image from Gregg at Creative Commons
What Is Cardiovascular Disease?
The term CVD includes diseases involving the heart and circulatory system. Some of the most common, and serious, forms of CVD are listed here.
Coronary Artery Disease
Coronary artery disease (CAD, also known as atherosclerotic heart disease) is the most common type of heart disease in the United States and often leads to heart attacks. The condition is caused by plaque buildup (atherosclerosis) in the lining of arteries that supply blood to the heart. This plaque, often made up of cholesterol, causes the arteries to narrow over time, blocking blood flow. These plaques can erode or rupture, leading to blood clots and blockages in the artery.
In a heart attack (also called myocardial infarction or cardiac arrest), blood flow to part of the heart muscle is insufficient, usually due to a blood clot. Coronary artery disease is the main cause of heart attacks; however, a severe spasm or sudden contraction of a coronary artery can also stop blood flow to the heart muscle.
High Blood Pressure
High blood pressure (also called hypertension) is characterized by blood flowing through blood vessels at higher than normal pressures. Blood pressure when the heart beats and pumps blood is referrred to as systolic pressure and is the first number in a blood pressure measure. The second number, called diastolic pressure, signifies pressure when the heart is at rest between beats. Pressures above 120/80 mm Hg weaken and damage blood vessels, leading to conditions such as heart attack, heart failure, peripheral artery disease and stroke. About one in three US adults have high blood blood pressure, defined as systolic pressure at or above 140 mm Hg or diastolic pressure at or above 90 mm HG, or otherwise diagnosed by a health professional.1
Blood pressure that is too low (called hypotension) can also be a symptom of cardiovascular diseases such as heart failure, heart attack and valve problems. Systolic pressures below 90 mm Hg and diastolic pressures below 60 mm Hg are considered lower than normal.
A stroke occurs when blood does not flow properly to the brain, injuring brain tissue. This can result from a clot that blocks the flow of blood (called an ischemic stroke) or a rupture of a blood vessel in the brain, leading to bleeding (called a hemorrhagic stroke). Each year, 795,000 people in the US are estimated to suffer strokes, and roughly 130,000 will die of the event.2
Heart failure occurs when the heart is unable to pump a sufficient supply of oxygen-rich blood to the body. Due to weakening or stiffening of the heart muscle, heart failure can result from coronary artery disease or high blood pressure. About 5.8 million people in the United States have heart failure, and about half of those who develop heart failure will die within five years of diagnosis.3
Congenital heart defects are not included here but are discussed on our Birth Defects page.
Cardiovascular disease (CVD) is a leading cause of death both worldwide and in the United States, with mortality rates increasing worldwide.4 In 2014, CVD was responsible for more than 17 million deaths globally. Although it is traditionally understood as a disease arising from diet, obesity, poor physical fitness and family history, research is increasingly being conducted on the effects of the environment—from air pollution to lead poisoning—on CVD risk.
An estimated 17.5 million people died from CVDs in 2012, representing 31 percent of all global deaths.6 CVD is the leading cause of global mortality.7 The burden is not limited to high-income countries, as 80 percent of CVD deaths occur in low- and middle-income countries.8
In the United States, more than 85 million people live with at least one type of cardiovascular disease, with roughly half of those aged 60 or older. CVD remains the leading cause of death in the US, with roughly 800,000 deaths (31 percent of US total) in 2014 resulting from these diseases.11
Trends in Cardiovascular Disease
Rates of CVD are increasing worldwide, up almost 41 percent between 1990 and 2013. One reason for this rise is low- and middle-income countries' success in preventing and treating communicable diseases such as malaria and influenza. Because risk for CVD increases as we age, rates rise as people live longer. However, other factors also contribute to rising rates, such as increasing rates of smoking, physical inactivity, poor diet, and hypertension—all known CVD risk factors.13
In high-income countries, the trends show the opposite: deaths from cardiovascular disease have been falling for decades. A 2015 study surmised that recent declines in CVD rates in high-income countries "are probably due to the combined effect of birth cohorts' decreased exposure to tobacco smoking, improvements in diet, and improved treatment of cardiovascular disease and cardiometabolic risk factors targeting the prevention of cardiovascular disease, and improved treatment of cardiovascular disease."14
In the United States, rates peaked in the 1950s and 1960s and since then have fallen. Age-adjusted mortality decreased 30 percent for heart disease and 36 percent for stroke from 2000 to 2010, but the declines in these rates slowed after 2011.15
(insert graph of declining rates)Trends in cardiovascular mortality in the US16
Several factors have contributed to this decrease in cardiovascular mortality in the US:17
- improvements to medical treatment of CVD and its precursors
- better management of blood pressure and cholesterol
- lower rates of smoking
- improved physical activity
Costs of Cardiovascular Disease
A 2010 report by the Harvard School of Public Health estimated that CVD worldwide was responsible for $863 billion in costs per year from medical costs and loss of life-years and productivity. The authors of that report projected that these costs could rise to $1.044 trillion ($1,044,000,000,000) by 2030.18
Food Choices: What Drives Our Options?
Dietary choices are not only due to individual preferences but are promoted or restricted by environmental and societal factors:
Nutrition is the most important factor influencing heart health, and any CVD-prevention efforts must address dietary choices. Diet not only influences weight and obesity but can have strong impacts on insulin sensitivity and diabetes, inflammation throughout the body, low-density lipoprotein (LDL) levels, and oxidative stress, among others.20 While new research on dietary health is ongoing, and recommendations continue to evolve, researchers have enough understanding of how most foods can improve or impair cardiovascular health to provide evidence-based advice.
Research has revealed that focusing on a single aspect of diet—such as “low-fat” or “low-carb” options—does not produce much benefit to cardiovascular health. Not all fats have the same effect on cardiovascular disease risk, and not all carbohydrates influence health equally. Focusing on the whole diet is more productive. Eating more fruits, vegetables, fish, whole grains, nuts and beans is tied to improved cardiovascular health and is correlated with lower rates of coronary heart disease and stroke.22
Vegetable oils such as extra virgin olive oil, although they are high in fat, have protective effects against cardiovascular disease. The PREDIMED trial in 2013 found that participants given extra virgin olive oil and nuts and recommended to follow a Mediterranean diet high in fish, vegetables, fruit and white meats saw a nearly 30 percent decrease in major cardiovascular events when compared to participants following a low-fat diet.23 On the other hand, foods that are high in sugar, sodium and industrial trans-fats show harm to cardiovascular health, with greater incidence of heart disease and stroke among people who eat greater quantities of these.24
Exercise has been shown to decrease blood pressure and reduce insulin resistance, both of which are important cardiovascular disease risk factors.25 The World Health Organization, Centers for Disease Control and the American Heart Association all recommend these levels of physical activity at a minimum each week for adults 18-64:26
photo from Fit Approach at Creative Commons
- Two muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).
These guidelines are adjusted for children, for older adults and for pregnant and postpartum women. Please see the CDC guidelines for more information.
What Is Metabolic Syndrome?
Metabolic syndrome is a collection of conditions that sharply increase a person’s risk for cardiovascular disease, diabetes and stroke. People with three or more of the following conditions are considered to have metabolic syndrome:
Information is from the National Institutes of Health.27
Several comorbidities are important for assessing cardiovascular disease risk.
- Diabetes patients develop cardiovascular disease at greater rates than those without diabetes, and those who develop cardiovascular disease tend to have poorer prognoses than those without diabetes.28
- Individuals with metabolic syndrome have a 53 percent increase in risk of developing CVD and 75 percent increase in risk of death from CVD.29
- High blood pressure can injure blood vessels, increasing the risk of stroke, atherosclerosis and other cardiovascular diseases.30
- Kidney disease is both a cause and a consequence of cardiovascular disease. Risk of death from cardiovascular disease can be 10 to 30 times greater in dialysis patients compared to the regular population.31
Cardiovascular Disease and the Social Ecological Model of Health
(move this section to be close to the prevention discussion.)
Our health and well-being are profoundly shaped by many aspects of the social and environmental setting in which we live. The laws and policies of our countries, states or provinces, and cities can influence the conditions in which we live, work and play. These laws and policies can also influence our access to health care, our education and the food we eat as well as our social interactions and community networks. Our social and community environments can influence the personal life and health choices we make and the effects those choices can have on our bodies.
In the ecological model of health, risks and exposures for a disease like CVD are viewed as interrelated and interconnected. For instance, a person’s race can influence exposure to microaggressions and discrimination that then cause stress. Access to education can influence social status, earning power, the ability to afford adequate housing and food, and on and on. these experiences influence opportunities in the workplace and personal relationships at home and can contribute to personal choices that influence health. Because cardiovascular disease is influenced by many of these factors, at many levels of the environment, they are integral to discussing cardiovascular disease prevention and treatment.
The social ecological model of health helps us to understand how factors influencing changes at one level of influence is situated within the larger model, and how such changes can influence other levels. Find more information on the Psychosocial Environment page.
graphic by Lorelei Walker