Cardiovascular Disease: Risk Factors, Types & Testing Options

What is Heart Disease?

Heart disease is a broad term referring to a number of conditions and disorders undermining the function of the heart itself. Other conditions can lead to heart failure without being heart disease.

Cardiovascular disease refers to diseases, disorders, and conditions of the cardiovascular system, including the heart but also extending to the circulatory system, including the blood, veins, and arteries.

Heart disease is the leading cause of death in the United States, Canada, the United Kingdom, and Australia across all races, sexes, and ethnicities. In the United States alone:

• Heart disease kills more than 800,000 people each year—about one in every three deaths
• Heart disease kills approximately the same number of people in the US every year as cancer, accidents and respiratory diseases such as pneumonia combined.
• Expenditures to treat heart disease cost the US $219 billion per year in 2014-2015

Different types of heart disease affect the heart in different ways. Common heart conditions include coronary heart disease, myocardial infarction, and arrhythmia.

Medication and surgery are the most common treatment options indicated.‍

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Cardiovascular Disease: Symptoms

Symptoms of cardiovascular disease vary widely, depending on the condition.

It’s important to note that certain cardiovascular conditions, such as hypertension, heart attack, heart disease, prediabetes and type-2 diabetes and more, most commonly present few or no symptoms at all. An example of this could be arterial plaque build up which is the leading cause of heart disease yet often presents very few symptoms meaning many victims of heart disease are unaware they have a medical issue.

Other conditions, like angina, may cause a feeling of pressure or pain in the chest, a clear indication that all is not as it should be in the heart.

Common symptoms of cardiovascular disease include:

• Pain in the left arm or shoulder, since the heart sits to the left side of the torso
• Back pain
• Elbow pain
• Jaw pain
• Nausea
• Fatigue
• Shortness of breath
• Lightheadedness
• Dizziness
• Cold sweats
• Painful, numb, weak, or cold arms and legs
• Fainting
• Racing or slow pulse
• Pale or blue skin
• Swelling of the legs, hands, ankles, eyes, or abdomen
• Fever
• Skin rashes
• Dry or persistent coughing

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Who is at Risk of Developing Cardiovascular Disease?

Cardiovascular disease can affect anyone at any time. However, doctors have identified certain risk factors, greatly increasing the likelihood of a person developing heart or cardiovascular disease.

People at higher risk of cardiovascular disease include:

• Males - Males of all ages and demographics, including younger men, suffer from heart disease in greater numbers than women. After menopause, women’s risk of heart disease increases, but men are still more susceptible to heart attacks than women in this older demographic.
• Elderly -  The risk of cardiovascular disease increases with age. Coronary heart disease, in particular, tends to strike people over 65. As both men and women age, the risk of heart attack increases. Men have more heart attacks, but women are more likely to die from one.
• People with a family history of cardiovascular disease - Certain heart diseases are congenital, meaning they get passed to the next generation at birth. Even non-congenital heart disease may run in families. African Americans have a particularly pronounced hereditary susceptibility to cardiovascular disease, including heart conditions and high blood pressure. Native Americans, Pacific Islanders, Latinos, and some Asians are at greater risk of developing heart disease than their Caucasian counterparts.
• Overweight or obese people - Overweight people tend to be at risk of hypertension, myocardial infarction, type 2 diabetes, insulin resistance/prediabetes and other cardiovascular conditions. “Undiagnosed prediabetes/insulin resistance is one of the leading problems associated with cardiovascular disease” says Ford Brewer, MD, MPH, Preventative Healthcare Specialist and imaware clinical advisor. 
• Smokers - Smoking cigarettes greatly increases the risk of ischemic heart disease and other cardiovascular conditions.
• Heavy drinkers - Excessive alcohol consumption increases the risk of high blood pressure, heart attack, and other cardiovascular diseases.
• People who mix cocaine and alcohol - Cocaine and alcohol combine in the liver to form a compound called cocaethylene, a toxin implicated in cases of arrhythmia, myocardial infarction, cardiomyopathy, and other heart diseases.

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Types of Heart Disease

Coronary Artery Disease (CAD)

Coronary artery disease (affecting 16.5 million Americans) is also known as “coronary heart disease,” because the coronary arteries supply blood to the heart itself. In doing so, they provide the heart with the oxygen it needs to do its job of pumping 3,000 gallons of blood through your system every day.

CAD blocks the coronary arteries, limiting the supply of oxygen to the heart. The cause of this blockage is atherosclerosis—a buildup of plaque (cholesterol or fatty tissue) inside the arteries. This plaque either physically restricts the flow of blood to the heart or impedes the artery’s ability to conduct blood by changing the tone or tension in the arterial walls.

Deprived of oxygen, the heart begins to starve. This can lead to acute chest pain (angina) or–if the heart’s energy needs exceed the supply of oxygen–to heart attack. A heart starved of oxygen suffers from ischemia. If symptoms only occur during exertion and subside with rest and medication, the patient is said to suffer from “stable CAD,” with the associated chest pain being called “stable angina.”

Ischemia can occur with few symptoms or warnings. The first sign may well be a heart attack. Some of the life-threatening effects of CAD are grouped into the category of acute coronary syndromes, all of which require emergency treatment. These include:

• Unstable angina. Acute chest pain that occurs more frequently and is more severe and of longer duration, even at rest.
• Non-ST Segment Elevation Myocardial Infarction. A type of heart attack that does not register on an ECG (electrocardiogram), usually with minor damage to the heart.
• ST Segment Elevation Myocardial Infarction. A type of heart attack that does register on an ECG, severely impacting large areas of the heart.

CAD may cause the heart to develop collateral circulation, the spontaneous development of new arteries to reroute blood through new arterial pathways. However, collateral circulation may not be enough to relieve ischemia, especially during periods of exertion.

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Arrhythmia

The heart beats as a result of electrical impulses from a natural pacemaker called the sinus node, attached to the right atrium. A healthy heart receives steady impulses, resulting in a stable, regular heartbeat—typically 60 to 100 beats per minute. Cardiac arrhythmia or heart arrhythmia results from irregularities in those electrical impulses, causing the heart to beat too slowly, too quickly, or variably.

Some arrhythmias are harmless—just a simple fluttering or racing of the heart, with no lasting negative effects. Other cardiac arrhythmias may be annoying at best, life-threatening at worst. They may also be a sign of a damaged or failing heart.

Arrhythmias can be broken down into the following categories.

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Tachycardia—Fast Heartbeat

Excessively fast heartbeats (100 or more beats per minute at rest) can originate in any chamber of the heart from a number of causes, including:

• Atrial Fibrillation. Chaotic electrical impulses, resulting in fast, weak atrial contractions.
• Atrial Flutter. More organized tachycardia than atrial fibrillation, a precursor to serious complications like stroke.
• Supraventricular tachycardia. Many forms of tachycardia originating in the ventricles, often starting and stopping abruptly.
• Wolff-Parkinson-White syndrome. Arrhythmia caused by the congenital development of an extra electrical node in the heart.
• Ventricular tachycardia. Rapid contractions of the ventricles that cause them to fill with and pump blood inefficiently.
• Ventricular fibrillation. Chaotic electrical impulses causing the ventricles to quiver instead of pumping blood, a condition that can be fatal within minutes.
• Long QT syndrome. A kind of ventricular tachycardia that can lead to fainting or death, caused by genetic mutations at birth or certain medications.

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Bradycardia—Slow Heartbeat

Excessively slow heartbeats (60 or fewer beats per minute at rest) can also originate in any chamber of the heart from a number of causes, including:

• Sick sinus syndrome. Disruption of the sinus node, possibly due to scarring.
• Conduction block. A blockage between the sinus node and the atrioventricular node that conducts electrical impulses between the chambers of the heart.

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Premature Heartbeats

The feeling of your heart “skipping a beat” is actually an extra beat of the heart. They are usually harmless unless they trigger a pattern of frequent premature heartbeats, which weakens the heart over time.

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Congenital Heart Disease

Congenital disorders are present at birth. In the case of congenital heart disease, the patient is born with an abnormality in the structure of the heart. Congenital heart disease can result in abnormalities of the walls, valves, or blood vessels near the heart. It is the most common type of birth defect.

Often showing no signs or symptoms well into adulthood, congenital heart disease can also slow down the blood flow, cause blood to flow in the wrong direction, or block the flow of blood completely.

Doctors may be able to detect severe congenital heart defects during pregnancy or shortly after birth. Severe congenital heart defects can cause life-threatening symptoms in infants, including:

• Fatigue
• Impeded circulation
• Hyperventilation (fast breathing)
• Cyanosis (bluish skin, lips, and fingernails).

Some congenital heart conditions require no treatment. Others require emergency intervention with medications or surgery. Some require lifelong care or medication.

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Atherosclerosis

Atherosclerosis is a specific type of arteriosclerosis. Sometimes, the two words get used interchangeably.

Arteriosclerosis generically refers to a hardening of the arteries, depriving them of the flexibility and elasticity they use to force blood through the circulatory system.

Atherosclerosis causes plaque to form inside the walls of the arteries. This sticky substance, made from fats and cholesterol among other substances, builds up in the artery walls, narrowing the passageway and restricting the flow of blood. If the plaque bursts, it can cause a blood clot, blocking the flow of blood completely.

Atherosclerosis builds up gradually, often with no symptoms until the condition becomes severe. At that point, symptoms may include:

• Acute angina (heart pain) in the case of atherosclerosis of the coronary arteries. The blockage of the coronary arteries deprives the heart of the oxygen it needs to function.
• Numbness or weakness in the arms and legs, slurred speech, loss of vision, or drooping facial muscles. These symptoms occur when atherosclerosis blocks blood to the brain. Doctors call this a transient ischemic attack. Left unchecked, it could lead to stroke.
• Leg or arm pain, in the event of atherosclerosis in the arteries serving the extremities.
• High blood pressure or kidney failure in the event that atherosclerosis blocks blood flow to the kidneys.

Atherosclerosis may be preventable. Common causes and risk factors include:

• Smoking
• Obesity
• High triglycerides (a kind of fat)
• High cholesterol
• High blood pressure
• Inflammation
• Diabetes or other forms of insulin resistance.

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Cardiomyopathy

Cardiomyopathy affects the cardiac muscle, causing the heart to weaken, struggle to supply the body with enough blood, and in some cases fail.

Early cardiomyopathy may present no symptoms. Signs of advanced cardiomyopathy may include:

• Shortness of breath
• Swollen feet, ankles, and legs
• Fluid buildup in the abdomen, leading to bloating
• Fatigue
• Rapid or fluttering heartbeat
• Lightheadedness, dizziness, or fainting
• Coughing, especially while lying down
• Chest pressure or discomfort.

Cardiomyopathy can have many different causes, including:

• High blood pressure
• Excessive drinking of alcohol over a period of years
• Complications of pregnancy
• Certain infections
• Excess of iron in the heart
• Chemotherapy
• Use of cocaine or amphetamines
• Use of anabolic steroids
• Metabolic disorders like hypothyroidism or diabetes.

Cardiomyopathy comes in several different types, including:

• Dilated cardiomyopathy. The left ventricle becomes dilated and unable to efficiently pump blood. Most common in middle-aged men, it is caused by a heart attack or coronary artery disease.
• Hypertrophic cardiomyopathy. The cardiac muscle becomes overly thick, impeding the ability to contract. Especially dangerous to children, possibly hereditary or a result of a genetic mutation.
• Restrictive cardiomyopathy. The muscle becomes hardened and loses elasticity, restricting its ability to expand and receive blood in the heart chambers. It could have no discernible cause or could relate to other stressors on the heart such as an excess of iron.
• Arrhythmogenic right ventricular dysplasia. A rare scarring of the right ventricle, possibly due to a genetic mutation.
• Unclassified cardiomyopathy. Cardiomyopathy that doesn’t fit the above descriptions.

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Heart Infections

Several kinds of infections can afflict the heart, including:‍

Endocarditis

Microbes can enter your body through the mouth or other points of entry and make their way all the way to the heart. They tend to attach to damaged areas, causing the heart tissue to become inflamed.

More than half of all cases of endocarditis occur in adults over 60. Congenital heart disease, as well as past heart transplants or valve replacement procedures, also increase the risk of endocarditis.

Symptoms often resemble the symptoms of other conditions—chills, fever, sweating, coughing, shortness of breath. Unchecked, however, endocarditis can damage the heart valves, causing arrhythmia or heart murmurs.

Patients with endocarditis can be treated with a high dose of antibiotics.

Pericarditis

The heart sits in a protective sac called the pericardium. If the pericardium becomes infected, inflammation of the pericardium or pericarditis could be the result.

Pericarditis presents as a sharp pain in the left side of the chest. It typically clears up on its own within a few weeks. Symptoms can be treated with pain medications and anti-inflammatory medications.

Myocarditis

In rare cases, an infection of the nose, stomach, or lungs, usually by the coxsackievirus, could spread to the muscle of the heart. The resulting myocarditis, or inflammation of the heart muscle, could cause fatigue, weight gain, swelling, and shortness of breath.

Mild myocarditis may clear up on its own. Severe myocarditis may threaten heart failure and require the kind of treatments appropriate for heart failure.‍

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Heart Attacks

A heart attack, also known as a myocardial infarction, occurs when blood cannot flow to the heart. The flow of blood may be blocked by a buildup of cholesterol, fat, calcium and other substances to form plaque. The buildup of plaque is known as atherosclerosis which, if left unchecked, can lead to coronary artery disease.

Soft plaque can be likened to the white sticky substance you would find inside a pimple. Similar to a pimple, soft plaque develops a thin calcific cap (head) which prevents the substance from entering the bloodstream. The sticky material attracts enzymes that can weaken the artery wall and the calcific cap which can be exacerbated by the stresses of constant flowing blood 24/7.

Eventually, this can cause the pimple-like lesion to eventually rupture into the bloodstream. Some of the attracted enzymes to this area can subsequently cause blood to clot (similar to a scab). If a traveling blood clot is not dissolved quickly it may be transported to a smaller vessel and cause serious problems. Worse still, blood clots can grow large enough to stop blood flow completely starving tissue of oxygen. If the tissue in this case is the heart, the result is a heart attack. This can be fatal. A heart attack requires emergency medical attention.

Signs a person may be in the midst of a heart attack include:

• Pain, tightness, or pressure in the chest, arms, neck, and/or jaw
• Shortness of breath
• Cold sweat
• Lightheadedness
• Dizziness
• Nausea
• Indigestion
• Heartburn
• Abdominal pain

Heart attacks come in several varieties, including:

• ST Segment Elevation Myocardial Infarction (STEMI). Sometimes described as a “major heart attack.” Blood supply is cut off to a large portion of the heart, often resulting in severe damage. It gets its name from its impact on the “ST” segment of an ECG wave diagram.
• Non-ST Segment Elevation Myocardial Infarction (NSTEMI). A partial blockage of the coronary artery leads to less damage and no effect on the ST segment of the EKG.
• Coronary Spasm, or Unstable Angina. The coronary arteries contract, often painfully, resulting in a temporary reduction of blood flow to the heart. It may be mistaken for other conditions and typically results in little or no damage to the heart. Sometimes referred to as a “silent heart attack.”

Not every heart attack will present the same symptoms or even the same severity of symptoms. The effects could be so mild that the patient may not realize the danger until it is too late.

If you suspect a heart attack, seek emergency medical care immediately.

Nitroglycerin or aspirin could help prevent or alleviate symptoms of a heart attack. Take them only if prescribed and/or as recommended by a doctor.

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How Cardiovascular Disease is Diagnosed

Doctors perform a series of evaluations and tests to diagnose cardiovascular disease. Some screening methods may detect a cardiovascular condition before symptoms even present themselves.

Doctors start by noting any family history of cardiovascular disease, since certain conditions may be hereditary. Following that, your blood pressure, cholesterol, age, sex and existing medication may be combined with a risk estimators such as the Framingham Risk Estimator. This estimator is not perfect in it’s calculation however, it provides doctors with estimated cardiovascular risk over a 10 year period in the form of a percentage:

• 10% or less: low risk;
• 10-20%: intermediate risk;
• 20% or more: high risk.

High blood cholesterol or triglycerides are also red flags. C-reactive protein (CRP) tests may be used to deduce the presence of inflammation.

Certain noninvasive tests may also be used in combination to help detect the presence of cardiovascular disease, such as:

• Electrocardiogram (EKG or ECG) - A test of the electrical activity in your heart, recorded as waves on a strip of paper or computer screen, to check for damage or arrhythmia.
• Echocardiogram - An ultrasound scan of the heart, using reflected sound waves to map the heart and discover the condition of the muscles and valves.
• Coronary calcium score - Aka ‘CACS’ is a measurement of calcium in the arteries using CT (computed tomography) imaging scan. The scan is used to detect calcium which signifies plaque or atherosclerosis (plaque build-up).
• Carotid intima-media thickness test (CIMT) - A test that uses ultrasound technology to measure cardiovascular inflammation and plaque. The CIMT probes the carotid artery in the neck to measure the thickness of the inner walls which indicates plaque build up.
• Carotid Ultrasound. A picture of the carotid arteries on either side of the neck, created by sound waves, to check for plaque and evaluate your risk of a stroke.
• Holder Monitor. A small device that records continuous EKG data while you wear it.
• Chest X-Ray. The creation of an image of the inside of your chest using a small amount of X-ray radiation, often used to ascertain the cause of chest pain or shortness of breath.
• Stress Test. An evaluation of the heart’s reaction to physical exertion, usually performed on a treadmill or stationary bike.
• Tilt Table Test. A mechanical table that tilts in different directions, commonly administered to determine the cause of fainting. The doctor monitors your heartbeat, oxygen level, and blood pressure at different angles of orientation on the table.
• CT Scan. The creation of cross-sectional images of the heart using multiple X-rays.
• Heart MRI. Radio waves and magnets create an image of the inside of your heart and blood vessels to track the action of the beating heart.

Certain invasive tests may be required to diagnose cardiovascular diseases, including:

• Coronary angiography / cardiac catheterization. The doctor makes a small cut in the groin or elsewhere on the body and inserts a long tube into a blood vessel. The tube is then threaded to the vicinity of your heart to check for conditions and abnormalities close-up.
• CT angiography - Aka computed tomography angiography. In a CT angiography test, computerized X-ray imaging is combined with an iodine dye that’s injected into a vein. X-ray is used to view the path of the dye as X-ray does not pass through iodine making it clear and visible on X-ray imaging. The  X-ray images in this process can be reformatted to create 3D images that clearly highlight narrowing of arteries due to plaque.
• Electrophysiology Study. Similar to coronary angiography, except the catheter includes a tiny electrode. It uses small electric pulses to map the heart’s electrical pathways.

Why Annual Testing for Heart Inflammation & Prediabetes is Critical

Prediabetes and insulin resistance can cause high blood pressure, high blood sugar and other issues which, over time can increase the risk of cardiovascular disease. Both prediabetes and insulin resistance are often symptomless until it’s a serious issue so It’s important to get tested for prediabetes and insulin sensitivity to identify your risk and help inform your journey to staying healthy.

Additionally, the major forms of heart inflammation—endocarditis, myocarditis, and pericarditis—may present with few symptoms, or symptoms that could easily be mistaken for the flu or other conditions.

That said, heart inflammation could be a precursor to or an early warning sign of serious heart conditions if left untreated. Examples include:

• Ischemic heart disease.
• Certain autoimmune diseases.
• Pericardial effusion (fluid in the sac that holds the heart).
• Constrictive pericarditis (scarring of the pericardium).
• Arrhythmia
• Cardiomyopathy.
• Certain forms of cancer.
• Life-threatening sepsis (infection) of the blood.
• Heart failure.

If detected early, heart inflammation can be treated with medication or surgery before more serious conditions develop. Annual testing is crucial to identifying early signs. If you are over the age of 40, smoke, are obese or have had any prediabetes, it is recommended that cardiovascular inflammation testing should be quarterly.

How to Treat Cardiovascular Disease

The appropriate treatment of cardiovascular disease can vary wildly, depending on the patient and specific disease. Options may include:

Cardiac Rehabilitation

Certain therapies and lifestyle changes are most important for treatment to allow the heart to regain strength or stave off serious complications of cardiovascular diseases. Recommendations may include:

• Exercises such as brisk walking, running, jogging, swimming etc
• Losing weight with a healthy diet
• Quitting smoking
• Reducing alcohol consumption
• Improving sleep cycle

Medication

Various medications may alleviate the symptoms or even reverse the course of certain cardiovascular diseases. Examples include:

• High doses of antibiotics for endocarditis.
• Nitroglycerin or aspirin to prevent heart attacks.
• Beta-blockers, ACE inhibitors, or other medications to relieve hypertension (high blood pressure).

Surgery

While maximally invasive, heart surgery may be the most appropriate treatment for certain cardiovascular conditions. Procedures include:

• Coronary artery bypass - A grafting of arteries from elsewhere in the body onto the heart to create new coronary artery pathways for blood to reach the heart.
• Valve repair - Open-heart surgery to repair part of the heart.
• Transplant - Replacement of the heart with a donor heart.

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Summary

The diseases and conditions collectively described as “heart disease” and “cardiovascular disease” represent a leading cause of death in much of the world.

The diseases are often related, with certain conditions leading to others. For example, atherosclerosis (plaque buildup) in the coronary arteries can lead to coronary artery disease. If the plaque causes a complete blockage, myocardial infarction (heart attack) could be the result.

The causes and risk factors of certain heart diseases are well-known, including lifestyle factors, heredity, and genetic mutations.

Symptoms can be limited or mistaken for symptoms of other diseases until a life-threatening cardiac emergency is underway.

Take no chances with the heart.

Taking action before symptoms occur is of course the best option. One of the most common causes of heart disease, highlighted by Dr Brewer, is prediabetes/insulin resistance.

If you suspect a cardiovascular disease or major cardiac event in yourself or anyone else, seek immediate medical attention. 

These symptoms include:

• Dizziness
• Fainting
• Lightheadedness
• Chest pain or pressure
• Arm, shoulder, neck, or jaw pain
• Swelling of the arms, legs, feet, or ankles
• Cold sweats
• Nausea or indigestion
• Heartburn or abdominal pain
• Racing, slow, or irregular pulse
• Shortness of breath
• Numbness or weakness
• Pale or bluish skin, fingernails, and/or lips.

Various methods can be used to diagnose cardiovascular diseases, including non-invasive screening such as X-ray scanning, coronary calcium score, MRI, electrocardiogram, ultrasound, stress tests, and tilt tests. In certain cases, more invasive methods like cardiac catheterization may be required to diagnose a particular heart disease.

While serious, many cardiovascular diseases are treatable or even reversible most importantly with lifestyle changes but also with medication, therapy and surgery.