Certificate

This is to certify that Miss. Jiya Nair of

class XII A of K V NO. 1 Port Blair has
completed his project titled “To
DETERMINE THE VARIOUS TYPE OF
HEART DISEASE” under my guidance
and to my atmost satisfaction keeping
in the norms laid by the CBSE Board in
partial fulfilment of project of Biology
Practical Examination conducted by
AISSCE.

Principal

Teacher-In-charge External Examiner

Acknowledgem
ent
I wish to express my deep gratitude and
sincere thanks to the Principal Mrs.
Raji, KV NO. 1 PORT BLAIR for her
encouragement and for all facilities
provided for this project work.

I heartly Mr. Arjunan Pandiyan

chemistry teacher who guided me to
success completion of this project.

And also sincerely thanks my parents

and my classmates who helped me to
carry out this project work successfully.
 Contents

1. INTRODUCTION
2. OBJECTIVE
3. MATERIALS REQUIRED
4. PROCEDURE
5. OBSERVATION
6. CONCLUSION
7. BIBLIOGRAPHY

INTRODUCTION
Cardiovascular disease (CVD) is a class of
diseases that involve the heart or blood
vessels. Cardiovascular disease
includes coronary artery diseases (CAD) such
as angina and myocardial infarction (commonly
known as a heart attack). Other CVDs
include stroke, heart failure, hypertensive heart
disease, rheumatic heart
disease, cardiomyopathy, heart
arrhythmia, congenital heart disease, valvular
heart disease, carditis, aortic
aneurysms, peripheral artery
disease, thromboembolic disease, and venous
thrombosis.

The underlying mechanisms vary depending on

the disease. Coronary artery disease, stroke,
and peripheral artery disease
involve atherosclerosis. This may be caused
by high blood pressure, smoking, diabetes, lack
of exercise, obesity, high blood cholesterol, poor
diet, and excessive alcohol consumption, among
others. High blood pressure results in 13% of
CVD deaths, while tobacco results in 9%,
diabetes 6%, lack of exercise 6% and obesity
5%.Rheumatic heart disease may follow
untreated strep throat.

It is estimated that 90% of CVD is preventable.

Prevention of atherosclerosis involves improving
risk factors through: healthy eating, exercise,
avoidance of tobacco smoke and limiting alcohol
intake. Treating risk factors, such as high blood
pressure, blood lipids and diabetes is also
beneficial. Treating people who have strep
throat with antibiotics can decrease the risk of
rheumatic heart disease. The use of aspirin in
people, who are otherwise healthy, is of unclear
benefit.

Cardiovascular diseases are the leading cause of

death globally. This is true in all areas of the
world except Africa. Together they resulted in
17.9 million deaths (32.1%) in 2015, up from
12.3 million (25.8%) in 1990. Deaths, at a given
age, from CVD are more common and have been
increasing in much of the developing world,
while rates have declined in most of
the developed world since the 1970s. Coronary
artery disease and stroke account for 80% of
CVD deaths in males and 75% of CVD deaths in
females. Most cardiovascular disease affects
older adults. In the United States 11% of people
between 20 and 40 have CVD, while 37%
between 40 and 60, 71% of people between 60
and 80, and 85% of people over 80 have
CVD. The average age of death from coronary
artery disease in the developed world is around
80 while it is around 68 in the developing
world. Disease onset is typically seven to ten
years earlier in men as compared to women.

There are many different types of heart disease.

Some are congenital (people are born with heart
problems), but a majority of heart diseases
develop over the course of time and affect people
later in life.
OBJECTIVE: To study the
various types of heart
diseases
 MATERIALS REQUIRED:
1) A sample of heart
2) A white paper to note down
observations
3) A pen
Procedure: 1. STUDY OF A HEART WITH CORONARY
ARTERY DISEASE
Coronary artery disease (CAD), also known
as ischemic heart disease (IHD), refers to a group of
diseases which includes stable angina, unstable
angina, myocardial infarction, and sudden cardiac
death. It is within the group of cardiovascular
diseases of which it is the most common type. A
common symptom is chest pain or discomfort
which may travel into the shoulder, arm, back,
neck, or jaw. Occasionally it may feel like heartburn.
Usually symptoms occur with exercise or
emotional stress, last less than a few minutes, and
improve with rest. Shortness of breath may also
occur and sometimes no symptoms are
present. Occasionally, the first sign is a heart
attack. Other complications include heart failure or
an abnormal heartbeat.

Risk factors include high blood

pressure, smoking, diabetes, lack of
exercise, obesity, high blood cholesterol, poor
diet, depression, and excessive alcohol. The
underlying mechanism involves reduction of blood
flow and oxygen to the heart muscle due
to atherosclerosis of the arteries of the heart. A
number of tests may help with diagnoses
including: electrocardiogram, cardiac stress
testing, coronary
computed tomographic
angiography,
and coronary angiogram,
among others.
Ways to reduce CAD risk
include eating a healthy
diet, regularly exercising,
maintaining a healthy weight, and not smoking.
Medications for diabetes, high cholesterol, or high
blood pressure are sometimes used. There is limited
evidence for screening people who are at low risk and
do not have symptoms. Treatment involves the same
measures as prevention. Additional medications such
as antiplatelets (including aspirin), beta blockers,
or nitroglycerin may be recommended. Procedures
such as percutaneous coronary intervention (PCI)
or coronary artery bypass surgery (CABG) may be
used in severe disease. In those with stable CAD it is
unclear if PCI or CABG in addition to the other
treatments improves life expectancy or decreases
heart attack risk.
In 2015 CAD affected 110 million people and resulted
in 8.9 million deaths. It makes up 15.9% of all deaths
making it the most common cause of
death globally. The risk of death from CAD for a given
age has decreased between 1980 and 2010, especially
in developed countries. The number of cases of CAD
for a given age has also decreased between 1990 and
2010.In the United States in 2010 about 20% of
those over 65 had CAD, while it was present in 7% of
those 45 to 64, and 1.3% of those 18 to 45. Rates are
higher among men than women of a given age.
2. STUDY OF HEART WITH ISCHEMIA
ISCHEMIA is a condition where the flow of oxygen-
rich blood to a part of the body is restricted.
Cardiac ischemia refers to lack of blood flow and
oxygen to the heart muscle.
Cardiac ischemia happens when an artery becomes
narrowed or blocked for a short time, preventing
oxygen-rich blood from reaching the heart. If
ischemia is severe or
lasts too long, it can
cause a heart
attack (myocardial
infarction) and can lead
to heart tissue death.
In most cases, a
temporary blood shortage to the heart causes the
pain of angina pectoris. But in other cases, there is
no pain. These cases are called silent ischemia.
Silent ischemia may also disturb the heart’s rhythm.
Abnormal rhythms such as ventricular
tachycardia or ventricular fibrillation can interfere
with the heart’s pumping ability and can cause
fainting or even sudden cardiac death.
3. STUDY OF ANGINA OF HEART
 Angina, also known as angina pectoris, is chest
pain or pressure, usually due to not enough blood
flow to the heart muscle.

Angina is usually due to obstruction or spasm of

the coronary arteries. Other causes
include anemia, abnormal heart rhythms,
and heart failure. The main mechanism of coronary
artery obstruction is an atherosclerosis. The term
derives from the Latin angere ("to strangle")
and pectus ("chest"), and can therefore be translated
as "a strangling feeling in the chest".

There is a weak relationship between severity

of pain and degree of oxygen deprivation in the heart
muscle (i.e., there can be severe pain with little or
no risk of a myocardial infarction (heart attack)
and a heart attack can occur without pain). In
some cases, angina can be quite severe, and in the
early 20th century this was a known sign of
impending death. However, given current medical
therapies, the outlook has improved substantially.
People with an average age of 62 years, who have
moderate to severe degrees of angina (grading by
classes II, III, and IV) have a 5-year survival rate of
approximately 92%.
Worsening angina attacks, sudden-onset angina at
rest, and angina lasting more than 15 minutes are
symptoms of unstable angina (usually grouped
with similar conditions as the acute coronary
syndrome). As these may precede a heart attack, they
require urgent medical attention and are, in general,
treated in similar fashion to myocardial infarction.

Stable angina
Also known as 'effort angina', this refers to the
classic type of angina related to myocardial ischemia.
A typical presentation of
stable angina is that of
chest discomfort and
associated symptoms
precipitated by some
activity (running,
walking, etc.) with
minimal or non-existent
symptoms at rest or after
administration of sublingual nitroglycerin. Symptoms
typically abate several minutes after activity and
recur when activity resumes. In this way, stable
angina may be thought of as being similar to
intermittent claudication symptoms. Other
recognized precipitants of stable angina include cold
weather, heavy meals, and emotional stress.

Unstable angina
Unstable angina (UA) (also "crescendo angina"; this
is a form of acute coronary syndrome) is defined as
angina pectoris that changes or worsens.
It has at least one of these three features:
it occurs at rest (or with minimal exertion), usually
lasting more than 10 minutes
it is severe and of new onset (i.e., within the prior
4–6 weeks)
it occurs with a crescendo pattern (i.e., distinctly
more severe, prolonged, or frequent than before).
UA may occur unpredictably at rest, which may be a
serious indicator of an impending heart attack. What
differentiates stable angina from unstable angina
(other than symptoms) is the Pathophysiology of the
atherosclerosis. The Pathophysiology of unstable
angina is the reduction of coronary flow due to
transient platelet aggregation on apparently normal
endothelium, coronary artery spasms, or coronary
thrombosis. The process starts with atherosclerosis,
progresses through inflammation to yield an active
unstable plaque, which undergoes thrombosis and
results in acute myocardial ischemia, which, if not
reversed, results in cell necrosis (infarction). Studies
show that 64% of all unstable anginas occur between
22:00 and 08:00 when patients are at rest.
4. STUDY A HEART WITH MYOCARDIAL
INFARCTION
Myocardial infarction (MI), commonly known as
a heart attack occurs when blood flow decreases or
stops to a part of the heart, causing damage to
the heart muscle. The most common symptom
is chest pain or discomfort which may travel into
the shoulder, arm, back, neck, or jaw. Often it
occurs in the centre or left side of the chest and
lasts for more than a few minutes. The discomfort
may occasionally feel like heartburn. Other
symptoms may include shortness of breath,
nausea, feeling faint, a cold sweat, or feeling
tired. About 30% of people have typical
symptoms. Women more often have atypical
symptoms than men. Among those over 75 years old,
about 5% have had an MI with little or no history of
symptoms. An MI may cause heart failure,
an irregular heartbeat, carcinogenic shock, or cardiac
arrest.

Most MIs occur due to coronary artery disease. Risk

factors include high blood
pressure, smoking, diabetes, lack of
exercise, obesity, high blood cholesterol, poor
diet, and excessive alcohol intake, among
others. The complete blockage of a coronary
artery caused by a rupture of an atherosclerotic
plaque is usually the underlying mechanism of an
MI. MIs are less commonly caused by coronary artery
spasms, which may be due to cocaine, significant
emotional stress, and extreme cold, among others. A
number of tests are useful to help with diagnosis,
including electrocardiograms (ECGs), blood tests,
and coronary angiography. An ECG, which is a
recording of the heart's electrical activity, may
confirm an ST elevation MI (STEMI) if ST elevation is
present. Commonly used blood tests
include trooping and less often creatine kinase MB.

Treatment of an MI is time-critical. Aspirin is an

appropriate immediate treatment for a suspected
MI. Nitroglycerin or opioids may be used to help with
chest pain; however, they do not improve overall
outcomes. Supplemental oxygen is recommended in
those with low oxygen levels or shortness of
breath. In a STEMI, treatments attempt to restore
blood flow to the heart, and include percutaneous
coronary intervention (PCI), where the arteries
are pushed open and may be stented,
or thrombolysis, where the blockage is removed
using medications. People who have a non-ST
elevation myocardial infarction (NSTEMI) are often
managed with the blood thinner heparin, with the
additional use of PCI in those at high risk. In people
with blockages of multiple coronary arteries and
diabetes, coronary artery bypass surgery (CABG)
may be recommended rather than angioplasty. After
an MI, lifestyle modifications, along with long term
treatment with aspirin, beta blockers, and statins,
are typically recommended.

Instable angina, the developing atheroma is protected

with a fibrous cap. This cap may rupture in unstable
angina, allowing blood clots to precipitate and further
decrease the area of the coronary vessel's lumen. This
explains why, in many cases, unstable angina
develops independently of activity.
5. STUDY OF HEART FAILURE
 Heart failure (HF), often referred to
as congestive heart failure (CHF), is when
the heart is unable to pump sufficiently to
maintain blood flow to meet the body's
needs. Signs and symptoms commonly
include shortness of breath, excessive
tiredness, and leg swelling. The shortness of
breath is usually worse with exercise,
while lying down, and may wake the person at
night. A limited ability to exercise is also a
common feature. Chest pain,
including angina, does not typically occur
due to heart failure.

Common causes of heart

failure include coronary
artery disease including a
previous myocardial
infarction (heart
attack), high blood
pressure, atrial
fibrillation, valvular heart
disease, excess alcohol
use, infection,
and cardiomyopathy of an unknown
cause. These cause heart failure by changing
either the structure or the functioning of the
heart. There are two main types of heart
failure: heart failure due to left ventricular
dysfunction and heart failure with normal
ejection fraction depending on whether the
ability of the left ventricle to contract is affected,
or the heart's ability to relax. The severity of
disease is usually graded by the degree of
problems with exercise. Heart failure is not
the same as myocardial infarction (in which
part of the heart muscle dies) or cardiac
arrest (in which blood flow stops
altogether). Other diseases that may have
symptoms similar to heart failure
include obesity, kidney failure, liver
problems, anemia, and thyroid disease.

The condition is diagnosed based on the history

of the symptoms and a physical examination
with confirmation by echocardiography. Blood
tests, electrocardiography, and chest
radiography may be useful to determine the
underlying cause. Treatment depends on the
severity and cause of the disease. In people with
chronic stable mild heart failure, treatment
commonly consists of lifestyle modifications
such as stopping smoking, physical
exercise, and dietary changes, as well as
medications. In those with heart failure due to
left ventricular dysfunction, angiotensin
converting enzyme inhibitorsor angiotensin
receptor blockers along with beta blockers are
recommended. For those with severe
disease, aldosterone antagonists,
or hydralazine with a nitrate may be
used. Diuretics are useful for preventing fluid
retention. Sometimes, depending on the cause,
an implanted device such as a pacemaker or
an implantable cardiac defibrillator may be
recommended. In some moderate or severe
cases, cardiac resynchronization
therapy (CRT) or cardiac contractility
modulation may be of benefit. A ventricular
assist device or occasionally a heart
transplant may be recommended in those
with severe disease that persists despite all
other measures.
6. TO STUDY A HEART WITH Heart arrhythmia
 Heart arrhythmia (also known
as arrhythmia, dysrhythmia, or irregular
heartbeat) is a group of conditions in which
the heartbeat is irregular, too fast, or too
slow. A heart rate that is too fast – above 100 beats
per minute in adults – is called tachycardia and a
heart rate that is too slow – below 60 beats per
minute – is called bradycardia. Many types of
arrhythmia have no symptoms. When symptoms are
present these may include palpitations or feeling a
pause between heartbeats. In more serious cases
there may be lightheadedness, passing
out, shortness of breath, or chest pain. While most
types of arrhythmia are not serious, some predispose
a person to complications such as stroke or heart
failure. Others may result in cardiac arrest.
There are four main types of arrhythmia: extra
beats, supraventricular tachycardias, ventricular
arrhythmias, and bradyarrhythmias. Extra beats
include premature atrial contractions, premature
ventricular contractions, and premature
junctional contractions. Supraventricular
tachycardias include atrial fibrillation, atrial flutter,
and paroxysmal supraventricular
tachycardia. Ventricular arrhythmias
include ventricular fibrillation and ventricular
tachycardia. Arrhythmias are due to problems with
the electrical conduction system of the
heart. Arrhythmias may occur in children; however,
the normal range for the heart rate is different and
depends on age. A number of tests can help with
diagnosis including an electrocardiogram(ECG)
and Holter monitor.
Most arrhythmias can be effectively
treated. Treatments may include medications,
medical procedures such as inserting
a pacemaker, and surgery. Medications for a fast
heart rate may include beta blockers or agents that
attempt to restore a normal heart rhythm such
as procainamide. This latter group may have more
significant side effects especially if taken for a long
period of time. Pacemakers are often used for slow
heart rates. Those with an irregular heartbeat are
often treated with blood thinners to reduce the risk of
complications. Those who have severe symptoms
from an arrhythmia may receive urgent treatment
with a controlled electric shock in the form
of cardioversion or defibrillation.
Arrhythmia affects millions of people. In Europe
and North America, as of 2014, atrial fibrillation
affects about 2% to 3% of the population. Atrial
fibrillation and atrial flutter resulted in 112,000
deaths in 2013, up from 29,000 in 1990. Sudden
cardiac death is the cause of about half of deaths due
to cardiovascular disease or about 15% of all deaths
globally. About 80% of sudden cardiac death is the
result of ventricular arrhythmias. Arrhythmias may
occur at any age but are more common among older
people.
7. TO STUDY A HEART WITH Peripheral
artery disease
 Peripheral artery disease (PAD) is a narrowing
of the arteries other than those that supply
the heart or the brain. When narrowing occurs
in the heart, it is called coronary artery
disease, while, in the brain, it is
called cerebrovascular disease. Peripheral
artery disease most commonly affects
the legs, but other arteries may also be
involved. The classic symptom is leg pain when
walking which resolves with rest, known
as intermittent claudication. Other symptoms
including skin ulcers, bluish skin, cold skin, or
poor nail and hair growth may occur in the
affected leg. Complications may include an
infection or tissue death which may
require amputation; coronary artery disease,
or stroke. Up to 50% of cases of PAD
are without symptoms.
The main risk factor is cigarette
smoking. Other risk factors
include diabetes, high blood pressure, and high
blood cholesterol. The underlying mechanism
is usually atherosclerosis. Other causes
include artery spasm. PAD is typically diagnosed by
finding an ankle-brachial index (ABI) less than 0.90,
which is the systolic blood pressure at the ankle
divided by the systolic blood pressure of the
arm. Duplex ultrasonography
and angiography may also be used. Angiography is
more accurate and allows for treatment at the same
time; however, it is associated with greater risks.
It is unclear if screening for disease is useful as it
has not been properly studied. In those with
intermittent claudication from PAD, stopping
smoking and supervised exercise
therapy improves outcomes. Medications,
including statins, ACE inhibitors, and cilostazol also
may help. Aspirin does not appear to help those with
mild disease but is usually recommended in those
with more significant disease. Anticoagulants such
as warfarin are not typically of benefit. Procedures
used to treat the disease include bypass
grafting, angioplasty, and atherectomy.
OBSERVATIONS
  Risk factors

There are many risk factors for heart diseases: age,

gender, tobacco use, physical inactivity,
excessive alcohol consumption, unhealthy diet,
obesity, genetic predisposition and family history
of cardiovascular disease, raised blood pressure
(hypertension), raised blood sugar (diabetes
mellitus), raised blood cholesterol
(hyperlipidemia), undiagnosed celiac disease,
psychosocial factors, poverty and low educational
status, and air pollution. While the individual
contribution of each risk factor varies between
different communities or ethnic groups the overall
contribution of these risk factors is very
consistent. Some of these risk factors, such as age,
gender or family history/genetic predisposition, are
immutable; however, many important cardiovascular
risk factors are modifiable by lifestyle change,
social change, drug treatment (for example
prevention of hypertension, hyperlipidemia, and
diabetes).People with obesity are at increased risk
of atherosclerosis of the coronary arteries.

 Genetics

Genetic factors influence the development of

cardiovascular disease in men who are less than 55
years-old and in women who are less than 65
years old. Cardiovascular disease in a person's
parents increases their risk by 3 fold.
Multiple single nucleotide polymorphisms (SNP) have
been found to be associated with cardiovascular
disease in genetic association studies, but usually
their individual influence is small, and genetic
contributions to cardiovascular disease are poorly
understood.

 Age

Age is the most important risk factor in

developing cardiovascular or heart diseases, with
approximately a tripling of risk with each decade
of life. Coronary fatty streaks can begin to form in
adolescence. It is estimated that 82 percent of
people who die of coronary heart disease are 65
and older. Simultaneously, the risk of stroke
doubles every decade after age 55.

Aging is also associated

with changes in the
mechanical and structural
properties of the vascular
wall, which leads to the loss
of arterial elasticity and
reduced arterial compliance
and may subsequently lead
to coronary artery disease.

 Sex

Men are at greater risk of heart disease than pre-

menopausal women. Once past menopause, it has
been argued that a woman's risk is similar to a
man's although more recent data from the WHO
and UN disputes this. If a female has diabetes, she
is more likely to develop heart disease than a male
with diabetes.
Coronary heart diseases are 2 to 5 times more
common among middle-aged men than women.
Among women, estrogen is the predominant sex
hormone. Estrogen may have protective effects on
glucose metabolism and hemostatic system, and may
have direct effect in improving endothelial cell
function. The production of estrogen decreases after
menopause and this may change the female lipid
metabolism toward a more atherogenic form by
decreasing the HDLcholesterol level while increasing
LDL and total cholesterol levels.

 Tobacco

Cigarettes are the major

form of smoked
tobacco. Risks to health
from tobacco use result not
only from direct consumption of
tobacco, but also from exposure to second-hand
smoke. Approximately 10% of cardiovascular
disease is attributed to smoking; however, people
who quit smoking by age 30 have almost as low a
risk of death as never smokers.

 Physical inactivity

Insufficient physical activity (defined as less than

5 x 30 minutes of moderate activity per week, or
less than 3 x 20 minutes of vigorous activity per
week) is currently the fourth leading risk factor
for mortality worldwide. In 2008, 31.3% of adults
aged 15 or older (28.2% men and 34.4% women) were
insufficiently physically active. The risk of ischemic
heart disease and diabetes mellitus is reduced by
almost a third in adults who participate in 150
minutes of moderate physical activity each week
(or equivalent). In addition, physical activity assists
weight loss and improves blood glucose control,
blood pressure, lipid profile and insulin
sensitivity. These effects may, at least in part,
explain its cardiovascular benefits.

 Diet

High dietary intakes of saturated fat, trans-fats

and salt and low intake of fruits, vegetables and
fish are linked to cardiovascular risk, although
whether all these associations are a cause is
disputed. The World Health Organization
attributes approximately 1.7 million deaths
worldwide to low fruit and vegetable
consumption. The amount of dietary salt consumed
is also an important determinant of blood pressure
levels and overall cardiovascular risk. Frequent
consumption of high-energy foods, such as
processed foods that are high in fats and sugars,
promotes obesity and may increase cardiovascular
risk. A Cochrane review found that replacing
saturated fat with polyunsaturated fat (plant based
oils) reduced cardiovascular disease risk. Cutting
down on saturated fat reduced risk of
cardiovascular disease by 17% including heart
disease and stroke. The relationship between
alcohol consumption and cardiovascular disease
is complex, and may depend on the amount of
alcohol consumed. There is a direct relationship
between high levels of alcohol consumption and risk
of cardiovascular disease. Drinking at low levels
without episodes of heavy drinking may be
associated with a reduced risk of cardiovascular
disease

 Celiac disease
Untreated celiac disease can cause the
development of many types of cardiovascular
diseases, most of which improve or resolve with
a gluten-free diet and intestinal healing. However,
delays in recognition and diagnosis of celiac disease
can cause irreversible heart damage.

 Socio economic disadvantage

There is relatively little information regarding

social patterns of cardiovascular disease within
low- and middle-income countries, but within
high-income countries low income and low
educational status are consistently associated
with greater risk of cardiovascular disease. Policies
that have resulted in increased socio-economic
inequalities have been associated with greater
subsequent socio-economic differences in
cardiovascular disease implying a cause and effect
relationship. Psychosocial factors, environmental
exposures, health behaviours, and health-care access
and quality contribute to socio-economic differentials
in cardiovascular disease. The Commission on
Social Determinants of Health recommended that
more equal distributions of power, wealth,
education, housing, environmental factors,
nutrition, and health care were needed to address
inequalities in cardiovascular disease and non-
communicable diseases.

 Air pollution
Particulate matter has been studied for its short-
and long-term
exposure effects
on cardiovascular
disease. Currently,
PM2.5 is the major
focus, in which
gradients are used
to determine CVD
risk. For every 10 μg/m3 of PM2.5 long-term
exposure, there was an estimated 8–18% CVD
mortality risk. Other research has implicated
PM2.5 in irregular heart rhythm, reduced heart rate
variability (decreased vagal tone), and most
notably heart failure. PM2.5 is also linked
to carotid artery thickening and increased risk of
acute myocardial infarction.
RESULT AND CONCLUSION
Cardiovascular risk assessment
Existing cardiovascular disease or a previous
cardiovascular event, such as a heart attack or
stroke, is the strongest predictor of a future
cardiovascular event. Age, sex, smoking, blood
pressure, blood lipids and diabetes are important
predictors of future cardiovascular disease in
people who are not known to have cardiovascular
disease. These measures, and sometimes others,
may be combined into composite risk scores to
estimate an individual's future risk of cardiovascular
disease. Numerous risk scores exist although their
respective merits are debated. Other diagnostic tests
and biomarkers remain under evaluation but
currently these lack clear-cut evidence to support
their routine use. They include family history,
coronary artery calcification score, high
sensitivity C-reactive protein (hs-CRP), ankle–
brachial pressure index, lipoprotein subclasses
and particle concentration, lipoprotein(a),
apolipoproteins A-I and B, fibrinogen, white blood
cell count, homocysteine, N-terminal pro B-type
natriuretic peptide (NT-proBNP), and markers of
kidney function. High blood phosphorus is also
linked to an increased risk.

Occupational exposure
Little is known about the relationship between work
and cardiovascular disease, but links have been
established between certain toxins, extreme heat and
cold, exposure to tobacco smoke, and mental health
concerns such as stress and depression.
Chemical risk factors
A 2015 SBU-report looking at non-chemical factors
found an association for those:
With mentally stressful work with a lack of control
over their working situation — with an effort-reward
imbalance
Those who work night schedules; or have long
working weeks
Those who are exposed to noise
Specifically the risk of stroke was also increased by
exposure to ionizing radiation. Hypertension develops
more often in those who experience job strain and
who have shift-work. Differences between women and
men in risk are small, however men risk suffering
and dying of heart attacks or stroke twice as often as
women during working life.
Non-chemical risk factors
Workplace exposure to silica dust or asbestos is also
associated with pulmonary heart disease. There is
evidence that workplace exposure to lead, carbon
disulphide, phenoxyacids containing TCDD, as well
as working in an environment where aluminium is
being electrolytically produced, is associated
with stroke.

Somatic mutations
As of 2017, evidence suggests that certain leukemia-
associated mutations in blood cells may also lead
to increased risk of cardiovascular disease.
Several large-scale research projects looking at
human genetic data have found a robust link
between the presence of these mutations, a
condition known as clonal hematopoiesis,
and cardiovascular disease-related incidents
and mortality.

Pathophysiology

Density-Dependent Colour Scanning Electron

Micrograph SEM (DDC-SEM) of
cardiovascular calcification, showing in
orange calcium phosphate spherical particles
(denser material) and, in green, the extracellular
matrix (less dense
material)

Population-based
studies show that
atherosclerosis, the
major precursor of
cardiovascular
disease, begins in
childhood. The
Pathobiological
Determinants of
Atherosclerosis in
Youth (PDAY) study
demonstrated that intimal lesions appear in all
the aortas and more than half of the right
coronary arteries of youths aged 7–9 years.
This is extremely important considering that
1 in 3 people die from complications
attributable to atherosclerosis. In order to
stem the tide, education and awareness that
cardiovascular disease poses the greatest
threat, and measures to prevent or reverse this
disease must be taken.
Obesity and diabetes mellitus are often
linked to cardiovascular disease, as are a
history of chronic kidney
disease and hypercholesterolaemia. In fact,
cardiovascular disease is the most life-
threatening of the diabetic complications and
diabetics are two- to four-fold more likely to die
of cardiovascular-related causes than
nondiabetics.

Screening
Screening ECGs (either at rest or with
exercise) is not recommended in those
without symptoms who are at low risk. This
includes those who are young without risk
factors. In those at higher risk the evidence
for screening with ECGs is inconclusive.
Additionally echocardiography, myocardial
perfusion imaging, and cardiac stress
testing is not recommended in those at low
risk who do not have symptoms.
Some biomarkers may add to conventional
cardiovascular risk factors in predicting the risk
of future cardiovascular disease; however, the
clinical value of some biomarkers is
questionable.

Prevention
Up to 90% of cardiovascular disease may be
preventable if established risk factors are
avoided. Currently practiced measures to
prevent cardiovascular disease include:
Tobacco cessation and avoidance of second-
hand smoke. Smoking cessation reduces risk
by about 35%.
A low-fat, low-sugar, high-fiber diet including
whole grains and fruit and
vegetables. Dietary interventions are
effective in reducing cardiovascular risk
factors over a year, but the longer term effects
of such interventions and their impact on
cardiovascular disease events is uncertain.
At least 150 minutes (2 hours and 30
minutes) of moderate exercise per
week. Exercise-based cardiac rehabilitation
reduces risk of subsequent cardiovascular
events by 26%, but there have been few high
quality studies of the benefits of exercise
training in people with increased cardiovascular
risk but no history of cardiovascular disease.
Limit alcohol consumption to the
recommended daily limits; People who
moderately consume alcoholic drinks have a
25–30% lower risk of cardiovascular disease.
Lower blood pressure, if elevated. A
10 mmHg reduction in blood pressure
reduces risk by about 20%.
Decrease non-HDL
cholesterol. Statin treatment reduces
cardiovascular mortality by about 31%.
Decrease body fat if overweight or obese. The
effect of weight loss is often difficult to
distinguish from dietary change, and evidence
on weight reducing diets is limited. In
observational studies of people with severe
obesity, weight loss following bariatric surgery is
associated with a 46% reduction in
cardiovascular risk.
Decrease psychosocial stress. This measure
may be complicated by imprecise definitions of
what constitute psychosocial
interventions. Mental stress–
induced myocardial ischemia is associated
with an increased risk of heart problems in
those with previous heart disease. Severe
emotional and physical stress leads to a form of
heart dysfunction known as Takotsubo
syndrome in some people. Stress, however,
plays a relatively minor role in
hypertension. Specific relaxation therapies
are of unclear benefit.

Diet
A diet high in fruits and vegetables decreases
the risk of cardiovascular disease
and death. Evidence suggests that
the Mediterranean diet may improve
cardiovascular outcomes. There is also evidence
that a Mediterranean diet may be more effective
than a low-fat diet in bringing about long-term
changes to cardiovascular risk factors (e.g.,
lower cholesterol level and blood
pressure). The DASH diet (high in nuts, fish,
fruits and vegetables, and low in sweets, red
meat and fat) has been shown to reduce
blood pressure, lower total and low density
lipoprotein cholesterol and
improve metabolic syndrome; but the long-
term benefits outside the context of a clinical
trial have been questioned. A high fiber
diet appears to lower the risk.
Total fat intake does not appear to be an
important risk factor. A diet high in trans
fatty acids, however, does increase rates of
cardiovascular disease. Worldwide, dietary
guidelines recommend a reduction in saturated
fat. However, there are some questions around
the effect of saturated fat on cardiovascular
disease in the medical literature. Benefits from
replacement with polyunsaturated
fat appears greatest; however,
supplementation with omega-3 fatty acids (a
type of polysaturated fat) does not appear to
have an effect.

Medication
Blood pressure medication reduces
cardiovascular disease in people at
risk, irrespective of age, the baseline level of
cardiovascular risk, or baseline blood pressure.
The commonly-used drug regimens have
similar efficacy in reducing the risk of all
major cardiovascular events, although there
may be differences between drugs in their
ability to prevent specific outcomes. Larger
reductions in blood pressure produce larger
reductions in risk, and most people with
high blood pressure require more than one
drug to achieve adequate reduction in blood
pressure.
Statins are effective in preventing further
cardiovascular
disease in
people with a
history of
cardiovascular
disease. Anti-
diabetic
medication may
reduce
cardiovascular
risk in people
with Type 2
Diabetes,
although
evidence is not conclusive. Aspirin has been
found to be of only modest benefit in those
at low risk of heart disease as the risk of
serious bleeding is almost equal to the
benefit with respect to cardiovascular
problems. In those at very low risk it is not
recommended. The United States Preventive
Services Task Force recommends against use of
aspirin for prevention in women less than 55
and men less than 45 years old; however, in
those who are older it is recommends in some
individuals.
The use of vasoactive agents for people with
pulmonary hypertension with left heart
disease or hypoxemic lung diseases may
cause harm and unnecessary expense.

Physical activity
A systematic review estimated that inactivity
is responsible for 6% of the burden of disease
from coronary heart disease worldwide. The
authors estimated that 121,000 deaths from
coronary heart disease could have been averted
in Europe in 2008, if physical inactivity had
been removed. A Cochrane review found some
evidence that yoga has beneficial effects on
blood pressure and cholesterol, but studies
included in this review were of low quality.
conclusion
Management
Cardiovascular disease is treatable with initial
treatment primarily focused on diet and
lifestyle interventions. Influenza may make
heart attacks and strokes more likely and
therefore influenza vaccination may decrease
the chance of cardiovascular events and death
in people with heart disease.
Proper CVD management necessitates a
focus on MI and stroke cases due to their
combined high mortality rate, keeping in
mind the cost-effectiveness of any
intervention, especially in developing
countries with low or middle income
levels. Regarding MI, strategies using aspirin,
atenolol, streptokinase or tissue plasminogen
activator have been compared for quality-
adjusted life-year (QALY) in regions of low and
middle income.
 BIBLIOGRAPHY
1. https://en.wikipedia.org/wiki/Cardiovascular
_disease
2. http://www.heart.org/HEARTORG/Conditions
/What-is-Cardiovascular-
Disease_UCM_301852_Article.jsp
3. https://www.medicalnewstoday.com/article
s/237191.php