Deciphering the Disease

Cardiovascular disease (CVD) is well recognized by both the scientific community and the general public as one of the major causes of death. It is defined by any one of a number of abnormal conditions that involve dysfunction of the heart and blood vessels. Although this definition is quite broad, studies frequently relegate CVD to just “heart disease” and “strokes”, two terms commonly understood by the public.

The common practice of separating the two terms leads the reader to infer that they are different disease processes. Only when looking at CVD in its totality can the true burden of disease be appreciated. An estimated 81-million U.S. adults have some form of CVD. In fact, it was the cause of 34% of all deaths and an underlying cause for about 56% of deaths in 2006; and CVD claims more lives than the next five leading causes of death combined. This statistic translates into nearly 2,300 Americans dying of CVD each day – or 1 death every 38 seconds.

According to the most recent statistics from the Center for Disease Control (CDC) on U.S. mortality, heart disease and stroke are ranked respectively as the first and fourth leading causes of death. Once again, although heart disease and stroke are both classified under the broad umbrella of CVD, the CDC reports them as two distinct causes of death. Furthermore, the grouping of heart disease and stroke fails to recognize the differences that exist within each group.

If one were to take a closer look at heart disease and stroke, it becomes clear that these two groups are more similar than they are different. Heart disease is defined as any organic, mechanical, or functional abnormality of the heart, its structures, or the coronary arteries. Heart disease includes a group of disease processes with only one common feature, which is that they affect the heart.

When evaluating stroke, the story is strikingly similar. Defined as the sudden death of brain cells in a localized area due to inadequate blood flow, stroke also includes a group of diseases with the one commonality of causing the death of brain cells.

The processes leading to death from ischemic stroke (restricted blood supply to brain) are very different from a hemorrhagic stroke (bleeding in the brain). In fact, an ischemic stroke shares more similarities to ischemic heart disease (restricted blood supply to the heart) since the causes, prevention, and treatment are quite similar given that they most likely are related to atherosclerosis.

Atherosclerosis is the build-up of plaques in arteries that can lead to progressive narrowing or complete occlusion of these vessels, thus cutting off blood supply to cells and potentially leading to their death. This process can occur at any level of the vascular tree causing stroke, blindness, heart attack, peripheral arterial disease, and even kidney failure. As a single entity, atherosclerosis is the leading cause of death in the U.S. and the rest of the developed world.

Reporting death according to atherosclerosis rather than heart disease or stroke would more accurately represent the disease process and its true burden. This is particularly important in the African American community where atherosclerosis is an epidemic. In fact, almost a quarter of deaths in this community were due to heart disease. Atherosclerosis is largely preventable through diet, exercise, and good medical management so it’s vitally important that we get the word out.

Dr. Bernard Ashby is a cardiologist and assistant professor of medicine at Columbia University’s Division of Cardiology at Mount Sinai Medical Center. His focus is clinical cardiology and vascular medicine. For more information about Dr. Ashby, visit www.msmc.com or call 305-674-CARE (2273).

Dr. Bernard Ashby










Dr. Bernard Ashby

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