Cardiovascular diseases (CVDs) are the foremost cause of death around the world and the rates continue to rise.

• 1990 - 2015 - CVD led to over 17 million deaths which increased by 42.4% from 1990 to 2015 (data from a 2021 research article).
• 2019 - there was an estimated 17.9 million people who died from cardiovascular related diseases, representing 32% of all global deaths (data from the World Health Organization).
• 1990-2019 - CVD deaths increased from 12.1 million in 1990 to 18.6 million in 2019 (data from a 2020 research article).
• Latest data from the World Heart Federation for 2023 - 20.5 million deaths per year.

Thrombosis is a major complication of CVD, leading to myocardial infarction (or heart attack) and stroke, with 85% of deaths worldwide being due to these conditions.

CVDs are a group of disorders related to the heart and blood vessels. They include:

• Coronary heart or artery disease – blood vessels supplying the heart.
• Cerebrovascular disease – blood vessels supplying the brain.
• Peripheral arterial disease – blood vessels supplying the arms and legs.
• Rheumatic heart disease – damage to the heart muscle and heart valves; and
• Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and stroke are usually acute or sudden events which are generally caused by a blockage that prevents blood flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits (plaque) inside the blood vessels. This build up is also known as atherosclerosis which is a major cause of CVD and a vascular problem representing the main mechanism accounting for myocardial infarction and stroke. 

Strokes can be caused by bleeding from a blood vessel in the brain or from blood clots. 

Coronary artery (heart) disease causes most heart attacks and occurs when one or more of the heart arteries are blocked due to plaque build-up. If a plaque breaks open, it can cause a blood clot in the heart. 

Atherosclerosis

In addition to plaque build-up causing blood flow blockage, plaque can also break or burst and cause a blood clot in any artery anywhere in the body. Another process which plays a part in atherosclerotic plaque development is oxidative stress or reactive oxygen species (ROS). Research shows that high levels of ROS have a critical role in platelet activation and are involved with cardiovascular disease. Please visit our website to read more about oxidative stress.

Nitric oxide (NO)

ROS and NO have opposite roles in the process of atherogenesis. Endothelial cells are tissue cells which form the lining of blood vessels, and are involved in all major haemostatic pathways, limit clot formation and restore vascular integrity. Endothelium-derived nitric oxide has an anti-atherogenic effect; maintains a non-thrombogenic surface; acts as a vasodilator as it increases blood flow to tissues and promotes vascular relaxation. Studies are showing that high intake of dietary sodium may decrease nitric oxide. Therefore, an increase in salt in the diet may result in the stiffening of arteries and endothelial cells.

A healthy endothelium helps to prevent thrombosis and coagulation!

Nutrition

Research investigating studies into nutrition and CVD found that components of the Mediterranean Diet may be beneficial in reducing the risk. Fruits, vegetables, olive oil, and nuts were among the foods suggested.

Studies have also shown that healthy lifestyle habits can help prevent atherosclerosis and antioxidants are involved in reducing oxidative stress. There is several literatures on the topic of nutrients having antithrombotic properties and that the antiplatelet effects may be useful for primary CVD prevention, however it is difficult to pinpoint specific nutrients.

The World Health Organization recommends a healthy diet consisting of 5 portions of fruits and vegetables daily to reduce the risk of noncommunicable diseases such as heart attack and stroke. The American Heart Association also suggest 1-2 meals per week consisting of seafood to decrease the risk of cardiac heart disease and ischaemic stroke.

Visit the PBI website for additional information about health, nutrition and thrombosis.

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Risk factors

There are many risk factors associated with cardiovascular disease:

• Age - as you age the risk of damaged and narrowed arteries; and a weakened or thickened heart muscle increases.
• Sex - males are usually at a higher risk, however the risk for women increases after menopause.
• Family history of heart disease.
• Smoking.
• Diets high in fat, salt, sugar and cholesterol have been linked to heart disease.
• High blood pressure.
• High cholesterol.
• Diabetes.
• Obesity.
• Lack of exercise - inactivity or a sedentary lifestyle is connected to many forms of heart disease. For additional information regarding the association between sedentary behaviours and CVD risk please visit CVD - risk factors
• Stress.
• Poor dental health - unhealthy teeth and gums increases the chance for germs to enter the bloodstream and travel to the heart.

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References

• Alkarithi, G., Duval, C., Shi, Y., Macrae, F.L. & Ariëns, R.A.S. (2021). Thrombosis structural composition in cardiovascular disease. Arterioscler Thromb Vasc Biol. 41:2370–2383. DOI: 10.1161/ATVBAHA.120.315754
• Amini, M., Zayeri, F. & Salehi, M. (2021). Trend analysis of cardiovascular disease mortality, incidence and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health 21, 401.
• Förstermann, U., Ning, X., & Huige, Li. (2017) Roles of Vascular Oxidative Stress and Nitric Oxide in the Pathogenesis of Atherosclerosis. Circulation research 120.4.
• Patik, J.C., Lennon, S.L., Farquhar,W.B., & Edwards, D.G. (2021). Mechanisms of dietary
  sodium-induced impairments in endothelial function and potential countermeasures. Nutrients 270. https://doi.org/10.3390/nu13010270.
• Russo, G., Leopold, J.A., & Loscalzo, J. (2002). Vasoactive Substances: Nitric Oxide and Endothelial Dysfunction in Atherosclerosis. Vascular pharmacology 38.5.
• Violi, F., Pastori, D., Pignatelli, P, & Carnevale, R. (2020). Nutrition, thrombosis, and cardiovascular disease. Circulation Research 126, 10.
• Cardiovascular diseases (CVDs) (who.int)
• Noncommunicable diseases (who.int)
• Heart attack - Symptoms and causes - Mayo Clinic
• Arteriosclerosis / atherosclerosis - Symptoms and causes - Mayo Clinic
• The pivotal role of the endothelium in haemostasis and thrombosis - PubMed (nih.gov)
• Immunity, atherosclerosis and cardiovascular disease - PMC (nih.gov)
• What is CVD? - World Heart Day (world-heart-federation.org)
• Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 Study
• Heart disease - Symptoms and causes - Mayo Clinic