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cardiovascular disease (CVD)

Disease of the cardiovascular system: Generally in collective reference to: 1) coronary artery disease 2) peripheral vascular disease 3) cerebrovascular disease Etiology: - see cardiovascular risk factor Epidemiology: - leading cause on death in the United States - among people > 75, more than twice as many die from cardiovascular disease than from cancer & related causes - mortality from cardiovascular disease in the U.S. - greater for blacks than for whites [3] - greater for American Indians & Hispanics than Asian Americans - mortality due to cardiovascular deaths continues to increase globally despite improvments in prevention & treatment [7] - 48% of U.S. adults with cardiovascular disease (CVD) in 2016 - prevalence largely driven new AHA/ACC definition of hypertension (>= 130/80 mm Hg) - 46% of adults with hypertension, compared with 32% under the older threshold of (>= 140/90 mm Hg)* - excluding hypertension, ~9% of U.S. adults with CVD in 2016. - coronary heart disease mortality declined 32% 2006 to 2016 - 40% of adults & 19% of youth were obese 2015-2016 - increase in economic prosperity in U.S. associated with small decrease in cardiovascular mortality [16] * it is significant that not all medical organizations have bought into the new AHA/ACC guidelines & financial incentives for tighter blood pressure control have not received enough attention Pathology: - see more specific cardiovascular disease - see age-associated changes in cardiovascular function Clinical manifestations: - see more specific cardiovascular disease - see dermatologic manifestations of cardiovascular disease Laboratory: - see ARUP consult [5] Management: - see cardiovascular risk factor - lipid-lowering for secondary prevention much more effective than primary prevention [3] - high-intensity statin (atorvastatin 40 mg QD) for patients with known cardiovascular disease - dose to achieve > 50% reduction in LDL cholesterol - add ezetimibe as needed & then a PCSK9 inhibitor for high-risk patients with LDL cholesterol > 70 mg/dL [12] - mortality risks decrease as statin doses increase [10] - moderate intensity statin + ezetimibe as effective as high-intensity statin & better tolerated [17] - anti-platelet agent for secondary prevention - lifetime duration of therapy [4] - influenza vaccine to reduce risk of cardiovascular events [3] Notes: - lower cardiovascular mortality at top-ranked hospitals, but not lower hospital readmission [11] - American College of Cardiology & American Heart Association guidelines are largely based on expert opinion - little improvement is seen in the evidence base from 2008-2018 [14] - younger patients less likely to comply with medications than older patients [15]

Interactions

disease interactions

Related

age-associated changes in cardiovascular function cardiopulmonary resuscitation (CPR) cardiovascular risk factor cardiovascular system dermatologic manifestations of cardiovascular disease secondary prevention in patients with cardiovascular disease sexual activity & cardiovascular disease

Specific

abnormal cardiovascular sound cardiometabolic disease cardiovascular disease in women cardiovascular-kidney-metabolic (CKM) syndrome genetic disease of the cardiovascular system heart disease (cardiac disease) hypertension (HTN, high blood pressure, HBP) hypotension syncope vascular disease (vasculopathy)

General

circulatory system disease

References

  1. The American Heart Association Guideline for the Prevention of Cardiovascular Disease in Women Prescriber's Letter 11(3):16 2004 Detail-Document#: 200315 (subscription needed) http://www.prescribersletter.com
  2. Smith SC et al, AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update Circulation 2006; 113:2363 PMID: 16702489 http://circ.ahajournals.org/cgi/content/full/113/19/2363 - Smith SC et al, AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update J Am Coll Cardiol 2006; 47:2130 PMID: 16697342
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
  4. Garcia Rodriguez LA et al Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care BMJ 2011; 343:d4094 http://www.bmj.com/content/343/bmj.d4094.full
  5. ARUP Consult: Cardiovascular Disease (Traditional Risk Markers) - Risk Markers CVD (Traditional) deprecated reference - ARUP Consult: Cardiovascular Disease (Non-traditional Risk Markers) - Risk Markers - CVD (Non-traditional) deprecated reference
  6. Go AS et al Heart Disease and Stroke Statistics - 2014 Update. A report for the American Heart Association http://newsroom.heart.org/pr/aha/document/FINAL_DRAFT-AHA_Statistical_Update.pdf - Lloyd-Jones D, Adams RJ, Brown TM et al Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010 Feb 23;121(7):948-54 PMID: 20177011
  7. Roth GA et al Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality. N Engl J Med 2015; 372:1333-1341. April 2, 2015 PMID: 25830423 http://www.nejm.org/doi/full/10.1056/NEJMoa1406656
  8. Dhawan SS, Quyyumi AA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep. 2008 Apr;10(2):128-33. PMID: 18417067
  9. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001 Dec 4;104(23):2855-64. PMID: 11733407
  10. Rodriguez F, Maron DJ, Knowles JW et al Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online November 9, 2016 PMID: 27829091 - Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: 27829079
  11. Wang DE, Wadhera RK, Bhatt DL. Association of Rankings With Cardiovascular Outcomes at Top- Ranked Hospitals vs Nonranked Hospitals in the United States. JAMA Cardiol. Published online November 28, 2018. PMID: 30484836 https://jamanetwork.com/journals/jamacardiology/article-abstract/2716297
  12. Grundy SM, Stone NJ, Bailey AL 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 3. PMID: 30423391 - Grundy SM, Stone NJ, Bailey AL et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 Nov 8 PMID: 30423393 https://www.sciencedirect.com/science/article/pii/S073510971839034X
  13. Benjamin EJ, Muntner P, Alonso A et al Heart Disease and Stroke Statistics - 2019 Update: A Report From the American Heart Association. Circulation. Jan 2019 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659
  14. Fanaroff AC, Califf RM, Windecker S, Smith SC Jr, Lopes RD. Levels of evidence supporting American College of Cardiology/American Heart Association and European Society of Cardiology guidelines, 2008-2018. JAMA 2019 Mar 19; 321:1069-1080 PMID: 30874755 https://jamanetwork.com/journals/jama/fullarticle/2728486 - Bonow RO, Braunwald E. The evidence supporting cardiovascular guidelines: Is there evidence of progress in the last decade? JAMA 2019 Mar 19; 321:1053=1054 PMID: 30874738 https://jamanetwork.com/journals/jama/fullarticle/2728466
  15. Mahtta D et al. Evaluation of aspirin and statin therapy use and adherence in patients with premature atherosclerotic cardiovascular disease. JAMA Netw Open 2020 Aug 3; 3:e2011051 PMID: 32816031 PMCID: PMC7441361 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769571
  16. Khatana SAM, Venkataramani AS, Nathan AS et al Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults. JAMA. 2021;325(5):445-453 PMID: 33528535 https://jamanetwork.com/journals/jama/fullarticle/2775712
  17. Kim BK, Hong SJ, Lee YJ et al. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): A randomised, open-label, non-inferiority trial. Lancet 2022 Jul 30; 400:380 PMID: 35863366 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00916-3/fulltext
  18. Damluji AA, Ramireddy A, Otalvaro L, Forman DE. Secondary cardiovascular prevention in older adults: an evidence based review. J Geriatr Cardiol. 2015 Sep;12(5):459-64. PMID: 26512234 PMCID: PMC4605938 Free PMC article.