In 2008, cardiovascular diseases (CVD) were responsible for 17.3 million deaths worldwide - almost a third of global deaths. However death rates vary worldwide with the low and middle-income countries representing 80% of these deaths.1
In Europe Coronary Heart Disease and Stroke have the highest death rates killing 1.92 million and 1.24 million respectively each year.2
The death rate from CVD has...
On the other hand, the death rate has increased in Central and Eastern Europe for example the death rate in men under 65 years increased by 57% and 19% in Albania and Ukraine respectively between 1994 and 2004. The trend is the same for women under 65 years in these countries with a 46% and 19% increase respectively within the period.2
Diseases of the cardiovascular system include hypertension,acute coronary syndrome or ACS, heart failure , stroke, cardiac arrhythmias, cardiac conduction defect, pericarditis, congenital heart disease, cardiac valvulopathy and venous thromboembolism.3
Although hypertension is a CVD, it's also a risk factor for other CVD. The risk of developing subsequent CVD is higher with more severe hypertension.4
Cardiac arrhythmias and cardiac conduction disorders are mainly represented by atrial fibrillation and bradycardia.5
Patients with atrial fibrillation are five times more likely to suffer a stroke, while those with either atrial fibrillation or myocardial infarction have an increased risk of heart failure.5
Acute Coronary Syndrome (ACS) and stroke are usually the end result of atherosclerosis -which is the most common cause of deaths in industrialised countries. Atherosclerosis is the formation of a plaque in the blood vessels. Its main components are LDL-cholesterol and its mechanism of formation is accurately described in both the Cholesterol and Heart Failure Knowledge Centres.
The main CVD modifiable risk factors are tobacco, excessive alcohol consumption, diet (salt and fat), physical inactivity, obesity, stress and diabetes. Usually, people combine several of these risk factors creating a synergic effect.3 By altering these lifestyle choices, 80% of cardiovascular diseases could be prevented.1
Some other risk factors are non modifiable such as, increased age, male gender and positive family history.3
There are two types of prevention: primary (to prevent atherosclerosis) and secondary (to prevent disease exacerbation).
Diagnostic techniques include blood pressure measurement, ECG, chest X-Ray, Echocardiography, cardiac catheterization, MRI and blood tests (K+, Cholesterol, Haemoglobin, natriuretic peptides).3
The treatment of CVD, can be divided in two categories. For ACS pharmacological management (e.g. statins) and non pharmacological management are available. For hypertension, the approach is similar, treated with both lifestyle and pharmacological intervention. The main goals of many CVD treatments are to lower LDL-C and blood pressure and prevent thrombus formation (anticoagulant agents).
- WHO, Fact Sheet N317 september 2011, available at: http://www.who.int/mediacentre/factsheets/fs317/en/index.html, accessed the 20th of September 2012
- The European Heart Network, European cardiovascular Statistics 2008 Edition available at: http://www.herzstiftung.ch/uploads/media/European_cardiovascular_disease_statistics_2008.pdf, accessed the 20th of September 2012
- Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003, 113-239
- NICE clinical Guideline, Hypertension Clinical Management of Primary Hypertension in Adults, August 2011, available at: http://www.nice.org.uk/nicemedia/live/13561/56008/56008.pdf, accessed the 20th of September 2012
- European Society of Cardiology, Guidelines for the Management of Atrial Fibrillation, 2010, available at: http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-afib-FT.pdf, accessed the 20th of September 2012
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Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.
Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.4
The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.5
Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.6
Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.
Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.
The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:
- Symptoms and Diagnosis
- Treatment Options
- Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
- Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
- Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
- Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
- Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
- NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.
Christopher D. Pfeiffer, Clinical Fellow, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Vance Fowler, Associate Professor and Infectious Diseases, Specialist, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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