Circulatory System Diseases

The Big Heart Disease Lie

Cardiovascular Disease Causes and Possible Treatments

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The elevation of blood pressure, and diastolic pressure in particular, known as hypertension, is fairly common in middle- and late life and especially among older women. The average blood pressure for adults is 120/80, but between 110/70 and 140/90 is not considered a problem. When a person's blood pressure goes over 140/90, however, some form of treatment—losing weight and keeping it off, eating less salt, cutting down on alcohol, getting more exercise, and/or prescribed drugs — is required.

High blood pressure can be a serious problem, but it is usually viewed as potentially fatal only by virtue of its association with heart (hypertensive heart disease), kidney, (hypertensive renal disease), or cerebrovascular disease. The designation essential hypertension is used when no other signs of disease are present, or malignant hypertension when the disease has progressed rapidly. Hypertension is significantly more common among blacks than among whites, the difference between the percentage of black and white women with hypertension (39% vs. 25%) being especially pronounced (American Heart Association, 1995). Treatment for hypertension includes dieting, reduced salt intake, relaxation, and various prescription drugs. Considering the American penchant for eating, and salty foods in particular, complying with the first part of this treatment is often difficult.

Heart disease, by far the most common cause of death in the United States, may be caused by blood clots, holes in the chamber walls of the heart, or defective heart valves. Both stationary (thrombus) and moving (embolus) blood clots are due principally to arteriosclerosis, an abnormal hardening and thickening of the arteries caused by fatty (atherosclerosis) and calcium deposits known as plaque on arterial walls. The result is a narrowing of the coronary arteries, which carry blood to the heart muscle. Thus, the heart must work harder, increasing the blood pressure and the likelihood of clotting. Inadequate supply of blood and oxygen to the muscles of the heart can produce chest pains or angina. In advanced cases of arteriosclerosis, the inadequate blood flow causes heart muscle to die and precipitates a heart attack or myocardial infarction. The symptoms of a heart attack include a sudden dull pain and a feeling of heaviness in the chest that moves down the arms, unrelieved indigestion, pain in the jaw or shoulders, and shortness of breath. These symptoms vary with the age of the individual, severe chest pains being less common in older adults.

Heart failure can also result in the third most common cause of death in

•The death rate for HIV infection peaks between ages 35 and 44, whereas the death rate for chronic liver disease and cirrhosis peaks between the ages of 65 and 74 (Singh, et al., 1996).

the United States—cerebrovascular accident (CVA), or stroke. A stroke, which may be even more disabling than a heart attack, is caused by an embolism (clot) or hemorrhage in a small ("small stroke") or large ("major stroke") blood vessel of the brain. Strokes come on suddenly, leading to dizziness or unconsciousness, temporary dimness or loss of vision, sudden falling, temporary loss of speech or difficulty speaking or understanding speech, and sudden weakness or numbness in an arm, a leg, the face, or on one side of the body (American Heart Association, 1995).

As shown in Figure 3-3, circulatory diseases of all kinds increase in frequency with age. On the whole, circulatory diseases are also more common among men than women and among blacks than whites (Singh, et al., 1996). Rates of death due to heart disease are, however, substantially lower for Asian/Pacific Islander, Hispanic, and Native Americans than for whites in the older adult range (National Center for Health Statistics, 1991). The lower rates of heart disease among Asians has been attributed, at least in part, to the higher amounts of vegetables and lower amounts of animal fat in their diets than in those of North Americans and Western Europeans. The heavy vegetarian diet of the Japanese, for example, enables them to maintain a low blood-cholesterol level. The high salt intake of the typical Japanese diet, however, increases blood pressure and thereby the likelihood of developing hypertension. The typical diet of the French is also instructive: large meals

Figure 3-3 Number of discharges with first-listed diagnosis of diseases of the circulatory system from short-stay hospitals by first-listed diagnosis, sex, and age: United States, 1994. (Based on data from Graves & Gillum, 1996.)

accompanied by wine but few between-meal snacks. This diet presumably contributes to the lower rate of cardiovascular disease found among the French than among North Americans.

In addition to varying with sex, race, and nationality, the incidence of cardiovascular diseases is related to heredity and lifestyle. Among the lifestyle factors of importance are lack of physical inactivity, heavy smoking, obesity, and psychological stress. Increased attention to these and other lifestyle factors has undoubtedly contributed to the reduction in heart disease in the United States since 1960. For example, it is now generally accepted that by increasing cardiac output, blood flow, and oxygen consumption, and lowering blood pressure, regular and moderate physical exercise reduces the incidence of cardiovascular disease (Blair et al., 1989; Hill, Storandt, & Mal-ley, 1993; Paffenbarger, Hyde, Wing, & Hsieh, 1986). Another controllable factor in heart disease and several other disorders is cigarette smoking. Heavy cigarette smoking causes reduced cardiac output, increased heart rate and blood pressure, and constriction of the peripheral blood vessels. Recent increases in smoking by women, and older women in particular, have contributed to the rise in smoking-related illness.

Obesity, which is associated with hypertension and digestive disorders, is also a factor in heart disease. A standard way of describing obesity is in terms of the body mass index (BMI), computed as 697.5 times the weight (in pounds) divided by the square of the height (in inches). The World Health Organization's international standard for measuring obesity is a BMI above 25, but the U.S. government has defined obesity as a BMI of 27.8 or over for men and 27.3 or over for women (Willman & Colker, 1996). To maintain the BMI at an acceptable level, it is recommended that a prudent diet, in which 30% or less of the calories are obtained from fats, be followed.

The incidence of heart disease has also been found to be greater among single, widowed, and divorced people than among married people (Lynch, 1977) and higher among people with so-called Type A personality. This is a personality pattern characterized by a combination of behaviors, including aggressiveness, competitiveness, hostility, quick actions, and constant striving. Reviews of research on Type A and related, disease-prone personalities have concluded that a personality characterized by depression, anger/hostility, and anxiety is an important contributor to coronary heart disease (Friedman, 1990; Friedman & Booth-Kewley, 1987). Finally, perhaps related to stress is the finding that the risk of a heart attack in the working population is significantly greater on Monday than on any other day of the week (Willich et al., 1992).

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