Cardiovascular diseases are those that affect both the circulatory system and the heart. These include coronary heart disease, valvular heart disease, high blood pressure, cerebrovascular accident ( thrombosis or stroke) or myocardial infarction.
Among ischemic heart diseases, acute myocardial infarction is the most frequent, with 61 per cent of deaths. Although this pathology in subjects between 25 and 74 years of age remains stable, it is estimated that each year the number of heart attacks and angina pectoris will increase by 1.5% due to the ageing of the population.
The cerebrovascular disease appears more frequently in the elderly population. The consequences can have different symptoms and severity, including vision problems and difficulty coordinating movements. This pathology is one of the leading causes of severe and prolonged disability in adults.
Causes
The underlying pathology of cardiovascular diseases is atherosclerosis, an inflammatory disease characterised by the accumulation of lipids, inflammatory cells and fibrous tissue in the arteries.
Its aetiology is multifactorial and complex, involving both environmental and genetic factors.
Symptoms
The clinical manifestations of cardiovascular risk factors will vary depending on the type of risk factor.
Prevention
The only risk factors that can be prevented are adjustable ones, such as obesity or high cholesterol. To achieve this, the patient must control these factors by modifying her lifestyle to lead to a healthier routine. We must take care of our diet, incorporate physical activity into our daily life, or stop smoking and consuming alcoholic beverages.
types
Currently, cardiovascular risk factors can be divided into two types:
not modifiable
- Age
As a person ages, their heart will too. For this reason, the elderly are the primary victims of most heart disease.
The incidence of heart failure doubles after 40-45 years, according to the Spanish Heart Foundation.
- Sex
Men are at higher risk of cardiovascular disease than women. Experts attribute this to female hormones exerting a protective effect. In fact, with menopause, there is an increase in the rate of heart disease in women.
- Genetic heritage
In recent years, specialists have observed a particular concentration of cardiovascular pathologies in some families, so it is considered that there could be an indication of a genetic cause.
- Arterial hypertension
It is a disease characterised by an increase in blood pressure figures above 140/90 mmHg and is considered one of the leading public health problems in developed countries.
Individuals with blood pressure between 130/80 and 139/89 have twice the risk of high blood pressure than those with lower values.
Hypertension is an asymptomatic disease that is easy to detect. However, it has severe and lethal complications if it is not treated in time. In 90 per cent of cases, the cause is unknown, which is why it has been called ‘essential arterial hypertension, which has a strong hereditary influence. Likewise, in ‘secondary arterial hypertension, there are causes directly responsible for the elevation of blood pressure figures. This form of hypertension can serve as an alert to locate more severe diseases.
- Cholesterol
It is one of the most crucial risk factors since, if its levels rise, it can cause hypercholesterolemia. For example, people with blood cholesterol levels of 240 mg/dl have twice the risk of having a heart attack than those with figures of 200.
Another important reason is that when the cells cannot absorb all the cholesterol, it can adhere to the walls of the arteries, facilitating their narrowing and the formation of atherosclerosis.
- Diabetes
Diabetic patients have a higher risk of suffering from cardiovascular disease, so preventing this pathology is key.
The reasons are that glucose can rise in the blood, damage blood vessels and accelerate atherosclerosis. In addition, diabetes also increases the risk of developing other diseases such as cerebrovascular diseases.
- smoking
It is the most crucial risk factor since the incidence of cardiovascular diseases in smokers is three times higher than in other people. The Spanish Heart Foundation points out that the possibility of suffering from heart disease is proportional to the number of cigarettes smoked per day and the years in which smoking is maintained.
- Lack of physical exercise
Lifestyle changes in Western societies have led to an increase in sedentary lifestyles in the general population, although a sedentary lifestyle has been linked to cardiovascular mortality.
People who do not perform physical activity are at higher risk of hypertension, atherosclerosis and respiratory diseases.
- Obesity
Obesity is involved in the development of many pathologies. For example, in the case of cardiovascular diseases, if fat accumulates in the abdomen, it will affect more cardiovascular risk.
Diagnosis
Some are at higher risk of having a heart condition. To distinguish one from the other, specialists will assess cardiovascular risk in people who are over 40 years old and have one or more of the cardiovascular risk factors that have been described.
The diagnosis should include the measurement and recording of the following clinical data:
- Family history of cardiovascular diseases.
- Age.
- Gender.
- ethnicity
- Tobacco use.
- Fasting lipid profile.
- Fasting blood sugar.
- Body mass index.
- Abdominal perimeter.
- If the person has diabetes, they should note the date of diagnosis and determine the glycated haemoglobin, the presence of albuminuria and serum creatinine.
Treatments
Depending on the risk of cardiovascular disease that exists, one treatment or another will be carried out, but some general conditions can be established:
- Improve diet habits.
- Do more physical activity.
- Available measures against overweight and obesity.
- Avoid tobacco.
Other data
Genetics and cardiovascular diseases
What are single nucleotide polymorphisms?
Single nucleotide polymorphisms (SNPs) are substitution mutations of one nucleotide for another. They are the most frequent forms of gene variation, with around 10 million SNPs in our genome. However, only 3 million of them are believed to explain most of the interindividual variability. Thanks to them, we can identify differences in the genome of living beings.
What is it, and what does genotyping tell us?
Genotyping consists of the identification of polymorphisms, also called genetic variants. Although there are several methodologies to detect these genetic variants, advances in biotechnology allow us to see many SNPs in a single test simply; such is the case of DNA microarrays.
Currently, many polymorphisms associated with the development of cardiovascular diseases are known. Among them are those associated with the development of acute myocardial infarction and others related to the predisposition to present classic cardiovascular risk factors (dyslipidemia, arterial hypertension, diabetes mellitus, obesity, thrombosis and degree of nicotine dependence).
This genetic information of great value and relevance with the patient’s clinical data and life habits would allow a personalized evaluation of long-term theoretical cardiovascular risk in a more specific manner than current assessment tools, a fact that undoubtedly would have a significant impact on the prevention of cardiovascular diseases.
Who can benefit from genotyping these genetic variants?
Currently, in developed countries, more than 50% of cardiovascular events occur in individuals classified as intermediate risk by current assessment tools (Framingham tables, REGICOR, SCORE, etc.). Although these tools are helpful, they are particularly inefficient in this risk group because many present not only classic risk factors but also a genetic risk factor that is not usually analyzed.
Likewise, the fact that acute myocardial infarctions in young adults (subjects under 65 years of age) occur in several consanguineous members of the same family indicates the presence of an underlying genetic component. That is why genotyping would be helpful in those individuals under 65 years of age classified by current assessment tools as “intermediate risk” and who also have a family history of acute myocardial infarction.
