, Townsend, Scarborough, & Raynes, European Cardiovascular Disease Statistics 4th

edition 2012: EuroHeart II, 2012). And for Americans, the projected future cost could be as

much as $444 billion in years to come (Million Hearts, 2014).


References

American Heart Association. (2013). Statisical Fact Sheet 2013 Update. Retrieved from American Heart Association: http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf

Center for Disease Control. (2010). FASTSTATS - Hypertension. Retrieved from Center for Disease Control: http://www.cdc.gov/nchs/fastats/hyprtens.htm

Center for Disease Control. (2011). Chronic Disease Prevention and Health Promotion. Retrieved from Center for Disease Control: http://www.cdc.gov/chronicdisease/resources/publications/aag/dhdsp.htm

Center for Disease Control. (2013). High Blood Pressure Facts. Retrieved from Center for Disease Control: http://www.cdc.gov/bloodpressure/facts.htm

Center for Disease Control. (2014, February 5). Heart Disease Home. Retrieved from http://www.cdc.gov/bloodpressure/facts.htm

Chockalingam, A., Campbell, N., & Fodor, J. (2006). Worldwide epidemic of hypertension. Canadian Journal of Cardiology, 553-555.

El, A., Adams, Moons, Den, R., Willem, Doevendans, & Leiner. (2014). Cardiac Magnetic Resonance Imaging findings and the risk of cardiovascular events in patients with recent myocardial infarction or suspected or known coronary artery disease – a systematic review of prognostic studies. Journal of the American College of Cardiology.

European Commision. (2014, April 13). Cardiovascular Disease. Retrieved from European Commision: http://ec.europa.eu/health/major_chronic_diseases/diseases/cardiovascular/index_en.htm

Glasser, S. P., Judd, S., Basile, J., Lackland, D., Halanych, J., Cushman, M., & Howard, G. (2011). Prehypertension, Racial Prevalence and Its Association With Risk Factors: Analysis of the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study. American Journal of Hypertension, 194-199.

Guo, Di, Zhang, & Walton. (2012). Trends in Prevalence, Awareness, Management, and Control of Hypertension among United States Adults, 1999 to 2010. Journal of the American College of Cardiology, 599-606.

Hu, F. B. (2008). Globalization of Food Patterns and Cardiovascular Disease Risk. Circulation.


Hubert, H., Feinleib, M., & Mcnamara, B. (1983). Obesity as an independent risk factor for cardiovascular disease: a 26 year follow up of participants on the Framingham heart study. Circulation, 968-977.

Kannel, W. B. (1974). Role of blood pressure in cardiovascular morbidity and mortality. Progress in Cardiovascular Diseases, 46-53.

Kershaw, K. N., Roux, A. V., Carnethon, M., Darwin, C., Goff, D. C., Post, W., & Watson, K. (2010). Geographic variation in hypertension prevalence among blacks and whites: the multi-ethnic study of atherosclerosis. American Journal of Hypertension, 46-53.

Kim, A. S., & Johnston, S. C. (2011). Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease. Circulation.

Million Hearts. (2014, April 13). About Heart Disease and Stroke. Retrieved from Million Hearts: http://millionhearts.hhs.gov/abouthds/cost-consequences.html

Nichols, M., Townsend, N., Scarborough, P., & Rayner, M. (2013). Cardiovascular disease in Europe: epidemiological update. European Heart Journal.

Nichols, M., Townsend, N., Scarborough, P., & Raynes, M. (2012). European Cardiovascular Disease Statistics 4th edition 2012: EuroHeart II. CardioPulse Articles.

Scarborough, P., Bhatnagar, P., Kaur, A., Smolina, K., Wickramasinghe, K., & Rayner, M. (2010). Ethnical Differences in Cardiovascular Disease 2010 edition.

Twisk, J. W., Kemper, H. C., Mechelen, W. V., & Post, G. B. (1997). Tracking of Risk Factors for Coronary Heart Disease over a 14 Year Period: A Comparison between Lifestyle and Biologic Risk Factors with Data from the Amsterdam Growth and Health Study. Journal of Epidemiology, 888-898.

White, Norris, Brown, Brandt, Whitlock, & Wild. (1987). Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation, 44-51.

World Health Organization. (2013). Cardiovascular diseases (CVDs). Retrieved from World Health Organization: http://www.who.int/mediacentre/factsheets/fs317/en/

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whiteeportfolio.files.wordpress.com€¦ · Web viewCardiovascular disease, also known as heart disease, is an epidemic throughout the world. It is the leading cause of death in the