Cardiovascular Disease Causes

Introduction 

Nowadays, everyone seems to be familiar with the term ‘cardiovascular disease’ in some way or another. Whether it is personally affecting you, your close friends or family, or just a distant colleague, cases of cardiovascular diseases are everywhere. So, what exactly are cardiovascular diseases?

Cardiovascular disease (CVD) is an umbrella term for a range of conditions that affect the heart or blood circulation through narrowing/blockage of your blood vessels. Affecting around 7.6 million people in the United Kingdom (UK), NHS England has categorised CVD as a ‘clinical priority’. According to data collected by the British Heart Foundation,  around 25% of all deaths in the UK are caused by heart or circulatory diseases. This equates to 460 deaths per day, which is 1 death every 3 minutes. The World Health Organisation (WHO) estimates that around 80% of all premature deaths caused by CVD are preventable.

The purpose of this article is to introduce you to CVD, their causes and consequences, as well as possible preventative measures. 

Types of Cardiovascular Disease

As CVD is rather broad, there are numerous different types of cardiovascular conditions. Some of the most common to lesser-known conditions that lead to CVD-related deaths are detailed below.1

Coronary Heart Disease

Coronary heart disease occurs when fatty substances build up in the vessels supplying blood (i.e. oxygen) to the heart, causing the blood vessel to harden and narrow; thus, ultimately reducing or restricting blood flow.2 Areas where the blood vessels, or arteries, are clotted are called atherosclerotic lesions. Coronary heart disease is also known as ischaemic heart disease or coronary artery disease. 

Stroke

Strokes occur when there is reduced or restricted blood flow to the brain. Strokes can be either ischaemic or haemorrhagic. Ischaemic strokes or transient ischaemic attacks (a.k.a. ‘mini-stroke’) occur when blood flow is blocked by a blood clot (85% of the time), atherosclerotic lesions or even air bubbles.3 On the other hand, haemorrhagic strokes occur when weakened blood vessels rupture, causing bleeding into the brain.4

Arterial Fibrillation

Arterial fibrillation is a condition that causes irregular and fast heartbeats(100 beats per minute whilst at rest). This is commonly associated with diseases that change the structure of the heart (e.g. coronary heart disease).5

Peripheral Arterial Disease

The peripheral arterial disease occurs when there is reduced blood flow in the arteries supplying the limbs, typically seen in the lower body. This can be caused by atherosclerotic lesions in the arteries supplying oxygenated blood from the heart to the limbs, commonly referred to as poor circulation.6

Aortic Aneurysm

An aortic aneurysm is a condition where the walls of the aorta (largest blood vessel in the body) weaken and bulge outwards. Aortic aneurysms can occur in the stomach or chest area and are also referred to as abdominal aortic aneurysms and thoracic aortic aneurysms.7, 8 

Cardiomyopathy

Cardiomyopathy is an umbrella term for heart muscle diseases where the walls (i.e. muscles) of the heart become thickened, stretched or stiffened. The main types of cardiomyopathies are hypertrophic cardiomyopathy, restrictive cardiomyopathy and arrhythmogenic cardiomyopathy.9-11 These can lead to the heart losing its ability to pump blood efficiently. Unlike other cardiovascular conditions, cardiomyopathy is typically inherited and is mostly seen in children and young individuals.

Hypertensive Heart Disease

Hypertensive heart disease results from long-term high blood pressure in the heart, making the heart work harder. This condition can go unnoticed and cause structural and functional changes to the heart muscle.12

Endocarditis

Endocarditis is a rare but lethal inflammation of the heart’s inner lining (the endocardium), caused by bacterial infection.13

Rheumatic Heart Disease

Rheumatic heart disease is a condition where the heart valves have been irreversibly damaged by rheumatic fever. Rheumatic fever is an inflammatory disease that can affect the heart, skin, brain and joints, and typically develops after a bacterial throat infection (e.g. strep throat or scarlet fever). Damage to the heart valves results in narrowing and leakage, making it harder for the heart to operate normally.14 

Types of Cardiovascular Diseases

According to the NHS, the 4 main types of CVD are:

  • coronary heart disease
  • strokes and transient ischaemic strokes
  • peripheral arterial disease
  • aortic disease (e.g. aortic aneurysm)

As coronary heart disease reduces or restricts blood flow to the heart, it strains the heart, resulting in chest pains, known as ‘angina’. More seriously, it can cause heart attacks, which occur when there is a sudden blockage of blood to the heart, or heart failure when the heart cannot supply blood to the rest of the body effectively.15

The brain is the most vital organ in humans. Strokes, which occur due to reduced or restricted blood flow to the brain, can result in brain damage, and late diagnosis can lead to death. 

The American Stroke Association recommends learning and sharing the F.A.S.T warning signs, which may help you save a life:

  • Face – their eyes and mouth may be drooping or become numb on one side, and they may be unable to smile.
  • Arms – their arms may become weak or numb, and they may be unable to lift both arms.
  • Speech – their speech may become slurred or unclear.
  • Time – call emergency services immediately if you see these symptoms. 

Peripheral arterial disease can cause pain or cramps in the thigh or calf while walking or running, as well as weakness, open sores and numbness in the legs and feet.

Lastly, if not spotted, an aortic aneurysm (i.e. bulging of the vessel) can get bigger over time and potentially burst, causing life-threatening internal bleeding.6

Aortic diseases do not show any symptoms but can result in sudden bursts of blood vessels leading to severe bleeding.7, 8 

Causes

The factors causing CVD could vary and depend on the type of disease. Common factors are discussed below.

The Non-modifiable Risk Factors

  • Age16 – Individuals aged 65 or older are more likely to suffer from CVD, especially heart attacks, heart failure, strokes and coronary heart disease. As you age, the structure of the heart and blood vessels inevitably change in shape and function. As you age, your heart will no longer be able to beat as fast during exercise as it used to. A general rule of thumb to calculate your maximum heart rate is to subtract your age from 220 (e.g. for a 50-year-old person, it would be 220 – 50 = 170 beats per minute).17  Fatty substances slowly build up in your arteries over time, resulting in atherosclerotic lesions. This is another major cause of an increased risk of cardiovascular diseases with increased age and will be discussed further below.
  • Gender18, 19 – Heart diseases, especially coronary heart disease, are commonly perceived as “a man’s disease”. This is because people assigned male at birth (AMAB) are more likely to develop coronary heart disease and generally are at a higher risk of CVD at a younger age compared to people assigned female at birth (AFAB). Though the sex differences in cardiovascular diseases are not yet fully understood, it has been suggested that differences in sex hormones may be the cause. The sex hormone of people AFAB, oestrogen, beneficially affects the cardiovascular system and helps protect the fertile age of people AFAB against the development of atherosclerotic lesions. However, at an older age (i.e. 70 years old and above) people AFAB are more likely to suffer from strokes. When considering the absolute number of individuals suffering and dying from CVD, the number of people AFAB is greater than people AMAB, despite people AMAB being more likely to develop CVD at a younger age. The reason for this is attributed to people AFABgenerally having a longer life expectancy, hence making up a larger proportion of the older population in which most cases of CVD are seen.  
  • Ethnicity20 – Black, Hispanic, Latino and Southeast Asian individuals are at a higher risk of CVD development and death compared to white Europeans. According to GOV.UK, around 13% of the UK population consists of individuals from minority ethnic groups, with the two largest groups being Black (3.3%) and Southeast Asian (4.5%). Whereas people of African origin are more likely to suffer from strokes, Southeast Asians are more likely to develop coronary heart disease. The causes of higher incidences of CVD are not completely understood as research is generally lacking in these population groups; however, socioeconomic status has been heavily attributed to the increased incidences of CVD in these groups.
  • Family History21 – Individuals with a family history of developing CVD at a younger age (i.e. 50 years old or younger) have a ~50% higher risk of dying from CVD. On top of sharing the same genetic makeup with your family, your habits (e.g. lifestyle and diet) and environment are more often than not similar to that of your parents, thus, increasing your risk of developing similar conditions.
  • Heart Defects22 – The most common heart defect condition seen is congenital heart disease, which is a malformation of the heart that develops in the womb and is observed in around 10% of newborns worldwide. Congenital heart defects can range from mild to severe. Some change the way blood flows through the heart, which can cause life-threatening complications. The structural and functional abnormalities caused by this disease make an individual more susceptible to CVD. In most cases, congenital heart defects develop due to a ‘mistake’ during foetal development, thus are generally unavoidable.
  • Infections23, 24 – Infections have been linked with the development of atherosclerotic lesions. Infections, such as SARS-CoV-2 (a.k.a. COVID-19) and influenza, trigger an inflammatory response from our immune system, causing the release of white blood cells. White blood cells defend our body against infections, but they also increase the ‘stickiness’ of platelets which are blood cells that clot blood when we get grazes and starches. However, inside the body, it can cause clotting of blood vessels that supply oxygen to the brain or the heart, resulting in heart attacks or strokes. The American Heart Association has suggested that individuals are more likely to develop CVD three months following an infection.  

Lifestyle Risks

  • Diet25 – Several foods can significantly increase your risk of CVD. A poor diet consisting of any of the following has been associated with a significantly higher risk of developing CVD:
  • Added sugars, found in soft drinks and most desserts, are considered the main risk factor for increased CVD development associated with a poor diet. Those who regularly consume soft drinks are at a 22% higher risk of a heart attack.
     
  • Trans-fats, found in fried foods, cause atherosclerotic lesion development and can lead to high cholesterol and increased risk of heart attacks and strokes. Research has shown that with every 2% increase in calories consumed from trans-fat, our risk of developing coronary heart disease increases by 23%.
  • Red and processed meat consumption of at least 50 grams per day, roughly 2 thick bacon rashers, increases the risk of coronary heart disease by 18%. Red and processed meat are high in salt and saturated fats (naturally occurring fats in meat), and they can lead to high cholesterol and high blood pressure, respectively; both of which are known risk factors for coronary heart disease.

Conversely, diets high in vegetables and fruits, and low in added sugars and salt have strong cardioprotective effects. Thus, it is important to hit the recommended 5-a-day portion of vegetables.

  • Smoking25 – Around 33% of people whose premature deaths are caused by CVD can be attributable to smoking. Chemicals in cigarettes, most notably nicotine, increase the strain put on our hearts and increase the risk of blood clots. Other chemicals, such as carbon monoxide found in the smoke, also negatively impact our bodies. People who regularly experience second-hand smoking have a 30% greater risk of coronary heart disease compared to those who do not.
  • Low activity Levels25 – People who live sedentary lifestyles are more likely to develop CVD. Exercise has protective effects against atherosclerotic lesion development. The NHS recommends adults aged 19-65 carry out at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity, spread throughout the week. Those who live active lifestyles have a stronger heart that can deliver blood to the body more efficiently and generally are healthier than their sedentary counterparts.
  • Alcohol26 – People who do not drink alcohol at all are linked with a higher risk of CVD development compared to those who drink light drinks (i.e. 1-2 drinks for people AMAB and 1 drink for people AFAB). However, if you regularly drink excessively (i.e. more than 14 units per week), you are at an increased risk of heart attacks.

Summary

In summary, there are several CVDs to be aware of. The main ones are coronary heart disease, strokes and transient ischaemic strokes, peripheral arterial disease and aortic diseases. Some causes of CVD, including age, gender, ethnicity, family history, heart defects and infections, are non-modifiable. However, lifestyle factors, such as diet, physical activity level, smoking and alcohol, are within our control. To reduce your risk of CVD, you should focus on the modifiable, lifestyle-related causes of CVD. This can be achieved by:

  • ingesting less added sugars, trans-fats, red/processed meats and alcohol 
  • regularly partaking in moderate to vigorous physical activity
  • avoiding smoking and second-hand smoking

References

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  2. Shahjehan RD, Bhutta BS. Coronary Artery Disease [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020.
  3. Hui C, Tadi P, Patti L. Ischemic Stroke [Internet]. Nih.gov. StatPearls Publishing; 2019.
  4. Unnithan AKA, Mehta P. Hemorrhagic Stroke [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020.
  5. Ludhwani D, Wieters JS. Paroxysmal Atrial Fibrillation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020.
  6. Zemaitis MR, Fatmata Bah, Boll JM, Dreyer MA. Peripheral Arterial Disease [Internet]. Nih.gov. StatPearls Publishing; 2019.
  7. Shaw PM, Loree J, Gibbons RC. Abdominal Aortic Aneurysm (AAA) [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020.
  8. Faiza Z, Sharman T. Thoracic Aorta Aneurysm [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Sep 17].
  9. Basit H, Brito D, Sharma S. Hypertrophic Cardiomyopathy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Aug 6].
  10. Brown KN, Pendela VS, Diaz RR. Restrictive (Infiltrative) Cardiomyopathy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Jun 8]. 
  11. Shah SN, Oliver TI. Arrhythmogenic Right Ventricular Cardiomyopathy [Internet]. Nih.gov. StatPearls Publishing; 2019 [cited 2020 Jan 23].
  12. Tackling G, Borhade MB. Hypertensive Heart Disease [Internet]. Nih.gov. StatPearls Publishing; 2019.
  13. Viliane Vilcant, Hai O. Bacterial Endocarditis [Internet]. Nih.gov. StatPearls Publishing; 2019.
  14. Sika-Paotonu D, Beaton A, Aparna Raghu, Steer A, Carapetis J. Acute Rheumatic Fever and Rheumatic Heart Disease [Internet]. Nih.gov. University of Oklahoma Health Sciences Center; 2017.
  15. Solomon SD, Wu JC, Gillam LD. Essential echocardiography : a companion to Braunwald’s Heart disease. 1st ed. Philadelphia, Pa: Elsevier; 2019.
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  17. CDC. Target Heart Rate and Estimated Maximum Heart Rate | Physical Activity | CDC [Internet]. www.cdc.gov. 2019.
  18. Bots SH, Peters SAE, Woodward M. Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010. BMJ Global Health [Internet]. 2017 Mar;2(2):e000298.
  19. Gao Z, Chen Z, Sun A, Deng X. Gender differences in cardiovascular disease. Medicine in Novel Technology and Devices [Internet]. 2019 Dec 1 [cited 2020 Apr 24];4:100025.
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  21. Bachmann JM, Willis BL, Ayers CR, Khera A, Berry JD. Association Between Family History and Coronary Heart Disease Death Across Long-Term Follow-Up in Men. Circulation. 2012 Jun 26;125(25):3092–8.
  22. Wang T, Chen L, Yang T, Huang P, Wang L, Zhao L, et al. Congenital Heart Disease and Risk of Cardiovascular Disease: A Meta‐Analysis of Cohort Studies. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease [Internet]. 2019 May 10;8(10).
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Jasmine Yeh

Master of Research - MRes, Clinical Research (Human Nutrition Pathway), Imperial College London
Hi! My name is Jasmine and I am currently doing an MRes in clinical research, specializing in human nutrition. I am extremely passionate about dissecting complex scientific papers and communicating them to those with non-scientific backgrounds to help them lead a healthy and balanced lifestyle. A healthy lifestyle to me should be maintainable, taking into account both physical and mental wellbeing, and is focused on prevention rather than treatment of diseases. I hope reading this article will help you take a positive step towards your idea of a healthy lifestyle!

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