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The causes of Cardiovascular Disease

There are some risk factors involved with CVD that can be controlled via changes to a persons lifestyle, while there are also others which are beyond their control. Three of the main examples involving factors that affect the development of CVD include genetic inheritance, the age of the person and their sex.

Firstly with genetics, it has been proven by certain studies that through inheritance of particular genes, some families/ethnic groups may be more or less likely to develop a CVD. The tendency varies, where for some the problem may be that they develop hypertension (high blood pressure) more readily causing damage to the arteries and increasing the likelihood of CVD. Additionally others may have inherited weaknesses in the biochemistry of their arteries, causing them to be damaged more easily, as well as negative inherited effects hindering the metabolism of cholesterol (important lipid for bodily processes, but excessive amounts can lead to atherosclerosis). Concerning genetics and certain groups, diabetes can also indirectly affect the risk of developing CVD with around 65% of diabetics die of some form of CVD. Diabetes tends to be related to specific ethnic groups (e.g. in America Native Americans) which can pass on inherited genes that increase incidence of this. Concerning age, the older the person gets the more the blood vessels begin to lose their elasticity and start to narrow. This increases the chance of a person developing CVDs, as their veins and arteries have less space (in the lumen) through which blood can travel through. With this, the hearts walls thicken and because of the narrowing vessels it is more difficult for it to pump blood to the rest of the body and the muscles. Older age is recognisably a significant risk factor for CVD, especially heart disease, where 4 out of 5 deaths caused by it occur in those aged above 65 years. Depending on whether a person is male or female could also affect their chances of developing a CVD. This is noticeable where men under the age of 50 are more likely to suffer from CVD than woman of similar ages. An explanation for the low incidence in younger woman can be seen where the female sex hormone oestrogen is produced in woman of such ages. It has an important role in the menstrual cycle and is associated with a reduction of plaque build up. This protection from CVD continues until the menstrual cycle ends with the menopause (at around age 50) and oestrogen levels start to fall. In addition to inherited factors, there are also other lifestyle factors that can affect the risk of developing CVD which can be controlled to some extent. The first of such factors would be exercise, which is important as the heart is a muscle and in this sense it becomes stronger and more efficient the more it is used through exercise. The effects of exercise include the slowing of the heart rate, the lowering of blood pressure and lower blood cholesterol levels. All of these additional factors from exercise can lower the risk of developing a CVD. Associated with exercise, weight would be another risk factor where being overweight puts an increased strain on the heart because it needs to work harder in order to pump the blood through the extra tissue gained. An overweight person has a higher chance of developing other problems that increase risk of CVD, such as high blood pressure and high blood cholesterol. Being overweight tends to have only a small impact on the risk of developing a CVD where what is significant would be the levels of exercise and different fats in the blood that are the best predictors of CVD.

Adam Clarke www.brain-freeze.co.uk

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A contributing factor for heart disease is stress, where it considered having an effect on the heart even though there is still little known about its direct effects. Such stress would be sourced from emotional stress, behaviour habits and socio-economic status- all of which could possibly have varying effects. Such effects have not actually been proven, as the way in which stress affects us can vary between people. One link between stress and its affects on the heart would be where stressful situations raise heart rate and blood pressure, thus increasing the hearts requirement of oxygen. A prolonged and excessive need for oxygen can bring about angina or chest pain, something people who already have heart disease are likely to suffer from. Additionally in times of stress the nervous system releases extra hormones (usually adrenaline) which can raise blood pressure and possibly cause damage to the lining of the arteries. As the arteries heal from such damage the walls may harden which can make it easier for plaque to build there. With particular diets being a risk factor, fatty meat and foods (with saturated fats) are recognised by some scientists as increasing the incidence of heart disease where people of certain countries that consume large amounts of these die more of heart disease. Involving the high levels of saturated fats, these may be a risk factor in diet. Associated with intake of saturated fats would be high blood cholesterol levels. Cholesterol is involved in the development of atherosclerosis, which suggests a connection between a high-fat diet and developing a CVD. Related to cholesterol in the blood are two lipoproteins (both lipid and protein) in the body that are linked with fat in the diet. The first, formed from saturated fats, cholesterol and protein would be low-density lipoproteins LDL. They contain a relatively large amount of cholesterol and can bind to cell membranes before they are taken into cells. If levels of LDL are high the membranes become saturated and so more LDL cholesterol remains in the blood. Alternatively formed from unsaturated fats, cholesterol and protein are the High-density lipoproteins HDL, which carry cholesterol from body tissue to the liver where it is broken down. This usually helps where it lowers blood cholesterol levels and removes cholesterol from fatty plaques held on the arteries. This is useful where it can lower the risk of heart disease from the condition of atherosclerosis. Connected to the diet, there are certain drugs that have associations with the development of CVDs. Firstly with alcohol, studies have shown that the risk of heart disease in people who didnt drink alcohol was slightly higher than those who drank moderate quantities. Even though this is a positive aspect of alcohol consumption, drinking more than the moderate amount of alcohol (2 drinks e.g. one drink = 4 fluid ounces of wine / 12 fluid ounces of beer) can cause high blood pressure and cardiomyopathy (disease of the heart muscle). Alcohol also usually contains large numbers of calories, which from it can add fat to body and increase the risk of heart disease. Secondly with tobacco, which greatly increases the risk of heart disease where the chemicals contained within it, that are released when smoked, have many harmful effects. These would include the increasing of the heart rate where major arteries are tightened and the development of irregularities in heartbeat timings, all of which can cause the heart to work harder. Smoking tobacco also raises blood pressure and increases the risk of CVD in those who already have high blood pressure. Chemicals in tobacco such as tar and carbon monoxide are harmful to the heart on their own, where they lead to fatty plaque building up in the arteries and possibly injuring the vessel walls. Additionally they can affect the levels of fibrinogen (blood-clotting material) and cholesterol, both of which can increase the risk of a blood clot leading to a heart attack. Lastly with drugs, birth control pills contain high levels of both estrogen and progestin. The consumption of these increases the chance of heart disease, especially in woman older than 35 with the additional risk factors such as smoking. Related to CVD, birth control pills tend to be considered safer in recent times, where developments have led to lower doses of hormones contained within them.

Adam Clarke www.brain-freeze.co.uk

The benefits and risks of treatments for CVD Antihypertensives

In general these are drugs that reduce the blood pressure, but there are multiple varieties of these each with their own benefits. Firstly with diuretics which increase the volume of urine produced thus removing excess fluids and salts causing the blood volume to fall and with the lower volume there is less blood pumped from the heart so the blood pressure falls. Beta blockers can interfere with the system controlling the heart where they can block the response of the heart to hormones like adrenaline which usually speed up the heart and increases blood pressure. They are effective in ensuring the heart rate stays slow and that the contractions are less strong making the blood pressure lower. Another group of hypertensives are the sympathetic nerve inhibitors, which affect the sympathetic nerves from the peripheral nervous system (PNS) that branch from the central nervous system (CNS) to all parts of the body. Such nerves usually stimulate the arteries making them constrict which raises blood pressure. The use of inhibitors prevents the nerves from signalling to the arteries so the arteries stay dilated lowering the blood pressure. Finally with angiotensin-converting enzyme inhibitors (ACE inhibitors), these block the production of angiotensin, a hormone which stimulates the constriction of blood vessels that cause the rising of blood pressure. As the inhibitors block the production of angiotensin this reduces the constriction of blood vessels and keeps the blood pressure lower. The benefits of using all of these antihypertensives are evident where they are effective in reducing blood pressure, thus reducing risk of CVDs. In addition to their primary aspect of reducing risk of CVDs they can also reduce the risk of damage to many organs, such as the kidneys and eyes because of the high blood pressure. They all work together as a combination to have an effect in reducing blood pressure. With the previously stated benefits, there are also numerous risks that come with the use of such treatments. Firstly, with the management of the blood pressure, where the use of antihypertensives could reduce the blood pressure too much. This can lead to injuries and falls because of the low blood pressure to parts of the body causing physical imbalance, resulting in potential further damage from the environment. Additionally there is the risk of side-effects from the way that the body reacts to the drugs. Concerning antihypertensives these could include coughs, ankle swelling, impotence (erectile dysfunction), tiredness, fatigue (exhaustion and inability to continue normal working functions) and constipation (inability to expel faeces). Additionally would be palpitations (rapid beating of the heart), abnormal heart rhythms, headaches, drowsiness and headaches because of blood pressure dropping too much. In comparison to the risks involved with high blood pressure, these may be worth the benefits of decreasing it, but to the patient they may still feel damaging to them. Adam Clarke www.brain-freeze.co.uk

Statins
These are a group of drugs that lower the level of cholesterol in the blood, where they block the enzyme in the liver that is responsible for making cholesterol and are effective in preventing the production of low-density lipoproteins. Statins are effective in reducing inflammation of the artery lining by improving the balance of LDLs to HDLs. Both the functions of statins can help to reduce the risk of developing atherosclerosis. There are possible side-effects of using statins, which include muscle and join aches, nausea, constipation and diarrhoea. In addition to these there are two more serious and rare side-effects. In some people statins can result in a form of fatal muscle inflammation and some may develop liver damage from their use. Some other risks include the consumption of statins to lower blood cholesterol, which could sometimes cause people to no longer attempt to have a healthy diet because they overestimate its effects, which could result in an unhealthy diet because of their assumptions about statins. Additionally statins reduce the absorption of certain helpful vitamins from the gut. Plant stanols and sterols These are not necessarily drugs, where they are mostly sold in certain foods such as yoghurts and spreads. These are effective where they reduce the quantity of cholesterol absorbed from the gut into the blood. This makes it easier for the body to manage cholesterol and reduces the levels of low-density lipoproteins in the blood. The benefits are recognisable with research results showing that if eaten regularly in recommended amounts they do work, and can possibly lower the risk of heart disease by 25%. The risks of consuming such plant stanols and sterols are not evident, where they do not have any noticeable side effects, though they should still be taken in moderation for dietary purposes.

Anticoagulants and platelet inhibitory drugs

Drug treatments can be used to prevent blood clotting too easily, an example of these drugs would be the group of anticoagulants. An example would be warfarin which interferes with the development of prothrombin in the body. Low levels of prothrombin can cause the blood to clot less easily. With this, the use of anticoagulants should be monitored carefully to stop the clotting of blood from being prevented completely and so it only reduces the clotting. The risks involved can be noticed if the person is injured; the reduction in clotting can cause excessive bleeding and fainting, though sometimes also result in death. Additionally they may cause allergic reactions, osteoporosis (weakening of the bones) and swelling of tissue. Platelet inhibitor drugs can make the platelets less sticky thus reducing the ability of the blood to clot. Examples of these include aspirin and clopidogrel, where the risks include the irritation of the stomach lining and the bleeding in the stomach which can become harmful. The uses of such platelet inhibitor drugs have beneficial effects where they can reduce the risk of CVD by around 20-25% in people already at low risk. The use of both drugs together could have potential side effects, where stomach bleeds can be caused with the use of them. In addition to this, side effects include rashes, diarrhoea, nausea (stomach discomfort), liver function problems and excessive bleeding (because of the prevention of blood clotting). Adam Clarke www.brain-freeze.co.uk