Cardiovascular Diseases

 What we know
 Incidence
 Environmental risk factors
 Costs

What we know

Cardiovascular diseases (CVD) affect the heart and the surrounding blood vessels. This group of diseases can take many forms: high blood pressure (hypertension), coronary artery (or heart) disease, congenital heart disease, valvular heart disease, stroke (cerebrovascular disease), rheumatic heart disease and heart failure. CVD can be caused by birth defects; abnormalities in the heart muscle; the conduction system that transmits electrical impulses that regulate heartbeat; and a build-up of fatty deposits (lipids), fibrous elements and inflammatory cells that narrow and harden blood vessels, known as atherosclerosis.

Incidence

In 2005, an estimated 17.5 million deaths were due to CVD, representing nearly 30% of all global deaths, Figure 1 [1]. Nearly half of all deaths (49%) in Europe and in the EU (42%) are due to CVD. In fact CVD causes 4.35 million deaths, 1.9 million of which are in the European Union (EU). It represents 23% of European disease burden [2].

Figure 1 Cardiovascular Diseases, World Health Organization (WHO) Enlarge the picture

The causes of CVD are multiple and include the following risk factors: a family history of diseases, high blood pressure, elevated blood cholesterol, obesity and type 2 diabetes, smoking, unhealthy dietary habits, excessive alcohol consumption, a sedentary lifestyle, psycho-social stress and exposure to environmental pollutants [3].

Environmental risk factors

Although the effects of genetic traits and environmental factors cannot be entirely disentangled, lifestyle factors such as smoking, exposure to second hand smoke (SHS), diet and a sedentary lifestyle, the latter of which result from an environment that restricts mobility and stimulates high consumption of saturated fats, salt and refined carbohydrates, are considered key determinants of cardiovascular disease [4].

Besides these, recent research also implicates direct exposures to air pollutants, chemicals and pesticides. Particulate matter (PM), a mixture of solid particles and liquid droplets suspended in the air, is one of the primary environmental agents associated with the disease [5]. Carbon monoxide is another suspected cause [6]. Both result from, amongst other things, vehicle and power generation emissions.

Heavy metals such as arsenic, lead, mercury, cadmium, and cobalt are also suspected of having a link to CVD. Other risk factors are industrial chemicals such as benzene, chloroform, heptane, toluene and fluorocarbons [7].

When discussing environmental risk factors, risk correlates for CVD must also be considered. These influence major risk factors, such as hypertension, cholesterol, or diabetes, rather than contributing to the absolute risk of heart disease. For example, research suggests that obesity may in some cases be linked to exposures to chemicals that mimic estrogens (xenoestrogens). Obesity is in turn a risk factor for CVD. These chemicals therefore represent and indirect cause of atherosclerosis.

Costs

Although the availability of quality data varies from across countries, it is estimated that total CVD costs amount to Euros 169 billion. Of this, €64 billion are due to lost productivity and the cost of informal care, and €105 billion are for treating CVD in the EU [8].

The rise in CVD reflects the effect of industrialisation, urbanisation and economic development on our environment, dietary habits, physical activity and tobacco consumption levels.

Most CVD cases are preventable through healthier lifestyles. However, a mounting body of evidence suggests that recent increases in CVD are also attributable to cumulative, transgenerational exposures resulting from living in artificial and harmful environments. Broad health protection policies aimed at reducing the risk of CVD therefore need to include preventive measures that address both lifestyle and environmental risk factors. Lastly, a reduction in CVD risk factors will not only lead to a reduction in CVD but also in other non-communicable diseases that share similar risk factors, such as cancer, lung disease, diabetes, kidney disease and liver disease.