Cardiovaskular Disease 3

The effect of a low salt diet is unclear. A Cochrane review concluded that any benefit in either hypertensive or normal tensive people is small if present.[61] Additionally, the review suggested a low salt diet may be harmful in those with congestive heart failure.[61] However, the review was criticized particularly for not excluding a trial in heart failure where people had low salt and water levels due to diuretics.[62] When this study is left out the rest of the trials show a trend to benefit. [62][63]

Another review of dietary salt[64] concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; the latter happens both through the increased blood pressure and, quite likely, through other mechanisms.[64][65] Moderate evidence was found that high salt intake increased cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes and left-ventricular hypertrophy.[64]

SupplementsWhile a healthy diet is beneficial, the effect of antioxidant supplementation (vitamin E, vitamin C, etc.) or vitamins generally has not been shown to improve protection against cardiovascular disease and in some cases may possibly result in harm.[66][67] Niacin, a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk. [68][69] Magnesium supplementation lowers high blood pressure in a dose dependent manner. [70] Magnesium therapy is recommended for patients with ventricular arrhythmia associated with torsade de pointes who present with long QT syndrome as well as for the treatment of patients with digoxin intoxication-induced arrhythmias.[71] Results from an observational study conducted in the general Japanese population demonstrated that lower serum magnesium levels were associated with a greater average intima-media thickness and the risk of at least two carotid plaques.[72] Evidence to support omega-3 fatty acid supplementation is lacking.[73]

MedicationAspirin has not been found to be of benefit overall in those at low risk of heart disease as the risk of serious bleeding is equal to the benefit with respect to cardiovascular problems. [74]

Statins are effective in preventing further cardiovascular disease in those with a history of cardiovascular disease.[75] As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women.[75] In those without cardiovascular disease but risk factors statins appear to also be beneficial with a decrease in mortality and further heart disease. [76] The time course over which statins provide preventation against death appears to be long, of the order of one year, which is much longer than the duration of their effect on lipids.[77]

ManagementCardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.[78][79][80]

Epidemiology

Cardiovascular diseases are the leading cause of death. In 2008, 30% of all global death is attributed to cardiovascular diseases. Death caused by cardiovascular diseases are also higher in low and middle-income countries as over 80% of all global death caused by cardiovascular diseases occurred in those countries. It is also estimated that by 2030, over 23 million people will die from cardiovascular diseases annually.

ResearchThe first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 1958.[82] The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is a common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular disease. [83] Also osteoprotegerin which involved with regulation of a key inflammatory transcription factor called NF-κB has been found to be a risk factor of cardiovascular disease and mortality. [84][85]

Some areas currently being researched include possible links between infection with Chlamydophila pneumoniae (a major cause of pneumonia) and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.[86]

Several research also investigated the benefits of melatonin on cardiovascular diseases prevention and cure. Melatonin is a pineal gland secretion and it is shown to be able to lower total cholesterol, very low density and low density lipoprotein cholesterol levels in the blood plasma of rats. Reduction of blood pressure is also observed when pharmacological doses are applied. Thus, it is deemed to be a plausible treatment for hypertension. However, further research needs to be conducted to investigate the side effects, optimal dosage and etc. before it can be licensed for use.[87]