Cardio Pathophysiology Chapter 1

Coronary Artery Disease (CAD)

Leading cause of death in adult Americans accounting for approximately 25% of all US deaths in 2021

CAD Economic Cost Projection

Projected cost of $229 billion and expected to reach $276 billion by 2030

Years of Life Lost to a Heart Attack

Estimated 15 years

CAD Adult Mortality Rank

Ranks number 1 for both adult men and adult women

CAD Labor Force Impact

Leading cause of permanent disability in the US labor force accounting for 19% of Social Security disability allowances

CAD Mortality vs Morbidity Trends (2010 to 2020)

Mortality declined about 34% while morbidity rates remained similar

AHA Coronary Event and Death Frequency

One coronary event occurs every 25 seconds and one CAD death occurs every 37 seconds

Annual Coronary Attack Frequency in the US

805000 total cases per year with 605000 new and 200000 recurrent

Inpatient Cardiovascular Procedures in 2021

Approximately 8 million total procedures performed with 4.6 million in males and 3.4 million in females

Cardiovascular Operations Increase (1979 to 2008)

Increased by 384%

Arteriosclerosis

Hardness or hardening of the arteries

Atherosclerosis

A specific type of arteriosclerosis involving blockages and plaque accumulation

Vessel Lumen

The inner open cavity or space of a blood vessel

Vessel Endothelium

The inner cellular layer lining the blood vessel

Non-Modifiable CAD Risk Factors

Increasing age plus male gender plus heredity

Modifiable CAD Risk Factors

Cigarette smoking plus hypertension plus hyperlipidemia plus physical inactivity plus obesity plus diabetes

Acute Risks of Tobacco Use

Increased heart rate increased blood pressure reduced blood oxygen capacity lower arrhythmia threshold coronary artery vasospasms and elevated platelet aggregation

Chronic Risks of Tobacco Use

Decreased HDL cholesterol LDL cholesterol oxidation elevated blood fibrinogen endothelial damage and increased blood viscosity

Hyperlipidemia Definition

High blood cholesterol levels

Total Cholesterol Goal

200 mg/dL or less

LDL Cholesterol Goal

130 mg/dL or less

HDL Cholesterol Goal

55 mg/dL or higher

Hypertension Definition

High blood pressure

Normal Blood Pressure Goal

Systolic under 120 mmHg and diastolic under 80 mmHg

Physical Inactivity and CAD Relationship

Inverse dose-response relationship where increased activity lowers disease risk and all-cause mortality up to a threshold

Android Obesity

Upper body or abdominal fat distribution associated with higher cardiovascular risk

Gynoid Obesity

Lower body hip and thigh fat distribution associated with lower cardiovascular risk compared to android

Waist to Hip Ratio Purpose

Anthropometric measurement developed to characterize cardiovascular risk based on fat distribution

Type 1 Diabetes Mellitus

Accounts for roughly 20% of cases where the pancreas fails to produce sufficient insulin and typically develops before age 30

Type 2 Diabetes Mellitus

Accounts for roughly 80% of cases characterized by cellular insulin resistance often resulting from obesity

Psychosocial Risk Factors for CAD

Type A personality and depression

Mechanisms Linking Depression to CAD

Higher prevalence of elevated blood pressure cholesterol imbalances smoking and obesity

Lipoprotein(a) [Lp(a)]

An LDL-like lipoprotein that promotes inflammation increases clotting prevents clot breakdown and raises plaque rupture risk

Fibrinogen

A blood clotting protein associated with increased CAD and thrombosis risk

Homocysteine

An amino acid from dietary proteins normally converted by folic acid that causes endothelial injury and altered coagulation when conversion fails

Oxidative Stress and CAD

Lack of antioxidants increases CAD risk by allowing oxidation of LDL and Lp(a) which promotes atherosclerosis

Moderate Alcohol Consumption CAD Effect

1 to 3 drinks per day is associated with decreased CAD risk via increased HDL and altered coagulation

Excessive Alcohol Consumption CAD Effect

Greater than 3 drinks per day increases CAD risk