Cardiovascular Disease Etiology and Prevention

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Cardiovascular Disease Etiology and Prevention

Introduction

Cardiovascular disease (CVD), also known as a heart disease, is a major cause of morbidity and mortality not only in the United States (Sharathkumer, Soucie, Trawinski, Greist, & Shapiro, 2011), but also in other advanced countries throughout the world (Perk, De Backer, Gohlke, Graham, Reiner, Verschuren & Zannod, 2012). Recent statistics from the American Heart Association demonstrate that an estimated 83.6 million of American adults have one or more types of CVD; of these, about 42.2 million are estimated to be in the ageing population of 60 years and older (American Heart Association, 2013). In addition to the foregoing statistics, there is compelling evidence indicating that cardiovascular-related deaths in the US are more common among men. However, CVD affects nearly as many women as men, albeit at an older age (Greenlund, Keenan, Clayton, Pandey & Hong, 2012). While the increased risk of CVD from modifiable risk factors such as tobacco use, hypertension, diabetes mellitus and hypercholesterolemia is well documented in the literature, the same cannot be said of non-established behavioral and lifestyle risk factors. Such include poor nutrition, obesity, physical inactivity and sedentary behavior (Barnes, 2013; Perk et al., 2012). This paper argues that although the impact of the outside factors is relatively strong, the inside factors have a strong influence on the development of CVD. The foregoing arguably means that raising awareness and encouraging people to adhere to good nutrition rules will help fight CVD efficiently.

Role of Nutrition in the Prevention of CVD

Many CVD patients put much focus on potent medications and major cardiovascular (CV) procedures due to lack of information or awareness (Whayne & Malik, 2012). Research has however shown the value of nutrition is critical regardless of the CVD risk factors involved (Whayne & Maulik, 2012). Moreover, there is excellent clinical proof to show that good nutrition consisting of essential vitamins, alternative supplements, saturated fats, antioxidants and moderated alcohol helps maintain optimal weight (Wang, He, Li, Luan, Zhai, Yang, & Ma 2013). Good nutrition further provides critical CV benefits, which include decreased inflammation and increased vasodilatation, hence decreasing the risk of CVD. Additionally, good nutrition lowers the bodys ability to absorb low-density lipoproteins (LDL), and this has been cited as critical to the prevention of CVD (Wang et al., 2013). Closely linked to good nutrition is the issue of caloric balance, which refers to the control of calories and the composition of the food providing those calories. It has been indicated that caloric balance is essential in fighting obesity, which is directly linked to prevalence of CVD (Whayne & Maulik, 2012).

Etiology of CVD

Evidence in literature demonstrates that CVD does not just happen; rather, it is a chronic progressive disorder which develops in ones body through time. Notably, the symptoms of CVD only occur when the disease is at an advanced stage (Albert, 2007; Perk et al., 2012). CVD is a class of diseases including coronary heart disease, hypertension, stroke, angina pectoris, ischemic heart disease, myocardial infarction, rheumatic heart disease, congenital heart disease and cardiomyopathies (Carrington, Kok, Jansen, & Stewart, 2013). Atherosclerosis is indicated as the causal pathology for cardiovascular disease. According to Albert (2007), atherosclerosis develops asymptomatic over years, and evidence of the disease is only noticeable when the disease is at an advanced stage.

CVD is caused by a wide range of uncontrollable (outside) and controllable (inside) factors (Barnes, 2013). The outside factors cannot be controlled by a patient and often include genetics, age, gender, congenital diseases, environmental pollution, and other diseases such as hypertension, diabetes mellitus, and hypercholesterolemia. In contrast, controllable or inside factors are those that an individual can modify through behavioral and lifestyle changes. They include smoking, inadequate physical activity, unhealthy eating habits (bad nutrition), obesity, high blood pressure, sedentary behavior, high blood cholesterol and excessive stress (Barnes, 2013; Perk et al., 2012). Owing to the fact that nutrition is the principal focus in this paper, it is important to mention that existing literature has cited poor dietary habits (e.g., high uptake of red meats, sweets, added sugars and sugary beverages) as contributing to the high prevalence of CVD in the United States (Greenlund et al., 2012).

Progression of CVD

The progression of CVD starts with fat accumulation in the visceral depot (Rosin, 2007). The visceral fat secretes bioactive molecules, which are known as adipokines. If the body is not able to regulate adipokines, pathogenesis of the same molecules occur leading to atherosclerosis. As time goes by, a person may develop metabolic syndrome. The foregoing syndrome has been cited as powerful and prevalent predictor of cardiovascular events (Mathieu, Pibarot & Despres, 2006, p. 285). At this point a person may develop insulin resistance, type 2 diabetes, hyperlipidemia, hypertension and vascular disease. Vascular disease affects the vascular system which consists of a network of blood vessels. It is indicated that vascular disease causes plague build-up, which thickens endothelium cells. Endothelium cells line the inside of all blood vessels, and upon thickening, they cause obstruction to the flow of blood in the vessels (Rosin, 2007). Consequently, the target organ (i.e. the heart in this context) does not receive adequate supply of oxygen and nutrients. In some cases, the plague build-up can cause the vessels to rupture in which case the person may have a heart attack or may suffer coronary artery disease, leading to heart failure.

Treatment of CVD

The initial evaluation of CVD consists of a history and physical examination to ascertain the clinical suspicion. Electrocardiograph and cardiac biomarker tests are also done to make a final confirmation of CVD and its subtype (Albert, 2007). Treatment should be commenced based on the severity of the condition. If CVD is diagnosed before it has progressed to a dangerous level, the patient should be educated on how to modify the presenting risk factors that lead to cardiovascular morbidity and mortality (Suri, Tincey & Gupta 2010). For instance, if the patients history reveals that unhealthy dietary uptake is the modifiable risk factor, he/she should be educated on making the right dietary choices to reduce CVD progression. Depending on CVD severity, it may be important to pharmacologically treat the patient using drugs such as Fondaparinux, Ivabradine, Dabigatron, Aspirin and Thienopyridines (Albert, 2007; Suri et al., 2010). Notably, behavioral and lifestyle modification must compliment therapy or any other form of treatment for CVD, hence the importance of creating awareness on modifiable risk factors in the treatment and management of disease.

Patients with congestive heart failure and other forms of advanced CV conditions may be treated using partially invasive techniques such as the implantation of a biventricular pacemaker under the skin to help a failing heart to beat in a more balanced way (Straka, Pirk, Pindak, Marek, Schornik, Cihak & Skibova, 2012). Still, open heart surgery (e.g., coronary artery bypass surgery) or new forms of heart surgery could be done on the patient to correct life-threatening CVD complications (Straka et al., 2012).

Recommended Diets

Available literature demonstrates that when compared to costly drug-related treatments, adjusting lifestyles is a more affordable way of reducing the CVD risk. Additionally, lifestyle adjustments can benefit the broader population when compared to conventional medicines, which are only accessible to patients who can afford them. Notably, lifestyle adjustment involves such practices as eating a healthy diet and adopting a regular physical exercise regimen (Wang et al., 2013 p. 1). In their study, Whayne & Maulik (2012) suggest the inclusion of foods that are high in vitamins, alternative supplements, saturated fats in diet and antioxidants in ones diet. Moderate alcohol consumption should also be factored in as part of a healthy eating habit. Specifically, however, Whayne and Maulik (2012) recommend the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets for their proved capacity to prevent adverse CV events. These foods include fruits, vegetables, fat-free or low-fat dairy products, whole grains, fish, poultry, beans, seeds, nuts, healthy fats, olive oil, legumes, and moderate wine consumption. It is worth noting that high intake of rice has also been associated with low prevalence of CVD risk factors among the Chinese population (Wang et al., 2013). Alternative supplements/medications with possible nutritional benefit for CVD prevention include acai berry, coenzyme Q-10, policosanol, omega-3-fatty acids, stanols, soy protein, red wine and red yeast rice (Whayne & Maulik, 2012)

Nursing Nutritional Assessment

Available nursing literature demonstrates a thorough assessment for CVD is critical in assisting to identify significant factors that can influence CV health in a patient. Such factors include high blood cholesterol, smoking, unhealthy dietary habits, diabetes mellitus and hypertension. Nutritional assessment is also critical in identifying other intricate patient experiences that could assist in the positive identification of new symptoms or any form of distress exhibited by the patient (Carrington et al., 2013). A proper nursing assessment for CVD should revolve around several dimensions, as indicated below.

The nurse should first take the patients history to know how their cardiovascular symptoms have developed. The next step involves obtaining information about the patients medical conditions based on their disease history. Such conditions may include hypertension, heart murmurs and elevated blood cholesterol among other conditions. Nursing assessment should then include taking the patients current lifestyle and determining their psychosocial status. Factors to look out for include: nutrition, smoking, alcohol use, physical exercises (or lack thereof) and drugs that the patient may be taking. Family history should also be reviewed with the view of identifying the patients risk factors for certain cardiovascular diseases and congenital medical conditions (Carrington et al., 2013).

Afterwards, chest pain should be assessed using PQRST Mnemonic. Symptoms to look out for include: proactive or palliative pain symptoms, quality of symptoms, region or radiation of symptoms, and severity of symptoms and timing. Assessment should then focus on other symptoms such as occurrence or presence of dyspnea, orthopnea, cough, fatigue and nocturia. The nurse should then commence the physical examination of the cardiac system, the respiratory system as well as the circulatory system in order to get holistic picture of the patients cardiovascular system (AMN Healthcare Education Services, 2004). All the findings and observations should then be clearly and coherently recorded (Carrington et al., 2013).

Nursing Nutritional Interventions/Considerations

Available literature demonstrates that there are distinct nursing interventions for variants of diseases under the CVD umbrella. Generally, however, the first consideration should be to check the patients vital signs such as blood pressure and heart rate before and after the cardiovascular activity (Perk et al., 2012). It is, however, important for the nurse to have nitroglycerin on standby for immediate deployment. Additionally, the nurse should note the cardiopulmonary response to activity and other important symptoms such as tachycardia, distrimia, dyspnea, sweating and paleness. Other scholars note that in undertaking nursing interventions for CVD, the nurse should be on the lookout for activity duration, activity severity and accompanying symptoms (Carrington et al., 2013).

In addition to monitoring the patient for chest pain, hypotension, coronary artery spasm and bleeding from the catheter site, the nurse should also provide the much needed information to the patient by, for instance, explaining the cardiac catheterization to the patient or explaining the surgery procedure and events if the patient is scheduled for surgery (Carrington et al., 2013). Some of the core components of nursing interventions for CVD, according to Perk et al. (2012), entail assisting the patient to: effectively cope with stress and identify activities that precipitate pain, follow a prescribed drug regimen, maintain a prescribed diet, and do regular, moderate physical exercises.

Nutritional Patient Education

Several approaches are being used in the United States to improve CV health in the general population and among older adults (Greenlund et al., 2012). Available statistics however show that the situation is far from getting better as more and more people, particularly the elderly, suffer from CVD (Labrunee, Pathek, Loscos, Coudeyre, Casillas & Gremeaux, 2012; Perk et al., 2012). Consequently, there is need to refocus attention on patient education as one of the key approaches that could be used to prevent CVD. This paper recommends a two-thronged patient education program for CVD involving raising patients awareness and underlining some preventive measures that could be used to prevent cardiovascular events.

Raising patients awareness should involve informing the general population about the basic types of CVD, precautionary and first aid information, and how they could seek for professional assistance in case of need. According to Parks, Turner, Perry, Lyons, Chaney, Hooper and Burns (2011), people need to be educated on such issues as (1) what it means to have CVD, (2) what one can do to cope with CVD, (3) when one can seek professional assistance for symptoms, (4) where one can find first aid or fast response in case of disease progression, (5) how one can monitor their disease to stay healthy, and (6) what one can do to prevent CVD from getting worse.

Preventive measures need to focus on patient education for purposes of encouraging good nutrition, physical fitness and regular screening for CVD (Wang et al., 2013; Whayne & Maulik, 2012). To avoid confusion, stakeholders in the health sector need to specify foods that are beneficial to CV heath.

Conclusion

This paper demonstrates that more and more people stand to benefit if relevant stakeholders in the health sector adopt paradigms aimed at raising awareness and encouraging people to adhere to good nutrition as the basis for efficiently fighting CVD. The paper has proved that inside factors are to a large extent involved in determining the development of CVD than outside factors, hence there is a need to design and put in place a detailed education program, which will not only raise awareness but also ensure that people are eating healthy diets and exercising more. It is important to educate people on the specific dietary requirements for CVD prevention, where to find help in case of need, and the benefits of physical exercises.

References

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American Heart Association. (2013). Statistical fact sheet 2013: Older Americans and Cardiovascular diseases. Web.

AMN Healthcare Education Services. (2004). Focused Cardiovascular Assessment. Web.

Barnes, A.S. (2013). Emerging modifiable risk factors for cardiovascular disease in women: Obesity, physical activity, and sedentary behavior. Texas Heart Institute Journal, 40(3), 293-295.

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