If cardiovascular disease is largely preventable, why not reduce it?

Currently, cardiovascular diseases, including coronary disease, valvular disease, arrhythmias and heart failure, are the leading cause of death worldwide.

An estimated 17.9 million people die each year from cardiovascular disease, accounting for 32% of all deaths worldwide. Representing higher mortality in women than in men.

In the specific case of Spain, in 2020 alone, they were responsible for 24.3% of the total number of deaths, in addition to cancer (22.8%) and diseases of infectious or parasitic origin (19.4%), among which covid-19.

In many cases, cardiovascular diseases go unnoticed and develop asymptomatically, because they are difficult to detect until the patient requires urgent hospitalization.

They can be caused by various risk factors, modifiable and non-modifiable. Age and race are the most common non-modifiable risk factors. The main modifiable factors are hypertension, obesity, diabetes, dyslipidemia, and lifestyle factors such as smoking, physical inactivity and unhealthy diets that lead to overweight.

Obesity and cardiovascular disease, a strong link

There is evidence that early nutrition, maternal diet during pregnancy, maternal obesity, and gestational diabetes (which may occur in the mother during pregnancy) are associated with the development of cardiovascular disease in offspring as they reach adulthood. On the other hand, maintaining a balanced diet in the first years of life is also necessary to reduce the risk of cardiovascular disease in the future.

In addition, obesity has been shown to be associated with less richness and diversity in the gut microbiome, the set of microorganisms that inhabit the intestinal tract.

It is also known that these modifiable risk factors can transform childhood obesity into later metabolic disorders during adolescence, which may persist into adulthood. In this sense, non-alcoholic fatty liver disease (NAFLD) non-alcoholic fatty liver disease) has become a major public health problem with increasing population prevalence in parallel with the global epidemic of obesity and type 2 diabetes.

In turn, cardiovascular disease remains the leading cause of death in patients with progressive NAFLD. Eventually, these patients end up suffering from a loss of normal heart function, resulting in an increase in the thickness and stiffness of the coronary arteries.

Atrial fibrillation, the great unknown

Atrial fibrillation is the most common cardiac arrhythmia and its frequency increases with age. It accounts for about 10% of diagnoses in the population of developed countries, but these figures increase to 20-40% with cardiac surgery.

Although this arrhythmia may be present without any of its classic symptoms (such as palpitations, shortness of breath, or chest pain), it is associated with an increased risk of stroke (stroke) or death. However, the risk of stroke and its consequences can be reduced by controlling modifiable risk factors and adequately prescribing oral anticoagulants.

Recently, the European Society of Cardiology suggested that treatment of modifiable risk factors and comorbidities is necessary for optimal management of atrial fibrillation. Thus, by identifying and treating risk factors such as obesity, hypertension, diabetes or sleep apnea, among others, the risk of developing this arrhythmia is reduced, the number of relapses of the pathology is reduced, and adverse clinical outcomes are reduced.

Environmental pollution, the enemy of cardiovascular disease

Among the main challenges our society is currently facing are environmental pollution and global warming, which can have an irreversible impact on human health.

Exposure to air pollutants, both long-term and short-term, is of great importance. In fact, they are responsible for 20% of the deaths that occur worldwide. How is this possible?

This is due to what is known as particulate matter or PM. particulate matter), formed by a mixture of solid organic and inorganic particles, which come mainly from the combustion of vehicles, as well as in agriculture and animal husbandry.

Sulfates and nitrates are important components of PM. These particles are classified according to their size. The best known are PM10 (larger, <10 µm diameter) and PM2.5 (smaller, <2.5 µm). Thanks to breathing, they are able to reach the lungs and very easily enter the bloodstream through the alveoli, reaching other organs and tissues.

Particulate matter is very harmful, as it increases the activation of the sympathetic nervous system, which increases the heart rate and the strength of contractions of the heart muscle. As a result, the release of pro-inflammatory substances is triggered, mitochondrial function worsens, and oxidative stress increases. And all this leads to the fact that the risk of getting a heart attack increases dramatically. In fact, it is estimated that by controlling pollution, 1 in 3 deaths from cardiovascular disease could be avoided.

Inevitable or Preventable?

All this information should make us think about the relevance of cardiovascular pathologies, as well as what we want to focus on when faced with them. While it is true that some of the factors that lead to these diseases are inevitable, cardiovascular disease is largely preventable.

In this sense, the practical application of a number of indications that would reduce its incidence is of great importance. These include following healthy eating habits, regular physical activity, not smoking, avoiding pollution as much as possible, getting good sleep, and maintaining good weight control.

Antonio J. Ruiz Alcaraz, Professor of Immunology at the University of Murcia and Investigator of the IMIB Innate Immunity Group, University of Murcia; Bruno Ramos Molina, Principal Investigator of the IMIB Group on Obesity and Metabolism and Professor of Biochemistry, University of Murcia; Dario Mandalio Collados, Research Fellow, IMIB Clinical and Experimental Cardiology Group, University of Murcia; Francisco Marin Ortuño, Cardiology Service, Virgen de la Arrixaca University Clinical Hospital, Professor, Faculty of Medicine, University of Murcia, University of Murcia; José Miguel Rivera Caravaca, MD, Associate Professor of Nursing (Faculty of Nursing, University of Murcia), University of Murciaand Raquel López Galvez, Research Fellow in Clinical and Experimental Cardiology. Center for Networked Biomedical Research in Cardiovascular Diseases (CIBER-CV), University of Murcia

This article was originally published on The Conversation. Read the original.