What are some cardiovascular risks?

 

Risk factors for heart disease: high blood pressure, high cholesterol, and smoking. Some risk factors for heart disease cannot be controlled, such as your age or family history. But you can take steps to lower your risk by changing the factors you can control. The importance of resting heart rate (HR) as a prognostic factor and potential therapeutic target is not yet generally accepted. Recent large epidemiologic studies have confirmed earlier studies that showed resting HR to be an independent predictor of cardiovascular and all-cause mortality in men and women with and without diagnosed cardiovascular disease. Clinical trial data suggest that HR reduction itself is an important mechanism of benefit of beta-blockers and other heart-rate lowering drugs used after acute myocardial infarction, in chronic heart failure, and instable angina pectoris. Pathophysiological studies indicate that a relatively high HR has direct detrimental effects on the progression of coronary atherosclerosis, on the occurrence of myocardial ischemia and ventricular arrhythmias, and on left ventricular function. Studies have found a continuous increase in risk with HR above 60 beats/min. Although it may be difficult to define an optimal HR for a given individual, it seems desirable to maintain resting HR substantially below the traditionally defined tachycardia threshold of 90 or 100  beats/min.

Depression is a risk factor for both onset of cardiovascular disease (CVD) and increased morbidity and mortality for those with CVD. Many, but not all studies, have found that depressed patients have alterations in heart rate (HR) and heart rate variability (HRV). This variability is thought to reflect autonomic dysfunction. HR tends to be higher in depressed patients and HRV lower. Both higher heart rates and lower HRV increase CVD risk. Beta-blockers reduce HR and increase HRV and should be considered for depressed patients with CVD, elevated HR and/or reduced HRV. Exercise has similar, but smaller effects. Few studies have examined the effects of psychological interventions on HRV and the results have either been modest or examined only short term. Future research should focus on well-characterized subgroups of depressed patients at risk for CVD with assessment of other important factors that may affect HRV and CVD risk. Studies of high frequency HRV need to account for the effects of respiration.

High blood pressure (BP), cigarette smoking, diabetes mellitus, and lipid abnormalities are major modifiable risk factors for cardiovascular disease (CVD). Among these, high BP is associated with the strongest evidence for causation and has a high prevalence of exposure. However, there is considerable evidence that a biologically normal level of BP in humans is considerably lower than what has been traditionally employed in clinical practice and research, leading to an underrepresentation of the role that BP plays as a risk factor for CVD. We propose the following integrated theory for CVD causation that is supported by a robust body of coherent and consistent evidence: CVD in humans is primarily caused by a right-sided shift in the distribution of BP.