heart disease

心疾患 心臓病

WordNet

1. a plane figure with rounded sides curving inward at the top and intersecting at the bottom; conventionally used on playing cards and valentines; "he drew a heart and called it a valentine"
2. the courage to carry on; "he kept fighting on pure spunk"; "you havent got the heart for baseball" (同)mettle, nerve, spunk
3. an inclination or tendency of a certain kind; "he had a change of heart" (同)spirit
4. a playing card in the major suit that has one or more red hearts on it; "he led the queen of hearts"; "hearts were trumps"
5. the locus of feelings and intuitions; "in your heart you know it is true"; "her story would melt your bosom" (同)bosom
6. the hollow muscular organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body; "he stood still, his heart thumping wildly" (同)pump, ticker
7. a firm rather dry variety meat (usually beef or veal); "a five-pound beef heart will serve six"
8. able to perceive sound
9. an opportunity to state your case and be heard; "they condemned him without a hearing"; "he saw that he had lost his audience" (同)audience
10. (law) a proceeding (usually by a court) where evidence is taken for the purpose of determining an issue of fact and reaching a decision based on that evidence
11. the ability to hear; the auditory faculty; "his hearing was impaired" (同)audition, auditory sense, sense of hearing, auditory modality
12. a session (of a committee or grand jury) in which witnesses are called and testimony is taken; "the investigative committee will hold hearings in Chicago"
13. receive a communication from someone; "We heard nothing from our son for five years"
14. examine or hear (evidence or a case) by judicial process; "The jury had heard all the evidence"; "The case will be tried in California" (同)try
15. perceive (sound) via the auditory sense
16. an impairment of health or a condition of abnormal functioning
17. caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological

PrepTutorEJDIC

1. 〈C〉『心臓』;胸 / 〈C〉(感情の中心をなす)『心』,気持ち / 〈U〉愛情,同情 / 〈U〉『勇気』,元気,熱意 / 《the ~》『中心』,内部,(物事の)本質,核心 / 〈C〉ハート形の物;(カードの)ハートの札
2. 〈U〉『聴力』,聴覚〈U〉〈C〉(…を)『聞くこと』,(…の)聞き取り《+『of』+『名』》・〈C〉聞いてもらう機会,聞いてやること・聴取・聴聞会〈C〉(法廷などでの)尋問,審問,;(刑罰の減免を求める)釈明,意見陳述 / 〈U〉聞こえる距離(範囲)
3. 〈音〉‘が'『聞こえる』,‘を'聞く(進行形にできない) / 〈人の言うこと〉‘に'『耳を傾ける』,‘を'注意深く聞く(listen);(裁判官などが)…の申し立てを聞く / 〈うわさ・ニュースなど〉‘を'『耳にしている』,聞いている / 『耳が聞こえる』 / 《しばしば命令形で》耳を傾ける,注意を向ける / 『うわさ』(『消息』)『を聞く』
4. (体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
5. 女性の話術芸人 =diseur
6. 病気にかかった / 病的な,不健全な(morbid)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/11/05 21:35:58」(JST)

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[Wiki en表示]

Cardiovascular disease
Classification and external resources
Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.
ICD-10	I51.6
ICD-9	429.2
DiseasesDB	28808
MeSH	D002318

Cardiovascular disease (also called heart disease) is a class of diseases that involve the heart, the blood vessels (arteries, capillaries, and veins) or both.

Cardiovascular disease refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of cardiovascular disease are diverse but atherosclerosis and hypertension are the most common. In addition, with aging come a number of physiological and morphological changes that alter cardiovascular function and lead to increased risk of cardiovascular disease, even in healthy asymptomatic individuals.

Cardiovascular disease is the leading cause of deaths worldwide, though, since the 1970s, cardiovascular mortality rates have declined in many high-income countries. At the same time, cardiovascular deaths and disease have increased at a fast rate in low- and middle-income countries. Although cardiovascular disease usually affects older adults, the antecedents of cardiovascular disease, notably atherosclerosis, begin in early life, making primary prevention efforts necessary from childhood. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, for example by healthy eating, exercise, and avoidance of smoking tobacco.

Types

Disability-adjusted life year for inflammatory heart diseases per 100,000 inhabitants in 2004.

  no data

  less than 70

  70-140

  140-210

  210-280

  280-350

  350-420

  420-490

  490-560

  560-630

  630-700

  700-770

  more than 770

• Coronary artery disease (also known as coronary heart disease and ischemic heart disease)
• Cardiomyopathy - diseases of cardiac muscle
• Hypertensive heart disease - diseases of the heart secondary to high blood pressure
• Heart failure
• Pulmonary heart disease - a failure at the right side of the heart with respiratory system involvement
• Cardiac dysrhythmias - abnormalities of heart rhythm
• Inflammatory heart disease
  • Endocarditis – inflammation of the inner layer of the heart, the endocardium. The structures most commonly involved are the heart valves.
  • Inflammatory cardiomegaly
  • Myocarditis – inflammation of the myocardium, the muscular part of the heart.
• Valvular heart disease
• Cerebrovascular disease - disease of blood vessels that supply blood to the brain such as stroke
• Peripheral arterial disease - disease of blood vessels that supply blood to the arms and legs
• Congenital heart disease - heart structure malformations existing at birth
• Rheumatic heart disease - heart muscles and valves damage due to rheumatic fever caused by Streptococcus pyogenes a group A streptococcal infection.

Risk factors

Evidence suggests a number of risk factors for heart diseases: age, gender, high blood pressure, hyperlipidemia, diabetes mellitus, tobacco smoking, processed meat consumption, excessive alcohol consumption, sugar consumption, family history, obesity, lack of physical activity, psychosocial factors, and air pollution. While the individual contribution of each risk factor varies between different communities or ethnic groups the consistency of the overall contribution of these risk factors to epidemiological studies is remarkably strong. Some of these risk factors, such as age, gender or family history, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, social change, drug treatment and prevention of Serrano's Cardiac Triad: hypertension, hyperlipidemia, and diabetes.

Age

Calcified heart of an older woman with cardiomegaly.

Age is by far the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life. It is estimated that 82 percent of people who die of coronary heart disease are 65 and older. At the same time, the risk of stroke doubles every decade after age 55.

Multiple explanations have been proposed to explain why age increases the risk of cardiovascular/heart diseases. One of them is related to serum cholesterol level. In most populations, the serum total cholesterol level increases as age increases. In men, this increase levels off around age 45 to 50 years. In women, the increase continues sharply until age 60 to 65 years.

Aging is also associated with changes in the mechanical and structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and may subsequently lead to coronary artery disease.

Sex

Men are at greater risk of heart disease than pre-menopausal women. Once past menopause, it has been argued that a woman's risk is similar to a man's although more recent data from the WHO and UN disputes this. If a female has diabetes, she is more likely to develop heart disease than a male with diabetes.

Among middle-aged people, coronary heart disease is 2 to 5 times more common in men than in women. In a study done by the World Health Organization, sex contributes to approximately 40% of the variation in the sex ratios of coronary heart disease mortality. Another study reports similar results that gender difference explains nearly half of the risk associated with cardiovascular diseases One of the proposed explanations for the gender difference in cardiovascular disease is hormonal difference. Among women, estrogen is the predominant sex hormone. Estrogen may have protective effects through glucose metabolism and hemostatic system, and it may have a direct effect on improving endothelial cell function. The production of estrogen decreases after menopause, and may change the female lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level and by increasing LDL and total cholesterol levels. Women who have experienced early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age group who have not yet gone through menopause.

Among men and women, there are notable differences in body weight, height, body fat distribution, heart rate, stroke volume, and arterial compliance. In the very elderly, age-related large artery pulsatility and stiffness is more pronounced in women. This may be caused by the smaller body size and arterial dimensions independent of menopause.

Air pollution

Particulate matter has been studied for its short- and long-term exposure effects on cardiovascular disease. Currently, PM_2.5 is the major focus, in which gradients are used to determine CVD risk. For every 10 μg/m³ of PM_2.5 long-term exposure, there was an estimated 8-18% CVD mortality risk. Women had a higher relative risk (RR) (1.42) for PM_2.5 induced coronary artery disease than men (0.90) did. Overall, long-term PM exposure increased rate of atherosclerosis and inflammation. In regards to short-term exposure (2 hours), every 25 μg/m³ of PM_2.5 resulted in a 48% increase of CVD mortality risk. In addition, after only 5 days of exposure, a rise in systolic (2.8 mmHg) and diastolic (2.7 mmHg) blood pressure occurred for every 10.5 μg/m³ of PM_2.5. Other research has implicated PM_2.5 in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure. PM_2.5 is also linked to carotid artery thickening and increased risk of acute myocardial infarction.

Pathophysiology

Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material).

Population-based studies show that atherosclerosis, the major precursor of cardiovascular disease, begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 7–9 years.

This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide, education and awareness that cardiovascular disease poses the greatest threat, and measures to prevent or reverse this disease must be taken.

Obesity and diabetes mellitus are often linked to cardiovascular disease, as are a history of chronic kidney disease and hypercholesterolaemia. In fact, cardiovascular disease is the most life-threatening of the diabetic complications and diabetics are two- to four-fold more likely to die of cardiovascular-related causes than nondiabetics.

Screening

Screening ECGs (either at rest or with exercise) are not recommended in those without symptoms who are at low risk. This includes those who are young without risk factors. In those at higher risk the evidence for screening with ECGs is inconclusive.

Some biomarkers may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the clinical value of some biomarkers is still questionable. Currently, biomarkers that may reflect a higher risk of cardiovascular disease include the following:

• Coronary artery calcification
• Carotid intima-media thickness
• Carotid total plaque area
• Higher fibrinogen and PAI-1 blood concentrations
• Elevated homocysteine
• Elevated blood levels of asymmetric dimethylarginine
• Inflammation as measured by C-reactive protein
• Elevated Low-density lipoprotein-p
• Elevated blood levels of brain natriuretic peptide (also known as B-type) (BNP)

Prevention

Currently practiced measures to prevent cardiovascular disease include:

• A low-fat, high-fiber diet including whole grains and fruit and vegetables. Five portions a day reduces risk by about 25%.
• Tobacco cessation and avoidance of second-hand smoke
• Limit alcohol consumption to the recommended daily limits consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30% However excessive alcohol intake increases the risk of cardiovascular disease.
• Lower blood pressures, if elevated
• Decrease body fat if overweight or obese
• Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week (multiply by three if horizontal);
• Reduce sugar consumptions
• Decrease psychosocial stress. Stress however plays a relatively minor role in hypertension (if it even plays any role in the development of hypertension at all is often disputed). Specific relaxation therapies are not supported by the evidence.

For adults without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease, routine counseling to advise them to improve their diet and increase their physical activity has not been found to significantly alter behavior, and thus is not recommended. It is unclear whether or not dental care in those with periodontitis affects the risk of cardiovascular disease. Exercise in those who at high risk of heart disease has not been well studied as of 2014.

Diet

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death. Evidence suggests that the Mediterranean diet may improve cardiovascular outcomes. There is also evidence that a Mediterranean diet may be more effective than a low-fat diet in bringing about long-term changes to cardiovascular risk factors (e.g., lower cholesterol level and blood pressure). The DASH diet (high in nuts, fish, fruits and vegetables, and low in sweets, red meat and fat) has been shown to reduce blood pressure, lower total and low density lipoprotein cholesterol and improve metabolic syndrome; but the long term benefits outside the context of a clinical trial have been questioned. A high fiber diet appears to lower the risk.

Total fat intake does not appear to be an important risk factor. A diet high in trans fatty acids; however, does appear to increase rates of cardiovascular disease. Worldwide, dietary guidelines recommend a reduction in saturated fat. However, there are some questions around the effect of saturated fat on cardiovascular disease in the medical literature. A 2014 review did not find evidence of harm from saturated fats. A 2012 Cochrane review found suggestive evidence of a small benefit from replacing dietary saturated fat by unsaturated fat. A 2013 meta analysis concludes that substitution with omega 6 linoleic acid (a type of unsaturated fat) may increase cardiovascular risk. Replacement of saturated fats with carbohydrates does not change or may increase risk. Benefits from replacement with polyunsaturated fat appears greatest however supplementation with omega-3 fatty acids (a type of polysaturated fat) does not appear have an effect.

The effect of a low-salt diet is unclear. A Cochrane review concluded that any benefit in either hypertensive or normal-tensive people is small if present. In addition, the review suggested that a low-salt diet may be harmful in those with congestive heart failure. However, the review was criticized in particular for not excluding a trial in heart failure where people had low-salt and -water levels due to diuretics. When this study is left out, the rest of the trials show a trend to benefit. Another review of dietary salt concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; the latter happen both through the increased blood pressure and, quite likely, through other mechanisms. Moderate evidence was found that high salt intake increases cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes, and left ventricular hypertrophy.

Supplements

While a healthy diet is beneficial, in general the effect of antioxidant supplementation (vitamin E, vitamin C, etc.) or vitamins has not been shown to protection against cardiovascular disease and in some cases may possibly result in harm. Mineral supplements have also not been found to be useful. Niacin, a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk. Magnesium supplementation lowers high blood pressure in a dose dependent manner. Magnesium therapy is recommended for patients with ventricular arrhythmia associated with torsade de pointes who present with long QT syndrome as well as for the treatment of patients with digoxin intoxication-induced arrhythmias. Evidence to support omega-3 fatty acid supplementation is lacking.

Medication

Aspirin has been found to be of benefit overall in those at low risk of heart disease as the risk of serious bleeding is equal to the benefit with respect to cardiovascular problems.

Statins are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease. As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women. In those without cardiovascular disease but risk factors statins appear to also be beneficial with a decrease in mortality and further heart disease. The time course over which statins provide preventation against death appears to be long, of the order of one year, which is much longer than the duration of their effect on lipids. The medications niacin, fibrates and CETP Inhibitors, while they may increase HDL cholesterol do not affect the risk of cardiovascular disease in those who are already on statins.

Management

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.

Epidemiology

Disability-adjusted life year for cardiovascular diseases per 100,000 inhabitants in 2004.

  no data

  <900

  900-1650

  1650-2300

  2300-3000

  3000-3700

  3700-4400

  4400-5100

  5100-5800

  5800-6500

  6500-7200

  7200-7900

  >7900

Cardiovascular diseases are the leading cause of death. In 2008, 30% of all global death is attributed to cardiovascular diseases. Death caused by cardiovascular diseases are also higher in low- and middle-income countries as over 80% of all global death caused by cardiovascular diseases occurred in those countries. It is also estimated that by 2030, over 23 million people will die from cardiovascular diseases each year.

Research

The first studies on cardiovascular health were performed in year 1949 by Jerry Morris using occupational health data and were published in year 1958. The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research, with hundreds of scientific studies being published on a weekly basis.

A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive protein (CRP) is a common inflammatory marker that has been found to be present in increased levels in patients who are at risk for cardiovascular disease. Also osteoprotegerin, which is involved with regulation of a key inflammatory transcription factor called NF-κB, has been found to be a risk factor of cardiovascular disease and mortality.

Some areas currently being researched include the possible links between infection with Chlamydophila pneumoniae (a major cause of pneumonia) and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.

Several research also investigated the benefits of melatonin on cardiovascular diseases prevention and cure. Melatonin is a pineal gland secretion and it is shown to be able to lower total cholesterol, very-low-density and low-density lipoprotein cholesterol levels in the blood plasma of rats. Reduction of blood pressure is also observed when pharmacological doses are applied. Thus, it is deemed to be a plausible treatment for hypertension. However, further research needs to be conducted to investigate the side-effects, optimal dosage, etc. before it can be licensed for use.

References

External links

• Cardiovascular disease at DMOZ
• European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 冠動脈疾患および脳卒中の一次予防の概要 overview of primary prevention of coronary heart disease and stroke
• 2. 冠動脈疾患の疫学 epidemiology of coronary heart disease
• 3. 冠動脈疾患のスクリーニング screening for coronary heart disease
• 4. 高齢者の弁膜症 valvular heart disease in elderly adults
• 5. 幼児および小児における心疾患の疑い：紹介の基準 suspected heart disease in infants and children criteria for referral

English Journal

• A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP).

• Bernabeu-Wittel M, Baron-Franco B, Murcia-Zaragoza J, Fuertes-Martin A, Ramos-Cantos C, Fernandez-Moyano A, Galindo FJ, Ollero-Baturone M.SourceInternal Medicine Department, Hospital Universitario Virgen del Rocio, Avda Manuel Siurot, s/n, 41013 Sevilla, Spain.
• Archives of gerontology and geriatrics.Arch Gerontol Geriatr.2011 Nov-Dec;53(3):284-91. Epub 2011 Jan 7.
• Little is known about the main features of the emergent population of PP. Our objective was to determine the clinical, care and social characteristics of a multi-institutional population of PP, by means of a cross-sectional study including a reference population of hospital-based PP from 36 hospital
• PMID 21215467

• Anemia in Cardio-Renal Syndrome: clinical impact and pathophysiologic mechanisms.

• Palazzuoli A, Antonelli G, Nuti R.SourceDepartment of Internal Medicine and Metabolic Diseases, Cardiology Section, S Maria alle Scotte Hospital University of Siena, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy, palazzuoli2@unisi.it.
• Heart failure reviews.Heart Fail Rev.2011 Nov;16(6):603-7.
• Anemia is a disease that is often associated with heart failure (HF) and renal insufficiency (RI). This unfavorable triad of conditions has been called Cardio-Renal-Anemia Syndrome (CRS). The association of HF, RI, and anemia is poorly reported in multicenter clinical trials, so the pathophysiologic
• PMID 21336549

Japanese Journal

• マスター二階段試験の総括

• 冨田 公博,Tomita Kimihiro,冨田 公博,Tomita Kimihiro
• 法政大学体育・スポーツ研究センター紀要 29, 7-10, 2011-03-31
• … Master’s Two－Step Test is the method of finding the subclinical coronary heart disease that cannot be the found the abnormality in quiet electrocardiogram. … Nowadays in clinical medicine, Master’s Two－Step Test is used as a inspecting method of the heart function. … As main point which I want to present are the relation of the physical load and the heart function, the relation of the ageing and the heart function. …
• NAID 120003056564

• 栄養や生活習慣病の治療に関する社会通念上の常識とエビデンスについて(国の予算が破綻しない健康づくりに向けて)

• 永田 耕司
• 活水論文集. 健康生活学部編 54, 13-34, 2011-03-31
• … This time, it is in the examination whether common sense concerning such a nutritional therapy and the lifestyle disease treatment has established as a really clear evidence or the common sense is correct. … 3) It was clarified that the trans fatty acid improved the risk of the heart disease. …
• NAID 110008380250

Related Links

• Heart disease - Wikipedia, the free encyclopedia

Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. As of 2007, it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the ...

Related Pictures

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★リンクテーブル★

リンク元	「心臓血管疾患」「心疾患」「cardiac disease」「cardiopathy」
拡張検索	「arteriosclerotic heart disease」「congenital heart diseases with decreased pulmonary blood flow」「rheumatic heart disease」「coronary heart disease」
関連記事	「disease」「hearing」「hear」「heart」

「心臓血管疾患」

　　[★]

英

cardiovascular disease, CVD

同

心血管疾患、心臓血管病、心血管病

関

心疾患 heart disease

[show details]

心臓血管病 cardiovascular disease : 83 件
心血管病 cardiovascular disease : 約 2,840 件
心臓血管疾患 cardiovascular disease : 約 65,400 件
心血管疾患 cardiovascular disease : 18,300 件

心臓血管病 : 約 332,000 件
心血管病 : 約 54,500 件
心臓血管疾患 : 約 1,340,000 件
心血管疾患 : 約 256,000 件

心臓血管病 cardiovascular : 約 52,100 件
心血管病 cardiovascular : 約 8,450 件
心臓血管疾患 cardiovascular : 約 178,000 件
心血管疾患 cardiovascular : 約 34,000 件

「心疾患」

　　[★]

英

heart disease

関

心臓血管病 cardiovascular disease

心臓の異常を構成する要素

• 駆出分画(EF)
• 虚血
• 不整脈

「cardiac disease」

　　[★]

関

heart disease

関

Cardiovascular disease

関

heart disease

「cardiopathy」

　　[★]

• n.

• 心疾患

関

cardiac disease、heart disease

「arteriosclerotic heart disease」

　　[★]

同

AHD, 動脈硬化性心疾患

redirect 動脈硬化性心疾患

• (病名)動脈硬化性心疾患

「congenital heart diseases with decreased pulmonary blood flow」

　　[★] 肺血流減少性先天性心疾患

「rheumatic heart disease」

　　[★] リウマチ性心疾患 RHD

「coronary heart disease」

　　[★] 冠動脈心疾患, CHD

「disease」

　　[★]

• n.

疾患：illnessより厳密な概念。「ある臓器に明確な障害が確認され、それによって症状が出ているとはっきり説明できる場合」 (PSY.9)

特定の原因、病態生理、症状、経過、予後、病理組織所見が全てそろった場合 (PSY.9)

• something that is very wrong with people's attitudes, way of life or with society.

関

ail、ailment、disease entity、disorder、ill、illness、malady、sick、sickness

• 注意

disease ≠ illness ≠ disorder

　 　 　

「hearing」

　　[★]

• n。

• 聴力、聴覚。聞くこと、聴取。聞こえる距離/範囲。聞いてやること、傾聴。聞いてもらうこと、発言の機会。(委員会などの)聴聞会、ヒアリング。(法)審問、尋問。

　 　 　 　 　 　

「hear」

　　[★]

• v.

• 聞く、聞こえる

　 　 　 　

「heart」

　　[★] 心臓