Cardiovascular disease (CVD) accounts for approximately 30 percent of deaths annually in the United States and remains the No. 1 killer in this country. But the good news is that cardiovascular deaths are declining.

In fact, in 2006 heart attack deaths dropped 30.7 percent and stroke deaths dropped 29.3 percent compared to rates in 1999 when the AHA set forth an initiative to decrease cardiovascular deaths by 25 percent by the year 2010. Wonderfully, that goal has already been met. However, modifiable risk factors are on the rise, particularly in younger patients – especially women. This will likely cause another spike in death rates in the future, as these potential patients age.

Cardiovascular disease, a general term used to describe a group of diseases affecting the heart or blood vessels, includes coronary artery disease and heart attack, peripheral vascular disease and stroke, congestive heart failure and arrhythmia (irregular heartbeat). The majority of deaths from CVD are due to stroke and heart attack. The arteries of the body, including those feeding the heart, may become progressively clogged with a sticky substance called plaque that can enlarge and prevent blood and oxygen from reaching  the heart and brain, causing heart attack or stroke. Plaque contains fibrous tissue, cholesterol and blood clots. Current treatments attempt to minimize deposition of all these substances onto the blood vessel walls.

Risk factors increasing the likelihood of cardiovascular disease are well known. Those we cannot change include age, sex, family history of the disease and race. Those that can be modified include hypertension, diabetes, elevated cholesterol and triglyceride levels, obesity, high fat diets, inactive lifestyle and cigarette smoking. The traditional risk factor assessment method is a screening tool to determine heart attack and CVD death risk over a 10-year period. This method, called the Framingham risk score, weighs age fairly heavily, since the majority of CVD deaths occur in older patients. Unfortunately, we are now seeing a progressive increase in the number of CVD deaths occurring in younger patients, and the need for prevention is more apparent. Since      20-25 percent of patients experience sudden cardiac death or nonfatal heart attack without prior warning or symptoms, prevention must target at-risk patients prior to symptom onset.

More recently appreciated risk factors include low levels of HDL (good cholesterol) and high levels of high sensitivity C-reactive protein (Hs-CRP). HDL is high density lipoprotein, the good cholesterol that works as a carrier to help take bad cholesterol away from the artery wall and prevent plaque formation. It appears that too little of the good cholesterol is almost as bad as too much bad cholesterol. Hs-CRP is a protein found in the bloodstream when inflammatory processes occur in the body, particularly in the blood vessels. Both HDL and Hs-CRP can be evaluated by a blood test.

Increasingly, doctors are also using noninvasive testing to detect the presence of CVD before the development of symptoms. These methods include ultrasound of the carotid arteries to measure wall thickness; coronary CT scans to assess calcium deposition in the walls of the heart arteries occurring prior to development of blockage; and the ankle-brachial index (ABI ) which measures the blood pressure difference between the legs and arms to detect blockage in the blood vessels of the legs.

Clearly, more clinical work needs to be done to decrease CVD rates. However, better adherence to current recommendations would significantly decrease rates if not one new test or medication were developed.

Dr. Lisa J. Young - Upon completing medical school at the University of Rochester School of Medicine, and her residency at the Naval Hospital - Oakland, Cal., Dr. Lisa J. Young completed her fellowship in Cardiology at the Naval Medical Center - San Diego, Cal.  She has been in private practice at Sutherland Cardiology Clinic since 2004, specializing in Clinical and Invasive Cardiology.