Misplaced Pages

This is an old revision of this page, as edited by 79.182.231.224 (talk) at 18:24, 20 July 2012 (jhm649 edits are bad for wikipedia. Go doctor something else.). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Cardiovascular disease
Specialty	Cardiology

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries and veins). 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/or hypertension are the most common.

Cardiovascular diseases remain the biggest cause of deaths worldwide, though over the last two decades, cardiovascular mortality rates have declined in many high-income countries. At the same time cardiovascular deaths and disease have increased at an astonishingly fast rate in low- and middle-income countries. Although cardiovascular disease usually affects older adults, the antecedants 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, such as healthy eating, exercise, and avoidance of smoking.

Types

• Coronary heart disease (also ischaemic heart disease or coronary artery disease)

• Cardiomyopathy - diseases of cardiac muscle

• Hypertensive heart disease - diseases of the heart secondary to high blood pressure

• Heart failure

• Cor pulmonale - a failure of the right side of the heart

• 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

• Stroke and cerebrovascular disease

• Peripheral arterial disease

Risk factors

Almost all cardiovascular disease in a population can be explained in terms of a limited number of risk factors: age, gender, high blood pressure, high serum cholesterol levels, tobacco smoking, excessive alcohol consumption, family history, obesity, lack of physical activity, psychosocial factors, diabetes mellitus, 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 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, drug treatment or social change.

Age

Age is an important risk factor in developing cardiovascular diseases. It is estimated that 87 percent of people who die of coronary heart disease are 60 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 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.

Gender

Men are at greater risk of heart disease than pre-menopausal women. However, once past menopause, a woman’s risk is similar to a man’s.

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, gender 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 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 have been studied for their 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/m 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/m of PM_2.5 resulted in a 48% increase of CVD mortality risk. Additionally, 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/m 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

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

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 which may reflect a higher risk of cardiovascular disease include:

• 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 blood levels of brain natriuretic peptide (also known as B-type) (BNP)

Prevention

Measures to prevent cardiovascular disease may include:

• a low fat high fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)
• a diet high in vegetables and fruit
• tobacco cessation and avoidance of second-hand smoke;
• limit alcohol consumption to the recommended daily limits;
• lower blood pressures, if elevated, through the use of antihypertensive medications;
• decrease body fat (BMI) if overweight or obese;
• increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;
• decrease psychosocial stress.
• Consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30% However excessive alcohol intake increases the risk of cardiovascular disease.

Diet

Evidence shows that the Mediterranean diet improves cardiovascular outcomes. In clinical trials the Dietary Approaches to Stop Hypertension (DASH) diet has also 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.

The link between saturated fat intake and cardiovascular disease is controversial (see Saturated fat and cardiovascular disease controversy). Dietary substitution of polyunsaturated fats for saturated fats may reduce risk, substitution with refined carbohydrates does not change or may increase risk. Increased dietary intake of Trans fatty acids significantly increases the risk of cardiovascular disease.

Supplements

As of 2010 vitamins have not been found to be effective at preventing cardiovascular disease. Evidence to support omega-3 fatty acid supplementation is equally poor.

Medication

Aspirin has not 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 those with a history of cardiovascular disease. A decrease risk of death however seems to only occur in men.

Management

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions. Medication may also be useful for prevention.

Epidemiology

According to the World Health Organization, chronic diseases are responsible for 63% of all deaths in the world, with cardiovascular disease as the leading cause of death.

Research

The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in 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 trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease. These studies include those conducted by the Ryan Mackey Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular Health. Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with healthier menu options.

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 at risk for cardiovascular disease. Also osteoprotegerin which 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 possible links between infection with Chlamydophila pneumoniae and coronary artery disease. The Chlamydia link has become less plausible with the absence of improvement after antibiotic use.

References

1. Maton, Anthea (1993). Human Biology and Health. Englewood Cliffs, New Jersey: Prentice Hall. ISBN 0-13-981176-1. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
2. ^ Bridget B. Kelly; Institute of Medicine; Fuster, Valentin (2010). Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington, D.C: National Academies Press. ISBN 0-309-14774-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
3. Mendis, S.; Puska, P.; Norrving, B.(editors) (2011), Global Atlas on cardiovascular disease prevention and control, ISBN 978-92-4-156437-3 {{citation}}: |first3= has generic name (help)
4. McGill HC, McMahan CA, Gidding SS (2008). "Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study". Circulation. 117 (9): 1216–27. doi:10.1161/CIRCULATIONAHA.107.717033. PMID 18316498. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
5. "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov. 11, 2009. {{cite web}}: Check date values in: |accessdate= (help)
6. Yusuf S, Hawken S, Ounpuu S; et al. (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". Lancet. 364 (9438): 937–52. doi:10.1016/S0140-6736(04)17018-9. PMID 15364185. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
7. "Understand Your Risk of Heart Attack". American Heart Association.http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeartAttack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp#
8. Mackay, Mensah, Mendis, et al. The Atlas of Heart Disease and Stroke. World Health Organization. January 2004.
9. ^ Jousilahti Vartiainen, Tuomilehto Puska (1999). "Sex, Age,Cardiovascular Risk Factors, and coronary heart diease". Circulation. 99: 1165–1172.
10. Jani B, Rajkumar C (2006). "Ageing and vascular ageing". Postgrad Med J. 82: 357–362.
11. ^ http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors
12. Jackson R, Chambles L, Higgins M, Kuulasmaa K, Wijnberg L, Williams D (WHO MONICA Project, and ARIC Study.) Sex difference in ischaemic heart disease mortality and risk factors in 46 communities: an ecologic analysis. Cardiovasc Risk Factors. 1999; 7:43-54.
13. National Heart Lung and Blood Institute. "What are the risk factors for heart disease?"
14. Jani B, Rajkumar C (2006). "Ageing and vascular ageing". Postgrad Med J. 82: 357–362.
15. Jani B, Rajkumar C (2006). "Ageing and vascular ageing". Postgrad Med J. 82: 357–362.
16. Jani B, Rajkumar C (2006). "Ageing and vascular ageing". Postgrad Med J. 82: 357–362.
17. ^ Khallaf, Mohamed (2011). The Impact of Air Pollution on Health, Economy, Environment and Agricultural Sources. InTech. pp. 69–92. ISBN 978-953-307-528-0. {{cite book}}: More than one of |author= and |last= specified (help)
18. ^ Franchini M, Mannucci PM (2012). "Air pollution and cardiovascular disease". Thrombosis Research. 129 (3): 230–4. doi:10.1016/j.thromres.2011.10.030. PMID 22113148..
19. ^ "Cardiovascular Effects of Ambient Particulate Air Pollution Exposure". Circulation. 121 (25): 2755–65. 2010. doi:10.1161/CIRCULATIONAHA.109.893461. PMC 2924678. PMID 20585020.
20. Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA (2006). "Awareness, knowledge, and perception of heart disease among adolescents". Eur J Cardiovasc Prev Rehabil. 13 (5): 718–23. doi:10.1097/01.hjr.0000214611.91490.5e. PMID 17001210. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
21. Highlander P, Shaw GP (2010). "Current pharmacotherapeutic concepts for the treatment of cardiovascular disease in diabetics". Ther Adv Cardiovasc Dis. 4: 43–54.
22. NPS Medicinewise (1 March 2011). "NPS Prescribing Practice Review 53: Managing lipids". Retrieved 1 August 2011.
23. Kvan E., Pettersen K.I., Sandvik L., Reikvam A. (2007). "High mortality in diabetic patient with acute myocardial infarction: cardiovascular co-morbidities contribute most to the high risk". Int J Cardiol. 121: 184–188.{{cite journal}}: CS1 maint: multiple names: authors list (link)
24. Norhammar A., Malmberg K., Diderhol E., Lagerqvist B., Lindahl B., Ryde; et al. (2004). "Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J". Am Coll Cardiol. 43: 585–591. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
25. DECODE , European Diabetes Epidemiology Group (1999). "Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria". Lancet. 354: 617–621. doi:10.1016/S0140-6736(98)12131-1. PMID 10466661.
26. Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino RB, Vasan RS (2006). "Multiple biomarkers for the prediction of first major cardiovascular events and death". N. Engl. J. Med. 355 (25): 2631–billy bob joe9. doi:10.1056/NEJMoa055373. PMID 17182988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
27. Spence JD (2006). "Technology Insight: ultrasound measurement of carotid plaque--patient management, genetic research, and therapy evaluation". Nat Clin Pract Neurol (2): 611–9. PMID 17057748.
28. Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T (2002). "Carotid Plaque Area: A Tool for Targeting and Evaluating Vascular Preventive Therapy". Stroke (33): 2916–22. PMID 12468791.{{cite journal}}: CS1 maint: multiple names: authors list (link)
29. Johnsen SH, Mathiesen EB, Joakimsen O; et al. (2007). "Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromso Study". Stroke (38): 2873–80. PMID 17901390. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
30. Mathiesen EB, Johnsen SH, Wilsgaard T, Bonaa KH, Lochen ML, Njolstad I (2011). "Carotid Plaque Area and Intima-Media Thickness in Prediction of First-Ever Ischemic Stroke: A 10-Year Follow-Up of 6584 Men and Women: The Tromso Study". Stroke (42): 972–8. PMID 21311059.{{cite journal}}: CS1 maint: multiple names: authors list (link)
31. Inaba Y, Chen JA, Bergmann SR (2011). "Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis". Atherosclerosis (220): 128–33. PMID 17057748.{{cite journal}}: CS1 maint: multiple names: authors list (link)
32. Spence JD (2011). "Carotid plaque measurement is superior to IMT Invited editorial comment on: Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis-Yoichi Inaba, M.D., Jennifer A. Chen M.D., Steven R. Bergmann M.D., Ph.D". Atherosclerosis (220): 34–5. PMID 21803357.
33. Wang TJ, Larson MG, Levy D; et al. (2004). "Plasma natriuretic peptide levels and the risk of cardiovascular events and death". N Engl J Med. 350 (7): 655–63. doi:10.1056/NEJMoa031994. PMID 14960742. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
34. ^ NHS Direct
35. Ignarro, LJ (2007 Jan 15). "Nutrition, physical activity, and cardiovascular disease: an update". Cardiovascular research. 73 (2): 326–40. doi:10.1016/j.cardiores.2006.06.030. PMID 16945357. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
36. McTigue KM, Hess R, Ziouras J (2006). "Obesity in older adults: a systematic review of the evidence for diagnosis and treatment". Obesity (Silver Spring). 14 (9): 1485–97. doi:10.1038/oby.2006.171. PMID 17030958. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
37. Linden W, Stossel C, Maurice J (1996). "Psychosocial interventions for patients with coronary artery disease: a meta-analysis". Arch. Intern. Med. 156 (7): 745–52. PMID 8615707. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
38. World Heart Federation (5 October 2011). "World Heart Federation: Cardiovascular disease risk factors". Retrieved 5 October 2011.
39. The National Heart, Lung, and Blood Institute (NHLBI) (5 October 2011). "How To Prevent and Control Coronary Heart Disease Risk Factors - NHLBI, NIH". Retrieved 5 October 2011.{{cite web}}: CS1 maint: multiple names: authors list (link)
40. Klatsky AL (2009). "Alcohol and cardiovascular diseases". Expert Rev Cardiovasc Ther. 7 (5): 499–506. doi:10.1586/erc.09.22. PMID 19419257. {{cite journal}}: Unknown parameter |month= ignored (help)
41. Walker C, Reamy BV (2009). "Diets for cardiovascular disease prevention: what is the evidence?". Am Fam Physician. 79 (7): 571–8. PMID 19378874. {{cite journal}}: Unknown parameter |month= ignored (help)
42. Sacks FM, Svetkey LP, Vollmer WM; et al. (2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". N. Engl. J. Med. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. PMID 11136953. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
43. Obarzanek E, Sacks FM, Vollmer WM; et al. (2001). "Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial". Am. J. Clin. Nutr. 74 (1): 80–9. PMID 11451721. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
44. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F (2005). "Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome". Diabetes Care. 28 (12): 2823–31. PMID 16306540. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
45. Logan AG (2007). "DASH Diet: time for a critical appraisal?". Am. J. Hypertens. 20 (3): 223–4. doi:10.1016/j.amjhyper.2006.10.006. PMID 17324730. {{cite journal}}: Unknown parameter |month= ignored (help)
46. Stamler J (2010). "Diet-heart: a problematic revisit". Am. J. Clin. Nutr. 91 (3): 497–9. doi:10.3945/ajcn.2010.29216. PMID 20130097. {{cite journal}}: Unknown parameter |month= ignored (help)
47. Siri-Tarino, PW (2010). "Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease". The American Journal of Clinical Nutrition. 91 (3): 535–46. doi:10.3945/ajcn.2009.27725. PMC 2824152. PMID 20071648. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |mont h= ignored (help)
48. Siri-Tarino Patty W, Sun Qi, Hu Frank B, Krauss Ronald M (2010). "Saturated fat, carbohydrate, and cardiovascular disease". American Journal of Clinical Nutrition. 91 (3): 502–509. doi:10.3945/ajcn.2008.26285. PMC 2824150. PMID 20089734.{{cite journal}}: CS1 maint: multiple names: authors list (link)
49. Micha, R (2010 Oct). "Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence". Lipids. 45 (10): 893–905. doi:10.1007/s11745-010-3393-4. PMC 2950931. PMID 20354806. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
50. Mozaffarian, D (2009 May). "Health effects of trans-fatty acids: experimental and observational evidence". European journal of clinical nutrition. 63 Suppl 2: S5-21. doi:10.1038/sj.ejcn.1602973. PMID 19424218. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
51. "Vitamins and minerals: not for cancer or cardiovascular prevention". Prescrire Int. 19 (108): 182. 2010. PMID 20939459. {{cite journal}}: Unknown parameter |month= ignored (help)
52. Kwak, SM (2012 Apr 9). "Efficacy of Omega-3 Fatty Acid Supplements (Eicosapentaenoic Acid and Docosahexaenoic Acid) in the Secondary Prevention of Cardiovascular Disease: A Meta-analysis of Randomized, Double-blind, Placebo-Controlled Trials". Archives of Internal Medicine. doi:10.1001/archinternmed.2012.262. PMID 22493407. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
53. Berger, JS (2011 Jul). "Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials". American heart journal. 162 (1): 115-24.e2. doi:10.1016/j.ahj.2011.04.006. PMID 21742097. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
54. ^ Gutierrez, J (2012 Jun 25). "Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysisStatin Therapy to Prevent Recurrent CV Events". Archives of Internal Medicine. 172 (12): 909–19. doi:10.1001/archinternmed.2012.2145. PMID 22732744. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
55. Ornish, Dean; et al. (1990). "'Can lifestyle changes reverse coronary heart disease?' The Lifestyle Heart Trial". Lancet. 336 (8708): 129–33. doi:10.1016/0140-6736(90)91656-U. PMID 1973470. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)
56. Ornish, D., Scherwitz, L. W., Doody, R. S., Kesten, D., McLanahan, S. M., Brown, S. E.; et al. (1983). "Effects of stress management training and dietary changes in treating ischemic heart disease". JAMA. 249 (54): 54. doi:10.1001/jama.249.1.54. PMID 6336794. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
57. Ornish, D., Scherwitz, L. W., Billings, J. H., Brown, S. E., Gould, K. L., Merritt, T. A.; et al. (1998). "Intensive lifestyle changes for reversal of coronary heart disease". JAMA. 280 (23): 2001–7. doi:10.1001/jama.280.23.2001. PMID 9863851. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
58. "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov. 11, 2009. {{cite web}}: Check date values in: |accessdate= (help)
59. "United Nations High-level Meeting on Noncommunicable Disease Prevention and Control". www.who.int.
60. Coronary Heart Disease and Physical Activity of Work by J. N. Morris and Margaret D. Crawford, British Medical Journal 1958 ; 2(5111): 1485–1496
61. Karakas M, Koenig W (2009). "CRP in cardiovascular disease". Herz. 34 (8): 607–13. doi:10.1007/s00059-009-3305-7. PMID 20024640. {{cite journal}}: Unknown parameter |month= ignored (help)
62. 20448212
63. Venuraju SM, Yerramasu A, Corder R, Lahiri A (2010). "Osteoprotegerin as a predictor of coronary artery disease and cardiovascular mortality and morbidity". J. Am. Coll. Cardiol. 55 (19): 2049–61. doi:10.1016/j.jacc.2010.03.013. PMID 20447527. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
64. Andraws R, Berger JS, Brown DL (2005). "Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials". JAMA. 293 (21): 2641–7. doi:10.1001/jama.293.21.2641. PMID 15928286. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

External links

• Template:Dmoz

Template:Medical conditions

• Heart diseases