Misplaced Pages

#667332

92-583: As the world's first multicountry epidemiological study, it systematically examined the relationships between lifestyle, diet, coronary heart disease and stroke in different populations from different regions of the world. It directed attention to the causes of coronary heart disease and stroke, but also showed that an individual’s risk can be changed. Writing in 1975, project officer Henry Blackburn identified two "strikingly polar attitudes", characterising them as persisting "academic" and "pragmatic" views with "much talk from each and little listening between." In

184-417: A coronary care unit for possible complications (such as cardiac arrhythmias – irregularities in the heart rate). Depending on the risk assessment, stress testing or angiography may be used to identify and treat coronary artery disease in patients who have had an NSTEMI or unstable angina. There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on

276-619: A healthy diet , regularly exercising , maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin ), beta blockers , or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease. In those with stable CAD it

368-401: A plant-based diet , focusing on unprocessed cereals , legumes , vegetables , and fruits . It also includes moderate consumption of fish , dairy products (mostly cheese and yogurt ), and a low amount of red meat . Olive oil has been studied as a potential health factor for reducing all-cause mortality and the risk of chronic diseases . The Mediterranean diet is associated with

460-483: A 2014 lifecycle analysis of greenhouse gas emissions , researchers found that a Mediterranean-like diet may reduce food production emissions below those of an omnivorous diet for 2050, with a per capita reduction of 30%. The concept of Mediterranean diet was first publicized in 1975 by the American biologist Ancel Keys and chemist Margaret Keys (a husband and wife team), but failed to gain widespread recognition until

552-470: A 2019 review indicated that the Mediterranean diet is a healthy dietary pattern that may reduce the risk of diabetes. A meta-analysis in 2008 found that strictly following the Mediterranean diet was correlated with a decreased risk of dying from cancer by 6%. Another 2014 review found that adherence to the Mediterranean diet was associated with a decreased risk of death from cancer. A 2017 review found

644-490: A Mediterranean diet could lead to reduced risk of cardiovascular diseases , overall cancer incidence, neurodegenerative diseases , diabetes , and early death . A 2018 review showed that practice of the Mediterranean diet may improve overall health status, such as reduced risk of non-infectious diseases, reduced total costs of living , and reduced costs for national healthcare . A 2016 review found similar weight loss as other diets. A 2019 Cochrane review found that there

736-656: A combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue. Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in

828-399: A decreased rate of cancer, although evidence was weak. An updated review in 2021 found that the Mediterranean diet is associated with a 13% lower risk of cancer mortality in the general population. Overweight adults who adopt Mediterranean diets may lose weight by consuming fewer calories. A 2019 review found that the Mediterranean diet may help obese people lower the quantity and improve

920-705: A few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack . Other complications include heart failure or an abnormal heartbeat . Risk factors include high blood pressure , smoking , diabetes , lack of exercise, obesity , high blood cholesterol , poor diet, depression , and excessive alcohol consumption. A number of tests may help with diagnosis including: electrocardiogram , cardiac stress testing , coronary computed tomographic angiography , biomarkers ( high-sensitivity cardiac troponins ) and coronary angiogram , among others. Ways to reduce CAD risk include eating

1012-405: A given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among males than females of a given age. The most common symptom is chest pain or discomfort that occurs regularly with activity, after eating, or at other predictable times; this phenomenon

SECTION 10

#1732852862668

1104-490: A heart attack or myocardial infarction, and immediate emergency medical services are crucial. With advanced disease, the narrowing of coronary arteries reduces the supply of oxygen-rich blood flowing to the heart, which becomes more pronounced during strenuous activities during which the heart beats faster and has an increased oxygen demand. For some, this causes severe symptoms, while others experience no symptoms at all. Symptoms in females can differ from those in males, and

1196-431: A myocardial infarction but does not change the overall risk of death. Aspirin therapy to prevent heart disease is thus recommended only in adults who are at increased risk for cardiovascular events, which may include postmenopausal females, males above 40, and younger people with risk factors for coronary heart disease, including high blood pressure , a family history of heart disease, or diabetes . The benefits outweigh

1288-504: A negative association with the risk of progressing from mild cognitive impairment to Alzheimer's, but acknowledged that only a small number of studies had been done on the topic. There is a correlation between adherence to the Mediterranean diet and a lower risk of depression. Studies on which these correlations are made are observational and do not prove cause and effect. As the Mediterranean diet usually includes products containing gluten , such as pasta and bread, increasing use of

1380-404: A neuropsychological assessment. There are a number of treatment options for coronary artery disease: It is recommended that blood pressure typically be reduced to less than 140/90 mmHg. The diastolic blood pressure however should not be lower than 60 mmHg. Beta-blockers are recommended first line for this use. In those with no previous history of heart disease, aspirin decreases the risk of

1472-511: A reduction in all-cause mortality in observational studies . A 2017 review provided evidence that the Mediterranean diet lowers the risk of heart disease and early death. The Mediterranean diet may help with weight loss in obese people . The Mediterranean diet is one of three healthy diets recommended in the 2015–2020 Dietary Guidelines for Americans , along with the DASH diet and vegetarian diet . A 2017 review found evidence that practice of

1564-427: A role. The diagnosis of CAD depends largely on the nature of the symptoms and imaging. The first investigation when CAD is suspected is an electrocardiogram (ECG/EKG), both for stable angina and acute coronary syndrome. An X-ray of the chest , blood tests and resting echocardiography may be performed. For stable symptomatic patients, several non-invasive tests can diagnose CAD depending on pre-assessment of

1656-558: A safe and feasible procedure that may offer some advantages over conventional CABG though it is more expensive. As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. This increased from 5.2 million deaths from CAD worldwide in 1990. It may affect individuals at any age but becomes dramatically more common at progressively older ages, with approximately a tripling with each decade of life. Males are affected more often than females. The World Health Organization reported that: "The world's biggest killer

1748-416: A significant role in stiffening the arteries and inducing the early phase of coronary arteriosclerosis . This can be seen in a so-called metastatic mechanism of calciphylaxis as it occurs in chronic kidney disease and hemodialysis . Although these people have kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into

1840-713: Is a highly significant predictor of the development of coronary heart disease, leading to excess rates of angina pectoris , myocardial infarction (MI) and coronary death, along with other studies about smoking, e.g., the Framingham Heart Study and the British Doctors Study . Initial results from the Seven Countries Study in North Karelia (Finland) prompted public pressure for the authorities to act to reduce historically high levels of chronic disease in

1932-570: Is another way of risk assessment. In one study the relative risk of incident coronary events was 91% higher among participants at high genetic risk than among those at low genetic risk. Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Prevention involves adequate physical exercise , decreasing obesity , treating high blood pressure , eating a healthy diet , decreasing cholesterol levels, and stopping smoking . Medications and exercise are roughly equally effective. High levels of physical activity reduce

SECTION 20

#1732852862668

2024-410: Is available. In the absence of ST-segment elevation, heart damage is detected by cardiac markers (blood tests that identify heart muscle damage). If there is evidence of damage ( infarction ), the chest pain is attributed to a "non-ST elevation MI" (NSTEMI). If there is no evidence of damage, the term "unstable angina" is used. This process usually necessitates hospital admission and close observation on

2116-507: Is called a myocardial infarction (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arteries can induce transient ischemia which leads to the induction of a ventricular arrhythmia , which may terminate into a dangerous heart rhythm known as ventricular fibrillation , which often leads to death. Typically, coronary artery disease occurs when part of

2208-503: Is characterized by heart problems that result from atherosclerosis. Atherosclerosis is a type of arteriosclerosis which is the "chronic inflammation of the arteries which causes them to harden and accumulate cholesterol plaques (atheromatous plaques) on the artery walls". CAD has several well-determined risk factors that contribute to atherosclerosis. These risk factors for CAD include "smoking, diabetes, high blood pressure (hypertension), abnormal (high) amounts of cholesterol and other fat in

2300-415: Is found in cardiac muscle; it is a 'cytolinker' that connects actin and desmin to facilitate cytoskeletal function and vesicular movement. The endocytic pathway is further modulated by changes in tubulin , a key microtubule protein, and fidgetin , a tubulin-severing enzyme that is a marker for cardiovascular risk identified by genome-wide association study . Protein recycling would be modulated by changes in

2392-491: Is inferior to non-invasive imaging methods due to the risk of false negative and false positive test results. The use of non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease. Invasive testing with coronary angiography (ICA) can be used when non-invasive testing is inconclusive or show a high event risk. The diagnosis of microvascular angina (previously known as cardiac syndrome X –

2484-453: Is ischemic heart disease, responsible for 13% of the world's total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7 million to 9.1 million deaths in 2021." It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to

2576-687: Is linked to an increased risk of coronary disease. The consumption of different types of fats including trans fat (trans unsaturated), and saturated fat , in a diet "influences the level of cholesterol that is present in the bloodstream". Unsaturated fats originate from plant sources (such as oils). There are two types of unsaturated fats, cis and trans isomers. Cis unsaturated fats are bent in molecular structure and trans are linear in structure. Saturated fats originate from animal sources (such as animal fats) and are also molecularly linear in structure. The linear configurations of unsaturated trans and saturated fats allow them to easily accumulate and stack at

2668-525: Is low in saturated fat with high amounts of monounsaturated fat and dietary fiber . One possible factor is the potential health effects of olive oil in the Mediterranean diet. Olive oil contains monounsaturated fats, most notably oleic acid , which is under clinical research for its potential health benefits. The European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies approved health claims on olive oil, for protection by its polyphenols against oxidation of blood lipids and for

2760-465: Is more effective than hemoglobin A1c (HbA1c) for detecting dysglycemia in patients with coronary artery disease. The study highlighted that 2-hour post-load glucose levels of at least 9 mmol/L were strong predictors of cardiovascular outcomes, while HbA1c levels of at least 5.9% were also significant but not independently associated when combined with OGTT results. A diet high in fruits and vegetables decreases

2852-489: Is most commonly used to provide rapid relief for acute angina attacks and as a complement to anti-anginal treatments in patients with refractory and recurrent angina. When nitroglycerine enters the bloodstream, it forms free radical nitric oxide, or NO, which activates guanylate cyclase and in turn stimulates the release of cyclic GMP. This molecular signaling stimulates smooth muscle relaxation, ultimately resulting in vasodilation and consequently improved blood flow to regions of

Seven Countries Study - Misplaced Pages Continue

2944-533: Is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction. Antibiotics for secondary prevention of coronary heart disease Early studies suggested that antibiotics might help patients with coronary disease to reduce the risk of heart attacks and strokes. However, a 2021 Cochrane meta-analysis found that antibiotics given for secondary prevention of coronary heart disease are harmful for people with increased mortality and occurrence of stroke. So,

3036-808: Is not the staple fat in the cuisines of all countries which border the Mediterranean: in northern and central Italy, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables; in both North Africa and the Middle East , sheep's tail fat and rendered butter ( samna ) are traditional staple fats. Consuming a Mediterranean diet or plant-based diet may contribute to improving environmental and agricultural sustainability , possibly due to lower use of dairy products, ruminant meat , and ultra-processed foods . The environmental impact and amount of energy needed to feed livestock exceeds its nutritional value. In

3128-626: Is preventing further sequelae of already established disease. Effective lifestyle changes include: Aerobic exercise , like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease. Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol. Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force found "insufficient evidence" to recommend that doctors counsel patients on exercise but "it did not review

3220-410: Is still uncertainty regarding the effects of Mediterranean‐style diet advice on cardiovascular disease occurrence and risk factors in people both with and without existing cardiovascular disease. The US 2015–2020 national guidelines devised a "Healthy Mediterranean-Style Eating Pattern", assessed against and mirroring the Mediterranean diet patterns and its positive health outcomes. It was designed from

3312-541: Is termed stable angina and is associated with narrowing of the arteries of the heart . Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing. Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction . In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease. Angina, shortness of breath, sweating, nausea or vomiting, and lightheadedness are signs of

3404-434: Is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk. In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries . The number of cases of CAD for

3496-561: The French paradox . By 2011, the Mediterranean diet was included by some authors as a fad diet promoted for losing weight. Since about 2016, the American Heart Association and American Diabetes Association have recommended the Mediterranean diet as a healthy dietary pattern that may reduce the risk of cardiovascular diseases and type 2 diabetes , respectively. The United Kingdom 's National Health Service also recommends

3588-530: The Harvard University School of Public Health since the mid-1990s. The Mediterranean diet is based on a paradox: although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries such as the United States where similar levels of fat consumption are found. A parallel phenomenon is known as

3680-562: The Mediterranean Basin : These proportions are sometimes represented in the Mediterranean Diet Pyramid . In a diet with roughly this composition, the fat content accounts for 25% to 35% of the total intake of calories , while the amount of saturated fat is, at most, 8% of the calorie content. Some cuisines of the Mediterranean region are not fully consistent with Mediterranean diet guidelines. For instance, olive oil

3772-659: The mortality rate after a coronary heart disease event or stroke was associated with the level of hypertension. In several cohorts of the study, stroke deaths exceeded deaths from coronary heart disease. It hinted that differences in overall mortality between the different regions of the seven countries are largely associated with variation in cardiovascular mortality. Coronary deaths in the United States and Northern Europe greatly exceeded those in Southern Europe, even when controlled for age, cholesterol, blood pressure, smoking, physical activity, and weight. The Seven Countries Study

Seven Countries Study - Misplaced Pages Continue

3864-818: The "Healthy U.S.-Style Eating Pattern", but it contains more fruits and seafood, and less dairy. In the 2020s, research on the Mediterranean diet indicates that a Mediterranean diet may contribute to health. The Mediterranean diet is included among dietary patterns that may reduce the risk of cardiovascular diseases. A 2013 Cochrane review found limited evidence that a Mediterranean diet favorably affects cardiovascular risk factors . A 2013 meta-analysis compared Mediterranean, vegan , vegetarian, low-glycemic index, low-carbohydrate, high-fiber , and high-protein diets with control diets. The research concluded that Mediterranean, low-carbohydrate , low-glycemic index , and high-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes, while there

3956-507: The 1940s, a University of Minnesota researcher, Ancel Keys , postulated that the apparent epidemic of heart attacks in middle-aged American men was related to their mode of life and possibly modifiable physical characteristics. He first explored this idea in a group of Minnesota business and professional men (executives aged 45 to 55) that he recruited into a prospective study in 1947, the first of many cohort studies eventually mounted internationally. The U.S. Public Health Service agreed to fund

4048-519: The 1990s. Objective data showing that the Mediterranean diet is healthy originated from results of epidemiological studies in Calabria , Naples and Madrid , confirmed later by the Seven Countries Study first published in 1970, and a book-length report in 1980. The most commonly understood version of the Mediterranean diet was presented by, among others, Walter Willett and colleagues of

4140-446: The Mediterranean diet as a healthy dietary pattern that may reduce the risk of cardiovascular diseases . A 2023 review found evidence for a reduction of mortality and cardiovascular disease risk in women on a Mediterranean-type diet. In 2014, two meta-analyses found that the Mediterranean diet was associated with a decreased risk of type 2 diabetes , findings similar to those of a 2017 review. The American Diabetes Association and

4232-626: The Mediterranean region. The Seven Countries Study, along with other studies, e.g., the Framingham Heart Study and the Nurses' Health Study , showed the importance of overweight , obesity and regular exercise as health issues. It showed a correlation between good cardiovascular health and dementia in the general population. It also showed that cardiovascular risk factors in mid life are significantly associated with increased risk of dementia death later in life. It indicated that cigarette smoking

4324-505: The US, with 75% and highest in one of the Japanese cohorts, with 100%. The study has continued for more than 50 years. The Seven Countries Study suggested that the risk and rates of heart attack and stroke (CVR), both at the population level and at the individual level, correlated directly and independently to the level of total serum cholesterol, in seven sampled out countries. It demonstrated that

4416-413: The arterial walls when consumed in high amounts (and other positive measures towards physical health are not met). High levels of cholesterol in the bloodstream lead to atherosclerosis. With increased levels of LDL in the bloodstream, "LDL particles will form deposits and accumulate within the arterial walls, which will lead to the development of plaques, restricting blood flow". The resultant reduction in

4508-543: The blood (dyslipidemia), type 2 diabetes and being overweight or obese (having excess body fat)" due to lack of exercise and a poor diet. Some other risk factors include high blood pressure , smoking , diabetes , lack of exercise, obesity , high blood cholesterol , poor diet, depression , family history , psychological stress and excessive alcohol . About half of cases are linked to genetics. Smoking and obesity are associated with about 36% and 20% of cases, respectively. Smoking just one cigarette per day about doubles

4600-573: The bone morphogenic proteins are members of the TGF-beta superfamily, and likewise impact Treg differentiation. Several of the transcripts ( TMEM98 , NRCAM , SFRP5 , SHISA2 ) are elements of the Wnt signaling pathway, which is a major determinant of Treg differentiation. Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the heart's muscle cells . The heart's muscle cells may die from lack of oxygen and this

4692-473: The channel of an artery, causing partial obstruction to blood flow. People with coronary artery disease might have just one or two plaques or might have dozens distributed throughout their coronary arteries . A more severe form is chronic total occlusion (CTO) when a coronary artery is completely obstructed for more than 3 months. Microvascular angina is a type of angina pectoris in which chest pain and chest discomfort occur without signs of blockages in

SECTION 50

#1732852862668

4784-510: The circulating immune system would be related to the immune synapse . One of the most differentially expressed genes, fibromodulin (FMOD), which is increased 2.8-fold in CAD, is found mainly in connective tissue and is a modulator of the TGF-beta signaling pathway. However, not all of the RNA changes may be related to the immune synapse. For example, Nebulette , the most down-regulated transcript (2.4-fold),

4876-493: The contribution to the maintenance of normal blood LDL-cholesterol levels by replacing saturated fats in the diet with oleic acid (Commission Regulation (EU) 432/2012 of 16 May 2012). A 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events and stroke, while monounsaturated fatty acids of mixed animal and plant origin showed no significant effects. The American Heart Association discussed

4968-440: The correlation between blood cholesterol level and coronary heart disease (CHD) risk from 5 to 40 years follow-up is found consistently across different specially selected cultures in these seven countries. Cholesterol and obesity correlated with increased mortality from cancer. The Seven Countries Study suggested that elevated blood pressure ( hypertension ) was correlated with risk of coronary heart disease and stroke. It showed that

5060-409: The diameter of their blood vessels, leading to decreased progression of atherosclerosis. In contrast, females who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression. Having a type A behavior pattern , a group of personality characteristics including time urgency, competitiveness, hostility, and impatience,

5152-413: The diet may have contributed to the growing rate of gluten-related disorders . There are variations of the "Mediterranean diets" in different countries and among the individual populations of the Mediterranean basin, due to ethnic, cultural, economic and religious diversities. The "Mediterranean diet" as defined by dietitians generally includes the following components, which are not typical of diets in

5244-469: The different variables above. A notable example is Framingham Score , used in the Framingham Heart Study . It is mainly based on age, gender, diabetes, total cholesterol, HDL cholesterol, tobacco smoking, and systolic blood pressure. When predicting risk in younger adults (18–39 years old), the Framingham Risk Score remains below 10–12% for all deciles of baseline-predicted risk. Polygenic score

5336-426: The evidence for possible prevention of cardiovascular disease by the diet was "limited and highly variable". Reviews in 2016-17 reached similar conclusions about the ability of a Mediterranean diet to improve cardiovascular risk factors, such as lowering the risk for hypertension and other cardiovascular diseases. A Mediterranean diet is recommended as a means of lowering Apolipoprotein B . The Mediterranean diet

5428-421: The evidence for the effectiveness of physical activity to reduce chronic disease, morbidity, and mortality", only the effectiveness of counseling itself. The American Heart Association , based on a non-systematic review, recommends that doctors counsel patients on exercise. Psychological symptoms are common in people with CHD, and while many psychological treatments may be offered following cardiac events, there

5520-793: The evidence is weak. Specifically, its use does not change the risk of death in this group. In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death. Revascularization for acute coronary syndrome has a mortality benefit. Percutaneous revascularization for stable ischaemic heart disease does not appear to have benefits over medical therapy alone. In those with disease in more than one artery, coronary artery bypass grafts appear better than percutaneous coronary interventions . Newer "anaortic" or no-touch off-pump coronary artery revascularization techniques have shown reduced postoperative stroke rates comparable to percutaneous coronary intervention. Hybrid coronary revascularization has also been shown to be

5612-430: The future, and one in three healthy 40-year-old females. It is the most common reason for death of males and females over 20 years of age in the United States. Mediterranean diet The Mediterranean diet is a concept first invented in 1975 by the American biologist Ancel Keys and chemist Margaret Keys. The diet took inspiration from the supposed eating habits and traditional food typical of Crete, much of

SECTION 60

#1732852862668

5704-436: The harms most favorably in people at high risk for a cardiovascular event, where high risk is defined as at least a 3% chance over a five-year period, but others with lower risk may still find the potential benefits worth the associated risks. Clopidogrel plus aspirin (dual anti-platelet therapy) reduces cardiovascular events more than aspirin alone in those with a STEMI . In others at high risk but not having an acute event,

5796-450: The heart affected by atherosclerotic plaque. Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD). A 2015 monograph explains that "Regardless of the nomenclature, stable angina is the chief manifestation of SIHD or SCAD." There are U.S. and European clinical practice guidelines for SIHD/SCAD. In patients with non-severe asymptomatic aortic valve stenosis and no overt coronary artery disease,

5888-466: The heart muscle). Diagnosis is clear-cut if ECGs show elevation of the " ST segment ", which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI); this is termed a STEMI (ST-elevation MI) and is treated as an emergency with either urgent coronary angiography and percutaneous coronary intervention (angioplasty with or without stent insertion) or with thrombolysis ("clot buster" medication), whichever

5980-428: The heart muscle). If part of the heart seems to receive an insufficient blood supply, coronary angiography may be used to identify stenosis of the coronary arteries and suitability for angioplasty or bypass surgery . In minor to moderate cases, nitroglycerine may be used to alleviate acute symptoms of stable angina or may be used immediately before exertion to prevent the onset of angina. Sublingual nitroglycerine

6072-783: The heart's blood supply due to atherosclerosis in coronary arteries "causes shortness of breath, angina pectoris (chest pains that are usually relieved by rest), and potentially fatal heart attacks (myocardial infarctions)". The heritability of coronary artery disease has been estimated between 40% and 60%. Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease. Several RNA Transcripts associated with CAD - FoxP1 , ICOSLG , IKZF4/Eos , SMYD3 , TRIM28 , and TCF3/E2A are likely markers of regulatory T cells (Tregs), consistent with known reductions in Tregs in CAD. The RNA changes are mostly related to ciliary and endocytic transcripts, which in

6164-512: The immune synapse, there were numerous transcripts that related directly to T cell function and the control of differentiation. Butyrophilin is a co-regulator for T cell activation. Fibromodulin is a modulator of the TGF-beta signaling pathway, a primary determinant of Tre differentiation. Further impact on the TGF-beta pathway is reflected in concurrent changes in the BMP receptor 1B RNA (BMPR1B), because

6256-428: The increased troponin T (above 14 pg/mL) was found associated with an increased 5-year event rate of ischemic cardiac events ( myocardial infarction , percutaneous coronary intervention , or coronary artery bypass surgery ). Diagnosis of acute coronary syndrome generally takes place in the emergency department , where ECGs may be performed sequentially to identify "evolving changes" (indicating ongoing damage to

6348-404: The larger coronary arteries of their hearts when an angiogram (coronary angiogram) is being performed. The exact cause of microvascular angina is unknown. Explanations include microvascular dysfunction or epicardial atherosclerosis. For reasons that are not well understood, females are more likely than males to have it; however, hormones and other risk factors unique to females may play

6440-633: The most common symptom reported by females of all races is shortness of breath. Other symptoms more commonly reported by females than males are extreme fatigue, sleep disturbances, indigestion, and anxiety. However, some females experience irregular heartbeat, dizziness, sweating, and nausea. Burning, pain, or pressure in the chest or upper abdomen that can travel to the arm or jaw can also be experienced in females, but females less commonly report it than males. Generally, females experience symptoms 10 years later than males. Females are less likely to recognize symptoms and seek treatment. Coronary artery disease

6532-412: The myocardium. Stable angina is short-term chest pain during physical exertion caused by an imbalance between myocardial oxygen supply and metabolic oxygen demand. Various forms of cardiac stress tests may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), echocardiography (using ultrasound of the heart) or scintigraphy (using uptake of radionuclide by

6624-515: The nutritional quality of food intake, with an overall effect of possibly losing body weight. A 2016 systematic review found a relation between greater adherence to a Mediterranean diet and better cognitive performance; it is unclear if the relationship is causal. According to a 2013 systematic review, greater adherence to a Mediterranean diet is correlated with a lower risk of Alzheimer's disease and slower cognitive decline. Another 2013 systematic review reached similar conclusions, and also found

6716-465: The population moved around frequently. In the mid-1950s, with improved methods and design, Keys recruited collaborating researchers in seven countries to mount the first cross-cultural comparison of heart attack risk in populations of men engaged in traditional occupations in cultures contrasting in diet, especially in the proportion of fat calories of different composition, the Seven Countries Study still under observation today. The Seven Countries Study

6808-416: The proteasomal regulator SIAH3 , and the ubiquitin ligase MARCHF10 . On the ciliary aspect of the immune synapse, several of the modulated transcripts are related to ciliary length and function. Stereocilin is a partner to mesothelin , a related super-helical protein, whose transcript is also modulated in CAD. DCDC2 , a double-cortin protein, is a modulator of ciliary length. In the signaling pathways of

6900-466: The rare coronary artery disease that is more common in females, as mentioned, is a diagnosis of exclusion. Therefore, usually, the same tests are used as in any person suspected of having coronary artery disease: Stable angina is the most common manifestation of ischemic heart disease, and is associated with reduced quality of life and increased mortality. It is caused by epicardial coronary stenosis which results in reduced blood flow and oxygen supply to

6992-547: The reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the arteries of the heart . It is the most common of the cardiovascular diseases . CAD can cause stable angina , unstable angina , myocardial ischemia, and myocardial infarction . A common symptom is angina, which is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn . In stable angina , symptoms occur with exercise or emotional stress , last less than

7084-475: The region. The results influenced a subsequent public health program, the North Karelia Project , which ran from 1972 until 1997, and which had among its aims a reduction in levels of peoples' saturated fat intake. Coronary heart disease Coronary artery disease ( CAD ), also called coronary heart disease ( CHD ), or ischemic heart disease ( IHD ), is a type of heart disease involving

7176-469: The rest of Greece, and southern Italy, and formulated in the early 1960s. It is distinct from Mediterranean cuisine , which covers the actual cuisines of the Mediterranean countries, and from the Atlantic diet of northwestern Spain and Portugal. While inspired by a specific time and place, the "Mediterranean diet" was later refined based on the results of multiple scientific studies. This approach emphasizes

7268-460: The risk of CAD. Lack of exercise has been linked to 7–12% of cases. Exposure to the herbicide Agent Orange may increase risk. Rheumatologic diseases such as rheumatoid arthritis , systemic lupus erythematosus , psoriasis , and psoriatic arthritis are independent risk factors as well. Job stress appears to play a minor role accounting for about 3% of cases. In one study, females who were free of stress from work life saw an increase in

7360-486: The risk of cardiovascular disease and death. Vegetarians have a lower risk of heart disease, possibly due to their greater consumption of fruits and vegetables. Evidence also suggests that the Mediterranean diet and a high fiber diet lower the risk. The consumption of trans fat (commonly found in hydrogenated products such as margarine ) has been shown to cause a precursor to atherosclerosis and increase

7452-541: The risk of coronary artery disease by about 25%. Life's Essential 8 are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association. AHA added sleep as a factor influencing heart health in 2022. Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counseling and education to bring about behavioral change might help in high-risk groups. However, there

7544-410: The risk of coronary artery disease. Evidence does not support a beneficial role for omega-3 fatty acid supplementation in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death ). There is tentative evidence that intake of menaquinone ( Vitamin K 2 ), but not phylloquinone ( Vitamin K 1 ), may reduce the risk of CAD mortality . Secondary prevention

7636-492: The risk profile. Noninvasive imaging options include; Computed tomography angiography (CTA) (anatomical imaging, best test in patients with low-risk profile to "rule out" the disease), positron emission tomography (PET), single-photon emission computed tomography (SPECT)/nuclear stress test/myocardial scintigraphy and stress echocardiography (the three latter can be summarized as functional noninvasive methods and are typically better to "rule in"). Exercise ECG or stress test

7728-602: The slowly changing habits of a population in the Mediterranean region, from a healthy, active lifestyle and diet, to a less active lifestyle and a diet influenced by the Western pattern diet , significantly correlated with increased risk of heart disease. Meanwhile, it has been confirmed by other researchers that there is an inverse association between adherence to the Mediterranean Diet and the incidence of fatal and non- fatal heart disease in initially healthy middle-aged adults in

7820-414: The smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis . With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory cells – to form a plaque . Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play

7912-720: The study (and then set up and proceeded to fund the Framingham Heart Study on a larger scale). The Minnesota men were followed through 1981 and the first major report appeared in 1963 after the fifteen-year follow-up study. The study contributed much to survey methods and confirmed larger studies that reported earlier on the predictive value for heart attack of several characteristics, the now-traditional risk factors of blood pressure and blood cholesterol level and cigarette smoking . Keys traveled widely with his wife Margaret who tested people's serum cholesterol. They sent their samples back to Minnesota for analysis. In 1952, Keys's hypothesis that coronary heart disease could be related to diet

8004-406: The use of antibiotics is not currently supported for preventing secondary coronary heart disease. A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females. Consequently, since research is showing that cardiovascular diseases, like CHD, can play a role as a precursor for dementia, like Alzheimer's disease, individuals with CHD should have

8096-677: Was first published in Voeding in The Netherlands. His work in post-wartime Naples led him to seek organization and funding for studies of different populations, as did his subsequent work in Uganda ; Cape Town , South Africa; Sardinia ; Bologna ; and Ilomantsi , Finland; and with Japanese men living in Hawaii and in Japan . He decided to concentrate on men living in villages , rather than those in cities where

8188-989: Was formally started in fall 1958 in Yugoslavia . In total, 12,763 males, 40–59 years of age, were enrolled as 16 cohorts, in seven countries, in four regions of the world (United States, Northern Europe, Southern Europe, Japan). One cohort is in the United States, two cohorts in Finland, one in the Netherlands, three in Italy, five in Yugoslavia (two in Croatia , and three in Serbia ), two in Greece, and two in Japan. The entry examinations were performed between 1958 and 1964 with an average participation rate of 90%, lowest in

8280-492: Was insufficient evidence to show an effect on mortality or actual cardiovascular events. In diabetes mellitus , there is little evidence that very tight blood sugar control improves cardiac risk although improved sugar control appears to decrease other problems such as kidney failure and blindness . A 2024 study published in The Lancet Diabetes & Endocrinology found that the oral glucose tolerance test (OGTT)

8372-651: Was investigated further in regard to an eating pattern loosely characterized as the Mediterranean Diet . What exactly is meant by "Mediterranean Diet" today, was detailed by Antonia Trichopoulou (wife of Dimitrios Trichopoulos ), and Anna Ferro-Luzzi. The diet was publicized and popularized by Greg Drescher of the Oldways Preservation and Exchange Trust and by Walter Willett of the Harvard School of Public Health . The Seven Countries Study also showed that

8464-402: Was limited evidence for an effect of vegetarian diets on glycemic control and lipid levels unrelated to weight loss. However, more cautious reviews arose in early 2016, raising concerns about the quality of previous systematic reviews examining the impact of a Mediterranean diet on cardiovascular risk factors. These reviews insisted upon the need for further standardized research, stating that

#667332