Cardiovascular disease

from Wikipedia, the free encyclopedia

Under cardiovascular disease or cardiovascular diseases diseases of the heart and blood vessels are summarized. Although cardiovascular diseases occur frequently and are responsible for the majority of deaths in Germany, these can usually be treated well if diagnosed in good time.


With 17.8 million deaths, cardiovascular diseases were the most common cause of death worldwide in 2017. Thus, on a global average, 32% of all deaths are due to cardiovascular diseases. Cardiovascular diseases also top the death statistics in Europe and Germany. In Europe, more than four million people die of cardiovascular disease every year; 1.4 million of them are younger than 75 years.

In Germany, around 339,000 people died of cardiovascular diseases in 2016; this corresponds to 37% of the total mortality. Especially in the eastern federal states (especially in Saxony-Anhalt, Brandenburg and Thuringia), but also in Schleswig-Holstein and North Rhine-Westphalia, the age-standardized cardiovascular death rates are above average.

Risk factors

The causes of cardiovascular diseases are diverse and can be divided into influenceable and non-influenceable risk factors. The risk factors that cannot be influenced include: age, gender and genetic predisposition. Risk factors that can be influenced include (in decreasing relevance according to GBD ): high blood pressure, diet, dyslipidemia (often hypercholesterolemia), diabetes, obesity, smoking, air pollution, sedentary lifestyle and excessive alcohol consumption. In addition, other modifiable risk factors are known: undiagnosed celiac disease , rheumatoid arthritis , psychosocial factors, poverty and low level of education.

Influenceable risk factors in Germany (in descending relevance according to GBD ):

high blood pressure

A main cause of cardiovascular diseases is untreated, arterial high blood pressure ( hypertension ). According to the WHO definition , a systolic blood pressure of more than 140 mmHg and / or a diastolic blood pressure of more than 90 mmHg is considered hypertension. Lowering blood pressure by 10 mmHg reduces the risk of disease by approx. 20%.


Although controlled, randomized intervention studies on nutritional-specific issues were rarely carried out due to the high level of effort in the past, current intervention studies show that diet plays a central role in the prevention of cardiovascular diseases. Of a total of 4.3 million cardiovascular-related deaths in Europe ( WHO European region) in 2016 , 2.1 million were due to an unbalanced diet. Of these, around 900,000 cardiovascular deaths occur in the EU. Men are more often affected by diet-related cardiovascular diseases and tend to be affected at a younger age, whereas women are only affected from the age of 50. Around 601,000 people under the age of 70 died in Europe in 2016 as a result of diet-related cardiovascular disease; of which 420,000 men and 181,000 women. While around 10,000 and 15,000 people in Switzerland and Austria died of diet-related cardiovascular diseases in 2016, around 165,000 premature deaths in Germany can be attributed to an unbalanced diet.

At the level of individual nutrients and food groups, it was shown that an excessively high intake of saturated fatty acids , trans fatty acids and salt as well as an insufficient intake of whole grain products, fruit, vegetables and fish are associated with an increased cardiovascular risk. Individual studies and systematic reviews show that replacing saturated fatty acids with complex carbohydrates, polyunsaturated or monounsaturated fatty acids reduces cardiovascular risk factors and lowers cardiovascular mortality. In addition, a high intake of trans fatty acids has negative effects on blood lipids and circulating inflammation markers. Therefore the elimination of trans fatty acids from the diet is recommended. In 2018, the WHO estimated that more than half a million deaths a year were caused by excessive trans fatty acid intake.

Studies also show that high sugar consumption, in addition to an increased risk of diabetes, also promotes high blood pressure and dyslipidemia. In addition, excessive consumption of foods high in salt and saturated fatty acids is associated with an increased risk of cardiovascular disease.


Under dyslipidemia pathologically increased concentrations of blood lipids, be understood included total cholesterol, triglycerides and LDL cholesterol or VLDL cholesterol fraction. Primary dyslipidemias are a disorder of their own, mostly genetic, while secondary dyslipidemias are sequelae of other causes.


Compared to the general population, people with diabetes mellitus have a higher risk of developing cardiovascular diseases. Heart attacks are more common and less favorable in diabetics than in people without diabetes. In many cases, the additional diabetic damage to the autonomic nervous system can lead to disturbances within the pain conduction and cardiac arrhythmias. In type 2 diabetes in particular, in addition to increased blood sugar levels, there are often disorders that have a negative effect on the blood vessels. Increased blood pressure ( hypertension ) and dyslipidemia also damage the vessel walls and cause constrictions ( stenoses ) and blockages ( thromboses ) of the arteries. Dyslipidemia can also occur in type 1 diabetes mellitus.

Overweight and obesity

With an increasing body mass index (overweight: BMI 25–29, obesity: BMI> 30), the risk of cardiovascular diseases increases. This leads to an increased production of pro-inflammatory metabolic products in the organism and a derailment of lipid metabolism, which promotes the formation of atherosclerotic plaques in the arteries. A study from 2016 showed that the risk of cardiovascular-related death is increased by 11% in overweight people with a BMI of 25 to 27.5 and by 35% in overweight people with a BMI of 27.5 to 30 compared to those of normal weight. The Framingham Heart Study found that being overweight by the age of 40 reduced life expectancy by an average of three years. Obesity at the age of 40 even led to a statistically reduced lifetime of six and a half years in the study population.


Around 10% of cardiovascular diseases worldwide are attributed to smoking . For people who quit smoking by the age of 30, the risk of cardiovascular disease drops to the level of non-smokers. In addition to active smoking, passive smoking also promotes the development of cardiovascular diseases. Children are particularly affected by this.

Air pollution

Calculations from 2017 show that air pollution from exhaust gases and cooking on open fires could be responsible for around 12% of all cardiovascular diseases worldwide. In Germany this proportion was 5.5%.

Physical inactivity (lack of exercise)

Inadequate physical activity (defined as less than five times 30 minutes of moderate activity per week or less than three times 20 minutes of vigorous activity per week) is another major risk factor for cardiovascular disease. The risk of ischemic heart disease and diabetes mellitus is reduced by almost a third in adults who regularly participate in endurance sports every week (at least 150 minutes in total). In addition, physical activity aids weight loss and improves blood sugar control, blood pressure, lipid profile, and insulin sensitivity.


A direct connection between alcohol consumption and the development of cardiovascular diseases has been proven with high amounts of alcohol. Alcohol is more protective in low doses. An international study in 2018 came to the result that the risk of cardiovascular diseases only increases after consuming six standard drinks daily (one standard drink in this study corresponded to 10 grams of alcohol). With regard to other illnesses (cancer, injuries caused by traffic accidents, tuberculosis, etc.), however, it has been observed that a daily increase in risk occurs from just one standard drink. In terms of total mortality, no more than one standard drink should be consumed per day, which corresponds to a glass of wine or 0.5 liters of beer per person.

Celiac disease

Untreated celiac disease can contribute to the development of many types of cardiovascular disease. Adhering to a gluten-free diet with resulting intestinal healing lowers the risk. Delays in detection ( diagnosis ) can cause irreversible heart damage.

Classification according to the ICD

Classification according to ICD-10
I00-I02 Acute rheumatic fever
I05-I09 Chronic rheumatic heart disease
I10-I15 Hypertension (high pressure sickness)
I20-I25 Ischemic heart disease
I26-I28 Pulmonary heart disease and diseases of the pulmonary circulation
I30-I52 Other forms of heart disease
I60-I69 Cerebrovascular diseases
I70-179 Diseases of the arteries, arterioles and capillaries
I80-189 Diseases of the veins, lymph vessels and lymph nodes, not elsewhere classified
I95-199 Other and unspecified diseases of the circulatory system
ICD-10 online (WHO version 2019)

As part of Chapter IX of the International Statistical Classification of Diseases and Related Health Problems (ICD), "diseases of the circulatory system" are classified as follows (codes I00 to I99)

It does not include, for example, congenital heart defects such as atrial septal defect , congenital vascular malformations such as coarctation of the aorta , tumors of the heart or blood vessels, inflammatory and necrotizing vascular diseases such as panarteritis nodosa and Takayasu syndrome , cardiac and vascular injuries and transient ischemic attacks .

Classification in human medicine

The term cardiovascular disease is not used consistently in medicine. Often most diseases of the heart and arteries are involved, but not the veins and lymphatic vessels. Inflammatory vascular diseases are often excluded, but inflammatory heart diseases are not. Congenital heart defects are usually included.

Occasionally, the term cardiovascular disease is only for those with atherosclerosis and the risk factors diabetes mellitus , smoking , lack of exercise , genetic predisposition , etc. associated cardiovascular diseases, as in the Monica study of WHO observed since the 1980s , used.

Older literature

  • Herbert Reindell , Helmut Klepzig: diseases of the heart and blood vessels. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 450-598.

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