Cardiovascular disease (CVD) is the leading cause of death and mortality worldwide. However, evidence indicates that premature deaths can be avoided by early detection and changes in lifestyle – this means managing our diet, exercise, sleep and stress levels.
We spoke to our expert Univ. Prof. Dr Winfried März, Director of SYNLAB Academy in Germany, to better understand CVDs and the role diagnostics play in identifying routes for early prevention and diagnosis, and when necessary, the most optimal path to targeted treatment.
What are cardiovascular diseases?
Cardiovascular diseases (CVDs) include a broad range of disorders affecting either blood vessels, mostly the arteries, or the heart. One of the major causes of CVD is atherosclerosis, a disease of the vessel wall often manifesting at multiple sites and characterised by deposition of lipids, inflammation, and cellular proliferation. Atherosclerosis can affect the arteries nourishing the heart (coronary artery disease), the brain (cerebrovascular disease), and the periphery. Consequently, blood flow to organs can be compromised chronically (angina pectoris or cerebral ischemia) or acutely (myocardial infarction or stroke).
Another major disease is heart failure in which the heart is unable to pump enough blood into circulation. Its causes include atherosclerosis, toxic damage, metabolic disorders, but also genetic factors. Other CVDs of the heart are arrhythmias, valve diseases, or aneurysms (bulges of the vessel wall).
Are there any latest developments in in vitro diagnostics (IVD) for the early detection or risk profiling of CVDs?
State-of-the-art risk assessment is accomplished by combining a few important clinical attributes like age, sex, smoking, and diabetes mellitus with a few generic laboratory values like low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides in risk calculators. Research of the last decade has consistently proven that newer biomarkers including natriuretic peptides (also used for the diagnosis of heart failure), cardiac troponins (cardiac damage, also used for the diagnosis of acute myocardial infarction) or cystatin C (a kidney function marker), or most recently ceramides (bioactive sphingolipids) are individually or in combination better markers for CVD risk.
Significant progress has also been made in the identification of measurable “polygenic” genetic risk factors for CVD which are commonly combined into polygenic risk scores and have the potential to refine risk assessment and open new avenues for CVD precision medicine. In the future, further innovations in early detection and risk profiling for CVDs will emerge through machine learning algorithms and artificial intelligence that consolidate and exploit different diagnostic technologies (clinical, imaging, circulating metabolites and proteins, genetics).
CVDs are a leading cause of death globally. How can they be treated?
In addition to lifestyle changes and drugs, medical invasive procedures are available to treat CVDs. Angioplasty and stenting are applied immediately after myocardial infarction to re-open occluded coronary arteries or in chronic coronary artery disease to reduce myocardial ischemia and angina pectoris. In severe coronary artery disease, coronary artery bypass surgery may be needed to restore blood flow. Damaged heart valves can be replaced surgically or by catheterisation. Arrhythmias are treated with pacemakers, implantable cardioverter defibrillators or ablation of abnormal heart tissue.
Any risk factors should be controlled rigorously following such procedures to halt or slow down disease progression. Current research into primary and secondary prevention focuses on tailoring therapeutic strategies to the individual needs of patients according to specific risk stratification algorithms.
How does an early diagnosis help in preventing and treating CVDs?
As mentioned, CVDs develop gradually from the second or the third decade of life onwards due to long-term exposure to risk factors. Both the severity of a risk factor and the time of exposure are crucial. For instance, CVD risk follows the number of cigarettes smoked per day and the number of years smoked, known as pack-years. Because it may be difficult to reverse atherosclerosis upon late intervention, it is crucial to recognise any CVD risks early, maintain a healthy lifestyle, and initiate medical treatment early if considered necessary.
How can the risks of CVDs be reduced?
Basically, there is one simple answer: Early prevention! Most CVDs develop over the years and could be prevented by early controls. Maintaining a heart-healthy lifestyle is key, like following a Mediterranean-type or plant-based diet rich in fruits, vegetables, whole grains, legumes, nuts, unprocessed meat, poultry, and fish. It is also important to limit salt intake, control weight, exercise regularly, avoid smoking, limit alcohol consumption, get regular sleep and get your risk factors checked regularly.
When lifestyle changes fail and the individual is at high risk, drugs may be required. This may apply to persons suffering from familial hypercholesterolemia, a genetic disorder of the metabolism of low-density lipoproteins that responds poorly to dietary changes and commonly requires treatment with a combination of cholesterol-lowering agents. Further pharmacological approaches include the use of antihypertensive or antidiabetic drugs. Once the need for medication has been established, patients should follow their prescriptions even if they still feel healthy and well.
What are the common symptoms of CVDs?
Clinical symptoms of CVDs often only appear after they have reached advanced stages. It is therefore important that risk factors and cardiovascular health are examined on a regular basis. The symptoms vary widely and of course depend on the specific disease. Some typical and concerning symptoms are sensations of chest pain upon exercise or emotional challenges (raising the suspicion of coronary artery disease), shortness of breath (pointing at heart failure, coronary artery disease or pulmonary embolism), irregular heartbeat, and leg pain during exercise (pointing at peripheral artery disease).
What are the common risk factors for CVDs?
Some major risk factors indicating the likelihood of developing a CVD can be influenced, like elevated concentrations of low-density lipoproteins (LDL, the most important vehicle of cholesterol in the blood), high blood pressure (hypertension), smoking, or diabetes mellitus. Other factors, however, cannot be adjusted or influenced, such as age, male sex, or genetic risks indicated by a positive family history of early CVD.
Modifiable risk factors are often the result of an inactive lifestyle or an unhealthy diet high in added sugars, saturated fat, salt, or processed food. Other risk factors may include obesity, systemic chronic inflammation and immune disorders, psychosocial stress, disrupted sleep patterns, loneliness and social deprivation, depression, excessive alcohol consumption, obstructive sleep apnoea, poor dental health, air and noise pollution, and ethnicity.
Why are CVDs increasing in prevalence?
There are several trends changing the clinical picture of CVDs. While we have witnessed a decline in cardiovascular mortality in western countries over the last decades, this trend has turned recently in the United States. CVD prevalence in high-income countries is mainly due to lifestyle factors such as overeating, obesity, and lack of physical activity. Improved access to healthcare has reduced early mortality, resulting in an aging population and higher prevalence rates of chronic cardiovascular disorders, such as arrhythmias. Furthermore, CVD is becoming more and more prevalent in low- and middle-income societies as the result of behavioural and demographic transitions (tobacco use, obesity, urbanisation).
Although CVDs are often perceived as diseases impacting men, they occur at similar rates in women. For instance, the likelihood of a woman dying from a CVD is ten times higher than from breast cancer. Further research into CVDs, specifically in women, is therefore needed. Finally, the unique cardiovascular complications of COVID-19 infections will have to be addressed in research and medical care.