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.

Occurrence

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%.

nutrition

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.

Dyslipidemia

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.

diabetes

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.

Smoke

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.

alcohol

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.

Individual evidence

  1. ↑ Gregory A. Roth, Degu Abate et al .: Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017 . In: The Lancet Volume 392, No. 10159, November 2018, pp. 1736-1788, doi: 10.1016 / S0140-6736 (18) 32203-7 PMID 30496103 .
  2. ↑ Elizabeth Wilkins, Lauren Wilson et al .: European Cardiovascular Disease Statistics 2017 . European Heart Network, Brussels 2017 ( [1] accessed online November 1, 2019).
  3. ↑ Nick Townsend, Lauren Wilson et al .: Cardiovascular disease in Europe: epidemiological update 2016 . In: Eur Heart J Volume 37, No. 42, November 2016, pp. 3232-3245, doi: 10.1093 / eurheartj / ehw334 PMID 27523477 .
  4. ↑ Federal Statistical Office: GENESIS online database . Wiesbaden 2019 ( [2] accessed online on April 18, 2019).
  5. ↑ Deutsche Herzstiftung: "German Heart Report 2016. - 28th Report" Cross-sector health care analysis for cardiology, heart surgery and pediatric heart medicine in Germany . Frankfurt / Main 2016
  6. ^ Edward J Ciaccio, Suzanne K Lewis et al.: Cardiovascular involvement in celiac disease . In: World J Cardiol (Review) Volume 9, No. 8, August 2017, pp. 652-666, doi: 10.4330 / wjc.v9.i8.652 PMID 28932354 .
  7. ↑ Elena Myasoedova, Arun Chandran et al: The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease . In: Annals of the rheumatic diseases Volume 75, No. 3, March 2016, pp. 560-565, doi: 10.1136 / annrheumdis-2014-206411 PMID 25637001 .
  8. ↑ Alexander M. Clark, Marie DesMeules et al: Socioeconomic status and cardiovascular disease: risks and implications for care . In: Nature Reviews Cardiology Volume 6, No. 11, September 2009, pp. 712-722, doi: 10.1038 / nrcardio.2009.163 PMID 19770848 .
  9. ^ Mariachiara Di Cesare, Young-Ho Khang et al .: Inequalities in non-communicable diseases and effective responses . In: The Lancet Volume 381, No. 9866, February 2013, pp. 585-597, doi: 10.1016 / S0140-6736 (12) 61851-0 PMID 23410608 .
  10. ↑ Dena Ettehad, Connor A Emdin et al: Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis . In: The Lancet Volume 387, No. 10022, March 2016, pp. 957-967, doi: 10.1016 / S0140-6736 (15) 01225-8 PMID 26724178 .
  11. ↑ Ramon Estruch, Emilio Ros et al .: Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts . In: New England Journal of Medicine Volume 378, No. 25, June 2018, p. E34, doi: 10.1056 / NEJMoa1800389 PMID 29897866 .
  12. ↑ Christine Dawczynski, Anne-Christin Schneider and others: Influence of a change in diet on cardiovascular risk factors - MoKaRi nutritional study . In: Proceedings of the German Nutrition Society Volume 23, ISBN 978-3-88749-257-1 , Bonn2017.
  13. ↑ Toni Meier, Kira Gräfe et al .: Cardiovascular mortality attributable to dietary risk factors in 51 countries in the WHO European Region from 1990 to 2016: a systematic analysis of the Global Burden of Disease Study . In: European Journal of Epidemiology Volume 34, No. 1, January 2019, pp. 37-55, doi: 10.1007 / s10654-018-0473-x PMID 30547256 .
  14. ↑ Yanping Li, Adela Hruby et al: Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: a prospective cohort study . In: J Am Coll Cardiol Volume 66, No. 14, October 2015, pp. 1538-1548, doi: 10.1016 / j.jacc.2015.07.055 PMID 26429077 .
  15. ↑ Hooper L, Martin N et al .: Reduction in saturated fat intake for cardiovascular disease. In: The Cochrane Database of Systematic Reviews Volume 6, No. 6, June 2015, CD011737, doi: 10.1002 / 14651858.CD011737 PMID 26068959 .
  16. ^ Dariush Mozaffarian, Renata Micha et al.: Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials . In: PloS medicine Volume 7, No. 3, March 2010, p. E1000252, doi: 10.1371 / journal.pmed.1000252 PMID 20351774 .
  17. ↑ Ronald P Mensink, Peter L Zock et al .: Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials . In: Am J Clin Nutr Volume 77, No. 5, May 2003, pp. 1146-1155, doi: 10.1093 / ajcn / 77.5.1146 PMID 12716665 .
  18. ↑ Chris S. Booker, JI Mann: Trans fatty acids and cardiovascular health: translation of the evidence base . In: Nutrition, Metabolism and Cardiovascular Diseases Volume 18, No. 6, July 2008, pp. 448-456, doi: 10.1016 / j.numecd.2008.02.005 PMID 18468872 .
  19. ↑ WHO: WHO plan to eliminate industrially-produced trans-fatty acids from global food supply . World Health Organization, Geneva 2018 ( [3] accessed online November 1, 2019).
  20. ↑ Lisa A Te Morenga, Alex J Howatson et al .: Dietary sugars and cardiometabolic risk: systematic review and meta-analyzes of randomized controlled trials of the effects on blood pressure and lipids . In: Am J Clin Nutr Volume 100, No. 1, July 2014, pp. 65-79, doi: 10.3945 / ajcn.113.081521 PMID 24808490 .
  21. ↑ Renata Micha, Georgios Michas, among others: Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes - an updated review of the evidence . In: Current atherosclerosis reports Volume 14, No. 6, December 2012, pp. 515-524, doi: 10.1007 / s11883-012-0282-8 PMID 23001745 .
  22. ↑ Di Angelantonio E, Bhupathiraju SN et al .: Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents . In: The Lancet Volume 388, No. 10046, August 2016, pp. 776-786, doi: 10.1016 / S0140-6736 (16) 30175-1 PMID 30496112 .
  23. ^ Anna Peeters, Jan J. Barendregt et al .: Obesity in adulthood and its consequences for life expectancy: a life-table analysis . In: Ann. Intern. Med. Volume 138, No. 1, January 2003, pp. 24-32, doi: 10.7326 / 0003-4819-138-1-200301070-00008 PMID 12513041 .
  24. ^ WHO: Global Atlas on Cardiovascular Disease Prevention and Control . Hrgs: World Health Organization, World Heart Federation, World Stroke Organization, 2011, ISBN 978-92-4-156437-3 ( [4] accessed online November 1, 2019).
  25. ↑ Richard Doll, Richard Peto et al .: Mortality in relation to smoking: 50 years' observations on male British doctors . In: Bmj Volume 328, No. 7455, June 2004, p. 1519, doi: 10.1136 / bmj.38142.554479.AE PMID 15213107 .
  26. ^ Henry W. West, Seana L. Gall et al .: Is Passive Smoking Exposure in Early Life a Risk Factor for Future Cardiovascular Disease? In: Current Cardiovascular Risk Reports Volume 9, No. 42, September 2015, S. doi: 10.1007 / s12170-015-0471-4 .
  27. ^ Henry W. West, Markus Juonala et al.: Exposure to parental smoking in childhood is associated with increased risk of carotid atherosclerotic plaque in adulthood: the Cardiovascular Risk in Young Finns Study . In: Circulation Volume 7, No. 131, March 2015, pp. 1239-1246, doi: 10.1161 / CIRCULATIONAHA.114.013485 PMID 25802269 .
  28. ↑ Jeffrey D. Stanaway, Ashkan Afshin et al .: Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 . In: The Lancet Volume 392, No. 10159, November 2018, pp. 1923-1994, doi: 10.1016 / S0140-6736 (18) 32225-6 PMID 30496105 .
  29. ^ WHO: Prevention of Cardiovascular Disease - Pocket Guidelines for Assessment and Management of Cardiovascular Risk . World Health Organization, Geneva 2007, ISBN 978-92-4-154726-0 .
  30. ↑ Max G Griswold, Nancy Fullman et al.: Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 . In: The Lancet Volume 392, No. 10152, August 2018, pp. 1015-1035, doi: 10.1016 / S0140-6736 (18) 31310-2 PMID 30146330 .
  31. ^ Edward J Ciaccio, Suzanne K Lewis et al.: Cardiovascular involvement in celiac disease . In: World J Cardiol (Review) Volume 9, No. 8, August 2017, pp. 652-666, doi: 10.4330 / wjc.v9.i8.652 PMID 28932354 .
  32. ↑ DIMDI: ICD-10-GM Version 2020 - Chapter IX Diseases of the Circulatory System (I00-I99) . Hrgs: German Institute for Medical Documentation, ( [5] accessed online on November 6, 2019).