Category: Cardiovascular Diseases

Professor Phillip Greenland, explored the subject of Predicting the Future: Can We Predict Who Will Develop Cardiovascular Events? In the seminar, he indicated it is difficult to predict the future even though there is a lot of information on cardiovascular information; more than knew about it 20 years ago. The information and guidelines in the topic stated that there exists evidence based on numbers; and for people to manage risks, they should know the numbers and the risk.

In Texas a bill was enacted in regards to cardiovascular disease, the bill stated that all health facilities that offer to screen need to set some resources necessary for screening from the insurance of the patient. The seminar discusses various ways of determining risks associated with an individual concerning cardiovascular challenges. The seminar focuses on methods of identifying the level of risk in individuals in regard to cardiovascular illnesses; it works to classify people as high risk, low risk and medium risk.

The purpose of the seminar is to design measures of various risks associated with cardiovascular diseases. The seminar also focuses on measuring outcomes based on adjusting risks and other aspects that are necessary to conduct proper research in health-related research and influence the outcome. The seminar provided an understanding of measuring risks and categorizing the risks. It provides a better understanding of aspects related to risks, this is a good avenue as it provides information important in determining initiatives related to measuring risk such as comparative effectiveness.

Professor Phillip Greenland, after claiming it is difficult to predict the future, stated that the best way to determine the future is to manage risks associated with cardiovascular illnesses. He then described the need and importance of determining the level of risk. He gave an example of a new law in Texas that stated the need to conduct screening to determine risks in an individual about cardiovascular illnesses.

The seminar and the book by Radosevich and Kane described the reason for measuring risk and the fundamental designs employed in risk measurement (1-354). The seminar and the book provide collected data on various subjects on risk measurement and analytical methods and proceed to discuss the results from the collected data to provide a better interpretation of the collected data. The information in the seminar is presented clearly and in a way the audience understands. The seminar and the book are appropriate educational materials as they offer comprehensive information for a researcher and both act as crucial resources.

Researching measuring risk factors involves determining and recognizing various factors associated with risk. Determining the level of risk in an individual ensures the proper provision of health care. Across the nation, people are demanding quality health care, the consumers, insurance companies and the government will achieve quality health care through research on measuring risks. The seminar and the book detail the methodology used in measuring risk thus assisting in predicting the future.

The key to dealing with cardiovascular illnesses is addressing the main cause of the illnesses; the seminar does not focus on this subject but instead focuses on risks associated with the disease. The seminar is important for medical students as it provides information necessary in analyzing medical challenges and is important when conducting research.

Works Cited

Kane, Robert. and David M Radosevich. Conducting Health Outcomes Research. Boston: Jones and Bartlett Publishers, 2011.

In this case study, a 76-year-old patient has congestive heart failure that is the major reason for her chief complaints. Heart failure can be perceived as a syndrome caused by various factors such as HTN, diseases of coronary vessels, diseases of valves, primary myocardial disorders, etc. (The American College of Cardiology Foundation and the American Heart Association, 2021). Due to one or several influencing factors (no data from the case), the patient, in the initial phase of the CHF, had a raised intracardiac pressure with left ventricular filling and increased afterload. These mechanisms increase chronotropic and inotropic responses that slowly but surely lead to myocyte hypertrophy, first eccentric, then dilatated hypertrophy (Dharmarajan & Rich, 2017). The latter leads to residual volume after each cardiac output and, consequently, the increased pressure in the chamber.

The Cardiovascular Pathophysiologic Processes

The described above pressure influences the left atrioventricular valve and left atrium that, due to increased pressure in the left ventriculus, also start dilatating. In this period, patients have a high risk of atrial fibrillation. When the compensative mechanisms of the left atrium are exhausted, the increased pressure spreads to the vessels of the pulmonary circuit that leads to blood congestion in peripheral lung vessels, pulmonary edema, dyspnoea, and shortness of breath. The latter triggers breathing troubles during the night, and the patient has to put two pillows under the head to get an adequate amount of air.

The Cardiopulmonary Pathophysiologic Processes

Moreover, such symptoms as weight gain, abdominal swelling, and peripheral edema are consequences of congestion in the central circulatory system. When pulmonary vessels are suffering from edema, the increased pressure from it reaches the right ventriculus and atrium, slowly causing their hypertrophy. The dilatated right chambers lose the ability to contract efficiently and lead to congestions in the veins of the body. That is how congestion in the lower extremities causes peripheral edema, while congestion in the liver causes abdominal swelling and arachnogastria. The weight gain of the patient can be explained by liquids congestion and inadequate work of the heart muscle.

Diuretics

Diuretics help reduce these symptoms to enhance the condition of the patients. Diuretics are used in the management of CHF; however, they are not influencing the causing agents. Moreover, if arterial hypertension is one of the major agents causing CHF, it can also affect kidneys and lead to chronic kidney disease, raising diuretic resistance (Shah et al., 2017). The latter means the tactic of CHF treatment should be diversified, targeting major initiating factors with a daily intake of medications. If the patient has to go to the bathroom because of the diuretics, it might be essential to reconsider the pharmacological group of the drugs. Loop diuretics are the strongest ones and might cause such symptoms, and they are also not recommended for daily intake (Yancy et al., 2017). Controlling the liquids intake can help improve the condition of the patient even though most of them have low compliance in following this rule.

Racial/Ethnic Variables that May Impact Physiological Functioning

Observing such influencing factors as racial or ethnic variables, it is essential to emphasize their impact on physiological functioning. The study by Mwansa et al. (2021) proved the higher prevalence of CHF among the black race and females. The authors of the research underline various genetic factors that must be further studied and social determinants of health level such as bias and structural racism. The statistical data proved the lower 5-year survival level among black patients after heart operations comparing to white people (Mwansa et al., 2021). This means the racial and ethnic factors, along with genetic specialties, should be studied to better comprehend the predisposing nonmodifiable issues causing chronic heart failure.

Summary

Hence, the interrelations between cardiovascular and pulmonary systems are central to the pathogenesis of CHF and can explain a patients symptoms. The major therapeutical issue of the patient, diuretics intake, can be solved by prescription of drugs targeting the main causing agents and limiting the daily water consumption. One of the factors that can also be influencing physiological functioning during the development of CHF is racial or ethnic variables that cannot be underestimated when the treatment of the patient is considered.

References

Dharmarajan, K., & Rich, M. W. (2017). Epidemiology, pathophysiology, and prognosis of heart failure in older adults.Heart Failure Clinics, 13(3), 417426.

Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/Ethnic and gender disparities in heart failure with reduced ejection fraction.Current Heart Failure Reports, 18(2), 4151.

Shah, N., Madanieh, R., Alkan, M., Dogar, M. U., Kosmas, C. E., & Vittorio, T. J. (2017). A perspective on diuretic resistance in chronic congestive heart failure. Therapeutic Advances in Cardiovascular Disease, 11(10), 271278.

The American College of Cardiology Foundation and the American Heart Association. (2021). 2021 ACC/AHA key data elements and definitions for heart failure: A report of the American College of Cardiology/American Heart Association task force on clinical data standards (Writing committee to develop clinical data standards for heart failure). Circulation: Cardiovascular Quality and Outcomes, 14(4), e000102.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., CaseyJr, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776-803.

Introduction

Cardiovascular diseases, CVDs, continue to cause deaths, despite improvements in medical research and clinical practices. CVDs mortality rates have continued to rise, such that in the next 20 years, CVDs are expected to cause more than 23 million deaths. As a result, numerous treatment methods have been developed. These include medication, regular physical exercises, and nutritional therapy. While medication and regular physical exercises provide prevention and cure for CVDs, nutrition-based treatment is a cost-effective and easy-to-implement treatment method. However, effective nutritional therapy requires the assessment of the patients nutritional and medical history, which helps in identifying the patients nutritional needs. In light of this, various medically acceptable standards govern nutritional assessment.

These standards seem to be necessitated by controversies surrounding research findings on nutritional therapy. This paper aims at evaluating medically acceptable standards on nutritional assessment. It also provides an assessment of medically acceptable nutritional therapy for the prevention and cure of CVDs.

Cardiovascular diseases; the background

The World Health Organization asserts that CVDs are the leading causes of death and disability in the world (WHO n.pgn). Cardiovascular diseases, CVDs, are a group of diseases that affect the human heart and related parts, such as the aorta, aortic valves, Endocarditis, among others (Maton 34 to 38). The World Health Organization further adds that for the last two decades, CVDs mortality rates in developed countries have dropped (WHO n.pgn). This implies that the prevalence of CVDs remains high in developing countries. Demographically, men are at a higher risk of CVDs than women (Maton 36).

While research identifies numerous causes of CVDs, the primary cause is thought to be an imbalance of the ratio between two lipoproteins namely LDL and HDL. Other causes of CVDs include a very high level of blood sugar, hypertension, and prolonged exposure to air pollutants such as mercury. It is also thought that the intake of unhealthy foods, as well as irregular eating habits, increases the risk of CVDs.

Nevertheless, debate still rages on about certain controversial research findings. For instance, some researchers claim that a moderate intake of alcoholic drinks reduces the risk of CVDs. These findings have elicited mixed reactions. Arguments to the effect that alcohol intake increases the intake of refined sugars associated with the occurrence of CVDs abound. Nevertheless, The World Health Organization offers medically acceptable standards on prevention and cure of CVDs.

Research on medically acceptable nutritional assessment standards

According to the World Health Organization 2010, CVD mortality is estimated to be 17.3 million. Despite improvements in medical research, the World Health Organization estimates that by the year 2030, CVDs will cause more than 23 million deaths annually (WHO n.pgn). One of the most effective methods for the management of CVDs is nutritional therapy. Current and past research works indicate that nutritional therapy is not effective unless certain nutritional assessment standards are adhered to. Nutritional assessment is a multidimensional approach aimed at identifying a patients nutritional requirements. Nutritional assessment leads to the development of patient-specific nutritional therapy. It involves the assessment of a patients diet and medical history as well as recording anthropometric patient measurements (Worthington 3).

According to Worthington (2), developing a nutritional therapy requires a thorough assessment of the type of CVD affecting each patient. This implies that in managing CVDs, the one-size-fits-all approach is not applicable. As Lee (646-653) asserts, major nutritional assessment involves the identification of the prevailing cardiovascular disease as well as its cause. Additionally, evaluating the medical history of patients and at-risk individuals is a prerequisite in designing a nutritional treatment plan. In light of these assertions, Charney (45) asserts that regulatory requirements have increased in scope, such that differentiating between nutritional screening and nutritional assessment is now possible. Research by Worthington asserts that nutritional screening is a major component of nutritional assessment (1).

Nutritional screening involves assessing a patients nutritional history as well as measuring a patients anthropometric data. Anthropometric data captures a patients mass, weight, sugar and fat levels, height as well as the level of the patients blood pressure. Thus, the National Center for Chronic Disease Prevention and Health Promotion identifies nutritional assessment as a major requirement in the management of CVDs. Assessing a patients nutritional requirements is based on thorough nutritional screening (Worthington 2). Additionally, research by the University of Washington reveals that nutritional screening and assessment works when closely monitored by physicians and dieticians. This implies that nutrition screening and assessment programs seem to be medically acceptable standards in the management of CVDs.

As explained herein, proper diagnosis as well as conducting an accurate nutritional assessment enables physicians to design appropriate nutritional therapy. However, research by Olendzki, Speed, and Domino reveals that certain factors, such as patients attitudes towards dieting and certain diet components affect the effectiveness of nutritional therapy in the management of CVDs (264). In light of this, The U.S. Preventive Services Task Force has identified nutritional counseling as a major requirement (257). Nutritional counseling helps patients adjust negative attitudes towards certain dietary habits. It also helps patients adapt to, and accept healthy eating habits.

A discussion of medically acceptable nutritional therapy and the management of CVDs

According to the World Health Organizations statistics, the CVDs mortality rate is expected to rise in the next 20 years. By the year 2030, the World Health Organization estimates that CVDs are likely to cause more than 23 million deaths annually (WHO n.pgn). This is an alarming figure bearing in mind that research in the prevention and cure of CVDs has intensified. This indicates that CVDs are among the leading causes of death globally. The occurrence of CVDs is attributed to several causes, including unhealthy eating habits, exposure to air pollutants, an imbalance in the ratio between two lipoproteins namely LDL and HDL, among others.

The World Health Organization further suggests several methods through which CVDs can be prevented and cured. These include medication, regular exercise, and proper nutrition (WHO n.pgn; Maton 36). The term proper nutrition is synonymous with the term nutritional therapy. Nutritional therapy, according to the World Health Organization, is a cost-effective method for preventing and curing CVDs. It is a multidimensional approach in the management of CVDs and involves the intake of healthy foods as well as the avoidance of unhealthy diet components (WHO n.pgn). Effective nutritional therapy is discussed elsewhere in this essay.

Several factors affect the effectiveness of nutritional therapy in preventing and curing CVDs. As explained by Mason (34 to 38), CVDs are a group of ailments that affect the heart and related parts. Each ailment has its cause. This implies that in developing a treatment method, identifying the prevailing type of CVD seems to be an overarching requirement.

Since each patient requires a unique treatment plan, proper diagnosis helps physicians and dieticians to determine the most appropriate nutritional therapy for each patient.

It is evident that in designing nutritional treatment plan, the one-size -fits-all approach is inapplicable as far as managing CVDs is concerned. Effective prevention and treatment of CVDs requires nutritional assessment for each patient. Conducting thorough nutritional assessment is complicated process, which also requires accuracy in obtaining data on a patients nutritional needs. Therefore, nutritional screening seems relevant (Worthington 1, 2).

Nutritional screening precedes nutritional assessment and involves evaluating a patients medical and diet history (Worthington 2). This helps physicians identify links between a patient dietary habits and the prevailing CVD. Additionally, these results are correlated with a data from a patients anthropometric measurements. It is important to note that significant variations in these measurements indicate a patients health status, especially with regards to CVDs. Such correlations also enable physicians and dieticians to design a proper nutritional plan for each CVD patient.

As explained earlier, nutritional therapy is a cost effective method for treating and preventing CVDs. According to Olendzki, Speed and Domino, nutritional therapy is a two phase process (258). Most people believe that avoiding the intake of unhealthy dietary items eliminates the occurrence of CVDs. Unhealthy dietary habits include smoking and exposure to second hand tobacco smoke as well as sustained intake of alcohol (Jani and Rajkuma 357 to 362).

However, there are other unhealthy eating habits. These include sustained intake of foods rich in polyunsaturated fats, refined sugars as well as saturated fats. Additionally, intake of more than one tablespoonful of salt is highly discouraged. Foods rich in these components are associated with occurrence of certain types CVDs. Additionally increased intake of animal proteins, mostly found in red meat is also associated with occurrence of CVDs (Jani and Rajkuma 359).

From the assertions made above, one is likely to conclude that avoidance of the foods mentioned above eliminates the risk of CVDs. Jani and Rajkuma (359) warn against intake of animal proteins especially those found in red meat. This does not imply that proteins are necessarily unhealthy diet items. Olendzki, Speed and Domino assert this and further suggest that CVD patients ought to substitute animal proteins with plant proteins (259). Plant proteins are readily available from leguminous plants, vegetables and whole grain meals such as beans, walnuts, chickpeas, lentils, broccoli, among other food items.

Together with fruits, these foods also provide CVD patients with low fat diet, which further reduces the intake of unhealthy fats. Bearing in mind that intake of foods rich in polyunsaturated and saturated fats causes most types with CVDs, a proper nutritional therapy ought to contain as sufficient amounts of plant proteins. CVDs are not only aggravated by polyunsaturated and saturated fats, but also by omega-6 fatty acids. To mitigate the influence of omega-6 fatty acids, Olendzki, Speed and Domino suggests that patients ought to increase intake of vegetables and soybeans (259. These foods are, rich in omega-3 fatty acids. Intake of these foods corrects the imbalance of omega-3 and omega-6 fatty acids, which reduces the risk of CVDs (Olendzki, Speed and Domino 260).

Fruits contain very high levels of sugar. Suggestions made to increase intake of fruits seem to contradict earlier assertions that increased intake of fruits reduces the risk of CVDs. Intake of fruits increases the intake of sugars. Increased intake of sugars, according to the World Health Organization, is unhealthy and causes CVDs. However, Olendzki, Speed and Domino explain that only refined sugars pose significant threat (260). As such, intake of sweetened beverages including alcohol is highly discouraged (Olendzki, Speed and Domino 261).

Designing a nutritional therapy may not necessarily work, due to the fact that each patient has unique nutritional requirements. In addition to this, a patients attitude towards certain nutritional component affects the effectiveness of nutritional therapy. However, as indicated by Lee (646-653) and Worthington (2), nutritional assessment involves identifying specific nutritional requirements for each patient.

Based on data derived from each patient, physicians and nutritionist are able to design an individual-specific nutritional treatment plan containing essential nutritional components. To improve the effectiveness of nutritional therapy especially for patients with maladjusted attitudes, nutritional counseling seems to be the most effective course of action (Olendzki, Speed and Domino 257). Nutritional counseling helps patients and at-risk individuals adjust their attitude appropriately as well as adapt to new dietary habits. This further increases the effectiveness of nutritional therapy.

Conclusion

It is unfortunate that CVDs continue to cause deaths, despite advancement in research and medical technology. Most of these deaths are preventable through readily available solutions such as medication, regular exercises and proper nutrition. Yet CVDs mortality rates continue to rise. While the increase in CVD mortality rates is attributed to poor lifestyles, inaccessibility to crucial information on the effects of nutrition seems to be a risk factor. Most people are unaware of the fact that CVDs can be adequately managed through proper nutrition. Additionally, patients nutritional attitudes seem to affect the effectiveness of nutritional.

Therefore, an effective nutritional therapy is preceded by nutritional counseling. The occurrence of CVDs is attributed to various causes, each requiring different solution. Each patient has unique treatment needs. This implies that nutritional therapy is only effective if designed for individual patients. Nutritional therapy is a cost effective method of preventing and curing CVDs. Nevertheless, each patient requires a nutritional plan based on the patients nutritional and medical needs. Additionally, nutritional counseling improves the effectiveness of nutritional therapy. Thus an effective nutritional therapy for CVD patients is patient -specific as well as proceeded by nutritional counseling.

Recommendations

Designing a nutritional therapy calls for collaboration between nutritionists and physicians. Nutritional counseling is a major requirement if success is to be attained. Nevertheless, nutritionists and physicians lack basic communication and counseling skills. This is a major barrier for physicians and nutritionists counseling CVD patients (Olendzki, Speed and Domino 257). As such, physicians and nutritionists require basic training on communication and counseling skills. Additionally, nutritional assessment relies on data from a patients diet history. Obtaining such data is prone to errors since it relies on memory. Accuracy in data gathering improves clinical decision making. As such, this is an area that requires urgent attention.

Works Cited

Charney, Pamela. Nutrition Screening vs Nutrition Assessment: How Do They Differ? Nutritional Clinical Practice. 2008. Web.

Jani Brani, and Chris Rajkumar. Ageing and vascular ageing. Postgraduate Medical Journal. 82 (2006):357-362. Print.

Lee, Clark. Indices Of Abdominal Obesity Are Better Discriminators Of Cardiovascular Risk Than BMI: A Meta-Analysis. Journal of Clinical Epidemiology. 61(2008): 646-653. Print.

Maton, Anthea. Human Biology and Health. Englewood Cliffs, New Jersey: Prentice Hall. 1993. Print.

Olendzki, Barbara, Christopher Speed and Frank Domino. Nutritional Assessment and Counseling for Prevention and Treatment of Cardiovascular Disease. America Family Physician. 2006. Web.

WHO. Cardiovascular Disease. 2012. Web.

Worthington, Patricia. Nutritional Assessment and Planning in Clinical Care. n.d. Web.

The study involved patients suffering from cardiovascular disease and people at risk. Participants had access to an app with all the necessary information about the disease. Online health risk calculators, incentive emails, and monitoring of behavioral lifestyle targets were provided. The average follow-up period was about 12 months. The control group consisted of 934 individuals, approximately 67.6 years of age (±8.1). 77% of the patients were male, and 41% had existing cardiovascular disease. 33.3% of the patients had coronary heart disease, 3.6% had peripheral artery disease, 3% had chronic kidney disease, 10.8% had atrial fibrillation, 1.1% had heart failure, and 9.3% of the patients surveyed had a previous stroke (Redfern et al., 2020). Participants were randomized and divided into two groups. One had access to the CONNECT web app in addition to their usual care, and the other received their usual care at a medical facility.

The first strength of the study is the individual approach to patients based on their diagnosis, age, and gender. Considering each patient and accepting their differences increases the accuracy of the results and makes it possible to apply them to the widest range of patients. The second strength may be that study participants received many features of this app that helped them to be more signi
cant about their diagnosis and provided support. For people with these serious illnesses or at risk of having them, it is important to have some knowledge to keep their health up to date.

The first disadvantage is the focus on healthcare facilities in large cities. The data can differ if researchers conduct the same study in a small city. Some clinics may need more modern technical equipment to implement this innovation. Another disadvantage is that the innovation is applied only to certain groups of people. Since most patients refused to participate, and others were not medically suitable, the application of this technology is aimed at a certain circle of people.

The results did not differ significantly between the groups. Adherence to the medications prescribed in the guidelines did not differ significantly according to the frequency of use of the intervention (p = 0.44) (Redfern et al., 2020). There were no significant changes in mean LDL cholesterol (p = 0.24) and BP (p = 0.92) (Redfern et al., 2020). These numbers mean that most participants were not active users of the app. Those people who did use the technology increased their physical fitness and improved their performance. Because of the low significance, no studies were conducted. Because most participants dropped out of the study, its accuracy can be assessed as low.

The study yielded a different result because of the small number of participants. This makes it impossible to evaluate the use of the innovation in a broader patient population. It can only be used in modern clinics and by people with certain data. On the other hand, some of the patients in the intervention group showed positive results in behavior and health indications, which gives hope for further development of the technology.

Reference

Redfern, J., Coorey, G., Mulley, J., Scaria, A., Neubeck, L., Hafiz, N., Pitt, C., Weir, K., Forbes, J., Parker, S., Bampi, F., Coenen, A., Enright, G., Wong, A., Nguyen, T., Harris, M., Zwar, N., Chow, C. K., Rodgers, A., Heeley, E., Panaretto, K., Lau, A., Hayman, N., Usherwood, T & Peiris, D. (2020). A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomized controlled trial. NPJ digital medicine, 3(1), 1-9.

Introduction

Cardiovascular disease (CVD) is a leading cause of mortality in the developed nations. The condition has been the single largest cause of death for a long period in the United States of America. According to Lakic, Tasic, and Kos (2014), CVD is a large burden to the society in terms of mortality and morbidity. Large amounts of resources are also directed to the prevention and control of this health problem. This expense has direct negative effects on the economy of any society. CVD also poses a significant problem in society as it deals with transience and morbidity.

The burden of CVD is high in the United States. The available statistical findings show that nearly 2,400 Americans succumb to the condition each day to make an average of one death after every 37 seconds (American Heart Association, 2012). The burden of a disease that is associated with CVD is evaluated through the measurement of the resources used in the prevention, treatment, rehabilitation, and other effects of the condition on the society. However, the economic burden of any condition can be classified according to the direct and indirect costs (Lakic, Tasic, & Kos 2014, p. 138). Therefore, the sum of the costs for CVD is high. The following report looks at cardiovascular disease in the United States, its etiology, risk factors, and other political and social issues associated with the condition.

Problem Description

Cardiovascular disease is a group of conditions that affect the cardiovascular system. Some of the diseases in this group include coronary heart disease (heart attack), cerebrovascular disease, peripheral artery disease, congenital heart disease, heart failure, rheumatic heart disease, and hypertension (Kelly, Narula, & Fuster, 2012). In most of the cases where CVD is used, it refers to heart disease and stroke. The condition is mostly associated with the elderly population. Several factors are recognized as predisposing the individuals. Physical inactivity, unhealthy diet, and tobacco use are the main causes of cardiovascular disease (World Health Organization, 2012). Although the condition is not the leading cause of death in the low and middle-income countries, most of the global deaths associated with CVDs are from these regions (World Health Organization, 2012).

The complications of heart disease include heart failure where the heart is unable to pump blood to all other parts of the body (Kelly, Narula, & Fuster, 2012). Coronary artery disease often results from the formation of a clot in the coronary artery. It can lead to sudden death in patients if the clot dislodges. The condition is equally distributed in both sexes in many parts of the world. The World Health Organization puts CVD as a global leading cause of death, with this status being projected to remain the same for a long time in the future (World Health Organization, 2012). An estimated 17 million people died of the direct and indirect effects of CVD in 2008. This figure was 30% of all the deaths recorded globally in the same year (World Health Organization, 2012). Heart attacks and stroke were the leaders in mortality from cardiovascular disease in the same year, representing 12% and 5% respectively (World Health Organization, 2012).

Extent of the Problem

As indicated above, cardiovascular disease is a global leader in mortality and morbidity. Millions of people die each year. In the national and local setting, the condition continues to cause significant damage to the economy in the loss of income and labor. This section looks at the extent of the problem in the USA and the State of Texas.

Nationally

The United States is among the countries that have a high burden of CVD. More people are dying from the condition. In 2008, the number of male people in the population who died from cardiovascular diseases was 392,210, with that of female patients being 419,730 (American Heart Association, 2012). The condition was the leading cause of mortality in the nation. All cancer cases come a distant second (American Heart Association, 2012). The prevalence of stroke in the same year was 14.5% of the male population and 14.8% of their female counterparts (American Heart Association, 2012). The distribution of CVD according to races and ethnicities showed that the black population was more predisposed, with the age adjusted death rates for stroke among this population being 57.6 per 100,000 (American Heart Association, 2012).

The condition is also a significant economic problem. In 2008, the amount of money spent directly and indirectly in the management of heart disease was 190.3 billion dollars (American Heart Association, 2012). Hypertension costs were $50.6 billion, with stroke and other CVDs costing 56.8 billion dollars for the same year (American Heart Association, 2012). The projection of the costs related to CVDs on the national economy shows that more money has to be spent in their management. It is projected that $564 billion will be spent in 2015, $704.7 billion in 2020, $886.2 billion in 2025, and $1117.6 billion in 2030 (American Heart Association, 2012).

Locally

The burden of cardiovascular disease in Texas is also as high as the national one. Heart disease is the single largest killer in this region. The average in Texas is significantly higher than the United States average (American Heart Association, 2012). In 2010 alone, the number of people who succumbed to heart disease is 38,253 (23% of all deaths) (American Heart Association, 2012). The conditions that are categorized as cardiovascular diseases were also independently common in the state of Texas. Stroke ranked the fourth largest cause of death in this state (American Heart Association, 2012). There were 9,180 deaths associated with stroke alone in 2010 (American Heart Association, 2012).

Billions of dollars were also spent in this state to prevent, treat, and deal with the effects of CVDs. The state spent the most amount of money on treatment of the condition. The elderly population was the most affected (American Heart Association, 2012). The region is also high in the rates of obesity and other predisposing factors of cardiovascular diseases such as smoking and alcoholism compared to other states (American Heart Association, 2012).

Etiology and Risk Factors

Cardiovascular diseases are non-communicable. They are caused by the interaction of genetic and environmental factors (Kelly, Narula, & Fuster, 2012). Research shows that the causes of CVDs are either modifiable or non-modifiable, with the major attributable modifiable risk factors being smoking, unhealthy diet, and physical inactivity (World Health Organization, 2012). The modifiable factors are within the control and prevention of the susceptible population while the non-modifiable factors such as genetics are not easily controlled (World Health Organization, 2012). The condition has a peak in the elderly because of the cumulative effects of the predisposing factors.

One of the recognized risk factors is obesity, which predisposes individuals mainly to stroke and heart attacks (Lakic, Tasic, & Kos 2014). Diabetes is also another recognized risk factor, with physical inactivity, smoking, and low socioeconomic status being the other factors (World Health Organization, 2012). The genetic predispositions to the condition reveal the disparity in the prevalence between ethnicities and races in the same geographic region such as the United States (He Hernandez, Fonarow, Liang, Al-Khatib, Curtis, La Bresh Hernandez et al., 2007). The control and prevention of cardiovascular diseases has to target these recognized risk factors.

Impact on Population

The impact of CVD on the population can be grouped into social and economic effects. The economic effects of the diseases include direct loss of income from the treatment of the condition and the loss of labor because of deaths from CVD (Kelly, Narula, & Fuster, 2012). When a person succumbs to A CVD or its complication, the dependents are unable to fill the space that the individual previously occupied. The families may experience financial insecurity. Families and insurance companies also have to pay large sums of money to the health institutions that manage the condition. This means that money that could be used in some important activities is lost.

The deaths from CVD lead to increase in the number of orphans. Many single families exist because of loss of spouses (Kelly, Narula, & Fuster, 2012). However, this effect is not largely felt, as most of people suffering from the conditions are mainly the elderly. The population is forced to take care of the patients of CVD. Time and resources are spent in the process. However, the biggest loser in the event of mortality and morbidity from CVD is the national economy (Kelly, Narula, & Fuster, 2012).

Preventive Approaches

The cost of preventing non-communicable diseases such as CVD is far less than what is spent in their management. Research into the causes of CVD has led to the development of simple strategies and measures that may be applied in the prevention of the condition (World Health Organization, 2012). The World Health Organization (2012) estimates that over 80% of premature mortality from stroke and heart disease can be avoided through cessation of smoking, healthy diet, and regular physical activity.

The prevention of CVD can simply be done through physical activity for at least 30 minutes in a day (World Health Organization, 2012). Healthy eating entails eating fruits and vegetables as part of the daily meal, limiting the amount of salt taken in a day, and avoiding fast foods (World Health Organization, 2012). The daily intake of salt should be reduced to less than a teaspoon. This strategy is likely to reduce the prevalence of CVD (Lakic, Tasic, & Kos 2014). Smoking tobacco is a recognized cause of CVD. It is estimated that more than one quarter of the CVDs can be reduced through the cessation of smoking (Hernandez et al., 2007). The mortalities from CVDs can be prevented through adequate and timely treatment of conditions.

Available Resources to solve the Problem in the Community

The resources available to solve the problem of CVD in the community can be put to use in the management of CVD. The financial resources available are mainly applied in the treatment of the CVDs, with little proportion of this money going to preventive measures. There is the need to put more finance into preventive measures of CVD compared to the treatment. Some of the interventions that can be applied in financial funding include funding of education and production of education materials.

The other resource that is available at the community level is the community health workers who are used to the prevention of CVDs at the community level through educating the general public on how to stay healthy and disease free (Lakic, Tasic, & Kos 2014). The media is also a resource in the prevention of CVDs. Although it is associated with a sedentary lifestyle and obesity, this tool can be used to prevent CDVs by acting as an avenue of education.

Ethical/Political Issues related to the Problems Resolution

The resolution of CVD as a problem affecting the American public has often been associated with several political and ethical issues, as with other health conditions. The prevalence of CVDs in the USA is said to be higher in the Blacks and other minority populations (Hernandez et al., 2007). Despite the rapid growth of the minority populations in the USA, the services accorded to these groups are significantly lower in quality compared to their white counterparts (Hernandez et al., 2007). The level of care for CVDs is one of the factors that have disparity in the population, with insurance companies providing lesser support to the minority populations (Hernandez et al., 2007).

There is progress in primary care for CVDs. However, an ethnic and racial disparity in cardiovascular care is still a significant problem (Hernandez et al., 2007). One of the latest developments in the care of CVD patients is the provision of ICD therapy (Hernandez et al., 2007). However, Black and women CVD patients are less likely to get this therapy in the USA even in the presence of guidelines and indications compared to white men (Hernandez et al., 2007). This observation is a major issue in the management and prevention of CVDs locally and in the USA.

Pertinent Legislation

Legislation is an important part in the control of any health problem. The authorities have a role in the development of policies for prevention and treatment. This section looks at the laws pertaining to the incidence, prevention, management, and control of cardiovascular disease.

International

Internationally, the main body that is tasked with the development of policies on health is the World Health Organization. This body has been in the forefront of developing policies that are aimed at preventing the increased use of tobacco in different parts of the world. Laws have been passed by which each member countries must abide. The WHO has also held a number of conventions that are aimed at developing policies to control hypertension, stroke, diabetes, and other forms of cardiovascular diseases. Smoking and the sale of other commodities listed as illegal drugs are subject to international control. The international laws prohibit the sale of some chemicals that are associated with the etiology of CVD combined with other conditions such as cancer (World Health Organization, 2012).

National

It is vital to investigate the policies that countries have put in place in dealing with health issues in an effort of gauging whether their citizens are safe or not. In the United States, much legislation is dedicated to the prevention of cardiovascular diseases and their management. The main laws in the United States that are related to the prevention of CVDs include the laws on smoking and the insurance policies. Companies that make alcoholic beverage and tobacco products also have to respect the existing policies such as not selling to minors and smoking in public since these acts are prohibited in most states. The Food and Drug Agency is the body that is charged with the security of the nationally available drugs. Some of the commodities that it controls are alcoholic and tobacco products. Therefore, there is adequate legislation at the national level. However, there is still room for more preventive measures.

Local

In the state of Texas, the prevention and management of cardiovascular diseases is supported by policies and legislation. Some of the significant policies include the use of electronic health records in the improvement of care for the CVD patients (Rossi, & Every, 1997). Collaborative services in the care of these patients are also encouraged using pharmacists in collaborative drug therapy (Kinn, Marek, OToole, Rowley, & Bufalino, 2002). The legislation used in the state is in line with the international and national guidelines, including the monitoring of progress for the CVD patients. The state of Texas is also in the process of ensuring that smoking becomes controlled. Smoking in public places is prohibited. Tobacco and alcohol companies have to abide by advertising and marketing policies in place where they are not allowed to sell to minors.

Conclusion

Cardiovascular disease is a significant global, national, and local health problem. Thousands of deaths that are witnessed every year are associated with the disease. CVD is a non-communicable condition that is prevalent in all parts of the world, mostly in the low and middle-income countries. The main problem associated with the condition is the loss of economic resources in a community where many hours are spent in the treatment of the condition. The report indicates that CVD is the leading cause of death in the United States. The prevalence is likely to increase over the next few years. The economic burden from CVD is also likely to increase over the next few decades if no interventions are put in place. The main interventions recognized as preventing CVD include cessation of smoking, eating a healthy diet, and engaging in regular physical exercises.

Summary

The burden of cardiovascular disease is large. It is ever increasing in different parts of the world. This report has looked at the definition of CVD and conditions that are witnessed in this group are states, with the most prevalent being heart failure and stroke. The main risk factors stated in the report include smoking, unhealthy diet, and lack of physical activity. The report has looked at the international, national, and local implications of CVD, with these implications being classified into direct and indirect effects. The suggested approaches in prevention include cessation of smoking, exercise regimes, and fruit and vegetables in the diet. The political and ethical issue in the condition management is the racial and ethnic disparities in the USA. Policies at the international, national, and local levels have been discussed to be related to CVD in the report. The conclusion is that more effort needs to be put in the management of CVD since it is a social and economic health problem.

Reference List

American Heart Association. (2012). Heart and Stroke Statistics-2012 Update. Dallas, TX: American Heart Association.

Hernandez, A., Fonarow, G., Liang, L., Al-Khatib, S., Curtis, L., La Bresh, K., Yancey, C., Albert, N., & Peterson, E. (2007). Sex and Racial Differences in the Use of Implantable Cardioverter-Defibrillators Among Patients Hospitalized with Heart Failure. JAMA, 298(13), 1525 1532.

Kelly, B., Narula, J., & Fuster, V. (2012). Recognizing Global Burden of Cardiovascular Disease and Related Chronic Diseases. Mount Sinai Journal of Medicine, 79(1), 632640.

Kinn, J., Marek, J., OToole, M., Rowley, M., & Bufalino, J. (2002). Effectiveness of the electronic medical record in improving the management of hypertension. Journal of Clinical Hypertension, 4(6), 4159.

Lakic, D., Tasic, L., & Kos, M. (2014). Economic burden of cardiovascular diseases in Serbia. Vojnosanit Pregl, 71(2), 137143.

Rossi, R., & Every, N. (1997). A computerized intervention to decrease the use of calcium channel blockers in hypertension. Journal of General Internal Medicine, 12(1), 6728.

World Health Organization. (2012). World health statistics, 2012. Geneva: World Health Organization.

Abstract

Among a variety of health problems that challenge humans, cardiovascular disease has always been a leading cause of death. People of different ages and both genders are frequently diagnosed with myocardial infarction, stroke, or ischemic heart disease. In addition to individual characteristics, there are many risk factors, including diabetes, hypertension, obesity, or cholesterol. Due to the inability to manage comorbidities or the consequences of family history, people may follow additional recommendations like avoidance of a sedentary lifestyle. The effects of diet and exercise on cardiovascular disease vary, depending on the frequency of interventions and the quality of food. Healthy dietary habits provoke a decrease in the cholesterol level and the control of blood pressure. Physical exercises support the work of muscles and the reduction of obesity-related problems. Both interventions are discussed in recent studies and by professional organizations. The evaluation of cardiovascular diseases and risk factors, along with nutritional and physical intervention, will be developed in this project. Being effective as separate practices for human health, diet and physical activities have to be combined to help people achieve positive health outcomes, stabilize the work of the heart, and predict mortality.

Introduction

Many factors, such as the age of a person, the chosen lifestyle, and family history, contribute to the risk of cardiovascular diseases. At the same time, some health conditions like high blood pressure and diabetes increase the prevalence of this group of diseases among the population. People who neglect the importance of physical exercise and support unhealthy habits (eating, smoking, or alcohol abuse) address their therapists for medical help and health checkups regularly (The Centers for Disease Control and Prevention, 2019). According to the ADAs Medical Knowledge Team (2018), cardiovascular disease is usually a broad term that is used to describe a variety of conditions that influence the work of the heart, including heart attack and stroke. In this research paper, the effects of diet and exercises on the progress of cardiovascular disease will be analyzed. To better understand the connection between dietary habits, physical exercises, and cardiovascular problems, the following aspects have to be discussed:

1. Cardiovascular diseases as a leading cause of death in the United States
2. Risk factors that provoke cardiovascular disease
3. Importance of dietary interventions for cardiac patients
4. The role of exercise training on cardiovascular disease management
5. Combined dietary and exercise interventions in cardiovascular events

Cardiovascular Diseases as a Leading Cause of Death in the United States

Angina, heart failure, stroke, infarction, and carditis are diseases with one similar characteristic that is the existence of problems or dysfunction of the heart or blood vessels. These conditions are usually introduced as a part of the same group of illnesses, known as cardiovascular disease (Cannie et al., 2019). It is one of the major causes of mortality worldwide, leading to about 18 million deaths in 2015 (Ruan et al., 2018). Regarding the current statistics and examinations, it is expected to observe the rise in numbers by 2020, with about 22 million people dying from cardiovascular disease annually (Ruan et al., 2018). The analysis of this condition focuses on the identification of associated factors such as age (older adults with damaged arteries and weakened muscles) or gender (women after menopause and men at any age).

There are many types of cardiovascular diseases that are caused by an unbalanced lifestyle and bad habits. For example, myocardial infarction or a heart attack is a condition when blood and oxygen cannot reach the heart muscle because of a blocked coronary artery (Saleh & Ambrose, 2018). Patients usually report on such symptoms as sharp chest pain, shortness of breath, nausea, and dizziness. Blood tests, a physical examination, and an electrocardiogram are the main diagnostic methods to check the condition and identify the level of the blockage and protein rating (Cannie et al., 2019). Patients get access to several pharmacological and operative treatment plans to remove the blocked vessel and promote oxygen transportation.

An ischemic stroke or simply stroke is another form of cardiovascular disease, the distinctive feature of which is that it occurs not in the heart but in the brain, affecting the work of blood vessels. The prevalence of stroke is discussed in terms of age and gender (more common in men aged between 70-79 years) (Ruan et al., 2018). The symptoms of this condition are usually sudden and short, so it is necessary for people in risk groups to be aware of the major signs and address for help as soon as possible. There is a FAST campaign for healthcare employees and populations to pay attention to the condition of face (dropping), arm (weakness), speech (difficult speaking), and time (call an ambulance soon) (Hickey et al., 2018). Other symptoms to consider include headache, soreness, vision problems, and confusion. In addition to the already mentioned tests, computer tomography scans are helpful to observe the brain and define damaged areas.

Risk Factors That Provoke Cardiovascular Disease

In addition to age and gender factors, family history, and unhealthy habits, cardiovascular disease may be provoked by such health conditions as high blood pressure, diabetes, and abnormal blood cholesterol levels. They are known as the major risk factors that provoke cardiovascular diseases. When the pressure of the blood is elevated and poorly controlled, it influences the work of the heart and the brain. As a silent killer, blood pressure must be reduced (if it is more than 115/75 mmHg) by means of antihypertensive drugs and therapies (The Centers for Disease Control and Prevention, 2019; Stewart et al., 2017). In addition, regular measurements and lifestyle changes are recommended to manage risks and predict cardiovascular disease.

Diabetes is a common chronic condition among people of different ages around the globe. It is characterized by high glucose levels in the blood, which results in the artery walls being damaged and fatty deposits being gathered in the arteries to provoke cardiovascular disease (The Centers for Disease Control and Prevention, 2019). Diabetic patients use insulin to control glucose and discover new sources of energy. The reduction of sugar in the blood is connected with the possibility of reducing the number of cardiovascular-related deaths (Stewart et al., 2017). However, if older adults are diagnosed with diabetes, they are at risk of having heart complications often.

Finally, the evaluation of the level of cholesterol is important in measuring the risk of cardiovascular disease. Cholesterol is a substance that is made by the liver, but its amount is usually not enough, and people have to take special food to maintain its healthy level (The Centers for Disease Control and Prevention, 2019). If extra cholesterol is observed, it may promote the creation of additional walls and boundaries in the arteries and challenge the heart, the brain, and kidneys. In the majority of cases, people do not have any symptoms during this condition, and the only chance to learn the levels is to take tests and check it up.

Importance of Dietary Interventions for Cardiac Patients

To maintain a healthy lifestyle, people are expected to stick to a balanced diet and their obesity-related problems. According to Stewart et al. (2017), diet is an intervention that plays a crucial role in predicting cardiovascular disease risks, but not much evidence is available about direct guidelines for people. For example, in the United States, there is the American Heart Association (AHA) that aims at developing various methods to promote healthy eating. The Dietary Approaches to Stop Hypertension (DASH) contain recommendations on how to use low-sugar products, including vegetables, fruits, and grains (Stewart et al., 2017). Diets that are high in saturated fats and cholesterol are also preferable to assist in stabilizing blood pressure (The Centers for Disease Control and Prevention, 2019). When patients have cardiovascular problems, their care plans are usually based on sugarless and saltiness diets.

More attention should be paid to salt and its impact on peoples tastes and health. In the majority of cases, people cannot stop using salt to add taste to their food. Millions of people around the globe take salt-water baths to improve the skins condition. The point is that salt consists of a number of elements, and one of them is sodium. The consumption of salty products must be minimized because sodium is associated with water retention, which, in its turn, provokes high blood pressure and heart failure risks (Bowen et al., 2018). Allowed limits of sodium are between <1500-2400 mg/day to achieve a blood pressure-lowering effect (Bowen et al., 2018). However, complete removal of salt from a daily ration is never recommended because the presence of this element in the organism has its positive outcomes.

Nowadays, people get access to a variety of diets that meet their preferences and physiological changes and depend on geographical locations. For example, Mediterranean diets focus on the diversity of fruits, vegetables, grains, fish, and dairy and reduce the risk of myocardial infarction and stroke (Lanier et al., 2016). Swedish diet that is characterized by a low intake of fat and sugar contributes to managing the risks of ischemic heart disease (Lanier et al., 2016). In many developing and developed countries, people follow the principles of the DASH diet because the results of cohort studies prove the connection between dietary changes and cardiovascular outcomes (Lanier et al., 2016). Patients who have coronary artery disease should include the DASH diet to their treatment plan and focus on the consumption of nuts, low-fat dairy products, and whole grains. In the world, there are many dietary interventions that depend on the quality of food and its accessibility in regions. Even if a person is not diagnosed with cardiovascular disease, physicians discuss the worth of specific diets to predict strokes and other heart-related complications.

Talking about dietary interventions, one should admit the importance of switching products and substances in the system. For example, saturated fats should be replaced with polyunsaturated fats (Stewart et al., 2017). Proteins are helpful in stabilizing the functions of the heart, and it is necessary to balance meat, fish, and vegetables that are rich in protein. The addition of the food that is rich in fiber is also considered as a healthy diet for people who are at risk of having heart problems (Bowen et al., 2018). These diets are effective for patients who try to manage their diabetes complications. Alcohol is not dangerous if normal limits are followed (one drink per day for women and two drinks per day for men) (The Centers for Disease Control and Prevention, 2019). Still, if a person has already diagnosed with heart disease, many doctors share the same thought  a total avoidance of alcohol.

The Role of Exercise Training on Cardiovascular Disease Management

The improvement of lifestyle modifications is an obligatory step in promoting a positive impact of health outcomes associated with cardiovascular disease. Although mortality and morbidity ratings due to physical exercises are minimal, the benefits of these initiatives cannot be ignored (Stewart et al., 2017). Guidelines and recommendations for society are usually developed by professional organizations and communities, and the National Institute for Health and Care Excellence (NICE) is one of them. In other words, people are not obliged to participate in exercises and physical training. Still, NICE continues offering different ways to promote health and reduce risks. The most common tasks include 150 minutes of moderately intensive aerobic activities or 75 minutes of dynamic activities per week (Stewart et al., 2017). Muscle strengthening is another activity that should occur once or twice per week (Stewart et al., 2017). However, people who are at risk of having heart problems should consult their therapists if the offered modification is appropriate for their specific health conditions.

The lack or absence of physical activities may result in the growth of heart disease and related physiological and health changes such as obesity, diabetes, and hypertension. Following several simple exercises regularly helps burn calories and maintains a healthy weight, which results in decreasing obesity and cholesterol problems (The many ways exercise helps your heart, 2018). The promotion of positive physiological and mood changes is also observed because the arteries are able to dilate (The many ways exercise helps your heart, 2018). There is one fact that has to be understood by all people who want to use physical activities as a means to predict cardiovascular disease: one or two irregular interventions are hardly effective. To achieve positive results and feel changes, exercises must be regular and last more than one week or even month. In addition, it is better to stop smoking, which may become one of the most cost-effective interventions (Stewart et al., 2017). When all these recommendations and hints on how to protect the heart from damage are properly followed, people get an opportunity to reach the full effect of cardiovascular disease prevention.

Combined Dietary and Exercise Interventions in Cardiovascular Events

The control of health conditions that increase cardiovascular risks is possible plays a crucial role. Individuals who take care of their dietary habits and reduce the use of unhealthy food experience face fewer or no problems with blood pressure that is a major risk factor for heart disease (The Centers for Disease Control and Prevention, 2019). People who take physical exercises regularly also get an opportunity of reducing obesity-related problems, high blood pressure, and high cholesterol levels (Stewart et al., 2017). The combination of dietary and exercise interventions is frequently recommended by their therapists and cardiologist for older adult patients with heart disease (Ruan et al., 2018). Some people find it normal to reduce the intake of fat or salty products without a professional medical examination or exhaust themselves with regular exercise to achieve the desired weight. Such decisions may cause more harm than positive outcomes because not all bodies are ready for these physiological changes. Therefore, in all cases, professional recommendations and medical experts support have to be recognized.

Another important aspect to remember is that certain health improvements due to exercises and diets are observed with time. It means that any practice (either diet or exercise) should not be a one-day initiative (The many ways exercise helps your heart, 2018). People have to develop special plans and follow them regularly during at least a month. In other words, if a person sticks to a diet during 1-2 weeks only, no evident results and positive changes in regard to cardiovascular disease prevention could be observed. Several physical activities once or twice per year would be hardly effective, and the threat of cardiovascular disease exists. As soon as a physician discovers the risk of cardiovascular disease, additional tests should be taken to examine the condition of the patient. When no evident threats associated with lifestyle changes are approved, further dietary changes or physical activities may be added to a treatment plan. In general, cooperation with a healthcare expert, keeping a diet and exercises on track, and following recommendations have to be a long-time procedure, with regular improvements and changes as per personal health characteristics.

The idea to combine exercise and diet is successfully promoted if participants consider the basics of both initiatives. In the United States, physicians support behavioral counseling even for people without evident cardiovascular risk factors (Lanier et al., 2016). The analysis of individual factors in the promotion of adherence to physical and nutritional interventions is required. Only when a person is ready for change, receives appropriate social support, and uses community resources, the reduction of heart problems is possible (Lanier et al., 2016). A sedentary lifestyle (the lack of a healthy diet and physical activities) is dangerous for a human heart (Saleh & Ambrose, 2018). In addition, people cannot control the impact of risk factors and comorbidities on cardiovascular disease (Ruan et al., 2018). Therefore, instead of provoking new problems, exercises and diet cannot be ignored. The combination of these interventions is characterized by the reduction of blood pressure problems and weight growth, which are the major risks of cardiovascular disease.

Conclusion

Cardiovascular diseases may vary, depending on symptoms and individual factors. The choice of a diet and the desire to take physical exercises regularly improve health, contribute to a healthy lifestyle, and predict the growth of risk factors in older adults. However, significant changes in body weight and blood pressure are not enough to protect the population against cardiovascular diseases. Many health conditions provoke the hearts damage or dysfunction of the brain. Therefore, attention to existing comorbidities and external factors, along with diet and exercise, is always required. In this research paper, the effects of exercise and diet on human hearts were discussed through the prism of the analysis of cardiovascular diseases, its types, and risk factors. In addition, the effectiveness of a combination of physical activities and nutritional recommendations was proved by evaluating their separate outcomes and their suitability.

References

The ADAs Medical Knowledge Team. (2018). Cardiovascular disease risk factors. ADA.

Bowen, K. J., Sullivan, V. K., Kris-Etherton, P. M., & Petersen, K. S. (2018). Nutrition and cardiovascular disease  An update. Current Atherosclerosis Reports, 20(2).

Cannie, D. E., Akhtar, M. M., & Elliott, P. (2019). Hidden in heart failure. European Cardiology Review, 14(2), 89-96.

The Centers for Disease Control and Prevention. (2019). Know your risk for heart disease. CDC.

Hickey, A., Mellon, L., Williams, D., Shelley, E., & Conroy, R. M. (2018). Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. European Stroke Journal, 3(2), 117-125.

Lanier, J. B., Bury, D. C., & Richardson, S. W. (2016). Diet and physical activity for cardiovascular disease prevention. American Family Physician, 93(11), 919-924.

The many ways exercise helps your heart. (2018). Harvard Health Publishing.

Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., Shi, Y., & Wu, F. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: Results from SAGE Wave 1. BMC Public Health, 18(1).

Saleh, M., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7.

Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovascular Disease, 6.

The heart is the central organ of the cardiovascular system. It is essential for carrying out the blood circulation process vital for maintaining normal homeostasis as per the bodys requirements. In this regard, it is essential to know the various functions of the cardiovascular system. The various mechanisms that regulate arterial blood pressure are those that may be instantly performing well and others that possess extended performance durations (Guyton and Hall, 2006). Here, the timing of an Electrocardiogram (ECG) depends on PTQ which is considered as a method to detect cardiac glycoside pharmacodynamics. The linear correlation between PTQ change and systolic time intervals influence arterial pressure which is regulated by local blood flow control and cardiac output control. The cardiac output is in turn regulated by altogether the blood flows of local tissues (Guyton and Hall, 2006). The mechanism proceeds with a high flow of blood through the tissues that leads to high venous return and good cardiac output.

This is because the heart pumps in an inherently regulated manner based on the Frank-Starling mechanism where certain neural involvement is believed to exist. Other mechanisms include Baroreceptor, Chemoreceptor, renal blood volume pressure control. Baroreceptor and chemoreceptor-mediated mechanisms are based on reflex actions that are neutrally, instantly, and long-acting (Guyton and Hall, 2006). A negative feedback action is always connected to this kind of mechanism. When there is high arterial blood pressure, the stimulation of these nerve endings leads to reduced activity of the sympathetic vasoconstrictor part of the vasomotor center and enhanced activity of the parasympathetic part of the vasomotor center (Guyton and Hall, 2006). Ventricular pressure may lead to blood flow to the atrium, A-Valve that is in agreement with the peak R wave of ECG, causing first hear sound. Subsequently, ventricular contraction, causes blood released out of arteries where the elastic nature of the artery could enable aorta and pulmonary circulation down the atrium and close the aortic valve, leading to the second heart sound.

This mechanism is essential in promoting the impulses to the vasomotor center and is essential for continuous and rapid monitoring of arterial blood pressure within a normal limit (Guyton and Hall, 2006). However, they are limited to long-term control actions. The chemoreceptor-mediated mechanism involves action during low levels of oxygen. It begins when there is a fall in arterial blood pressure which leads to decreased oxygen amount that finally causes stimulation of vasomotor center and a rise in arterial blood pressure (Guyton and Hall, 2006). The first and second Heart sounds could be subjected to analysis by Fourier transform enabled the digital spectrum analysis. This leads to assess the cardiac blood flow during conditions where cardiac blood flow is minimum which in turn requires the long term control of systemic arterial pressure: This involves the action of kidneys that exert long term control on arterial blood pressure by regulating extracellular fluid volume (Guyton and Hall, 2006).

This occurs when there is high arterial blood pressure that enables increased water to get filtered from the glomerular capillaries. This also lowers blood volume and raises urinary output through the action of the Frank-Starling mechanism (Guyton and Hall, 2006). The renin-angiotensin system of mechanism offers efficient renal excretion of Na+ and water leading to decreased vasoconstriction(Guyton and Hall, 2006). Rennin gets released due to a fall in arterial blood pressure and is responsible for the conversion of angiotensin II angiotensin I in the lungs(Guyton and Hall, 2006). Other mechanisms regulate arterial blood pressure more slowly as they depend on enhancing the volume of blood by lowering the output of urine (Guyton and Hall, 2006). These are the Central nervous system ischaemic response which is a potent control system that enhances arterial blood pressure when cerebral ischemia occurs due to inimical low arterial blood pressure (Guyton and Hall, 2006). Muscle (venous) pump which facilitates compression of the venous region by the nearby contraction of skeletal muscles that promotes venous return when the exercise gets initiated.

Abdominal compression reflex involves Baroreflex or chemoreflex mediated activation of abdominal skeletal muscles that exert a kind of compressing action on the large abdominal capacitance veins which promotes venous return. The speed of onset of mechanisms involved in the cardiovascular system has a beneficial role in the compensation of cardiac failure (Guyton and Hall, 2006). Whenever there is heart damage, there could be a low cardiac output (Guyton and Hall, 2006). This is counteracted by reflex mechanisms of baroreceptors and chemoreceptors that influence sympathetic stimulation and parasympathetic inhibition of the heart and blood vessels. Semi-chronic accumulation of fluid by the kidneys to enhance increased cardiac output through the Frank-Starling law of the heart and the Bainbridge reflex (Guyton and Hall, 2006).

References

Guyton GC and JE Hall. Textbook of Medical Physiology.11th ed. Philadelphia: Elsevier Saunders.. 2006.

Abstract

The present description is concerned with highlighting two papers by comparing and contrasting the research and analysis. The first paper was focused on the survey program to determine the utility of complementary and alternative medicines (CAM) in Australia. The second paper was focused to determine if supplementation of vitamin E or C for a prolonged period would lessen the threat of chief cardiovascular events in male individuals. The first paper is a Longitudinal Study of Ageing which began in 1992 and continued till 2004 to better obtain sound data in 4 approaches.

The second paper is a Physicians Health Study II (PHS II) that was undertaken in a randomized, double-blind, placebo-controlled factorial trial manner on the role of vitamins E and C. It began in 1997 and continued till 2007. In the first study, nearly 2087 adults aged 65 years and above who were staying in the community or residential aged care were selected. In the second study, nearly 14,641 U.S. male physicians aged 50 years and above were selected. This included 754 (5.1%) men with prevalent CVD at randomization. In the first paper, findings revealed that the utility of CAM or OTC was recorded to be 17.7% during 2000-2001. This increased during 2003-2004 to 35.5% The utility of important classes of CAM and OTC medicines did not change during the study period indicating the stability. In addition to vitamins, the CAMs more often used components were found to be herbal drugs and nutritional products, whereas the frequent OTCs were found to be aspirin at small doses and analgesic drugs.

It was revealed that females and those with younger age were more susceptible to CAM usage in contrast to OTC. In the second paper, the findings revealed that vitamin E does not influence the incidence of major cardiovascular events, total MI, total stroke and cardiovascular mortality. Similarly, vitamin C does not produce any significant effect on major cardiovascular events MI, total stroke and cardiovascular mortality. These two vitamins also did not correlate significantly with total mortality. However, vitamin E was related to an increased risk of hemorrhagic stroke.

Therefore, the paper that was identified for critical analysis was that of Vitamins E and C in the Prevention of Cardiovascular Disease in Men. This is because the health benefits of vitamin E and C supplementation in preventing CVD are still in debate due to inconsistent reports. The problem of CVD in US men has also become a problematic issue. Hence there is a need for a thorough analysis of studies that furnish insights on the significant rile of vitamin supplementation. Moreover, as vitamins are safer in contrast to drug therapy, choosing the strategy of vitamin supplementation is the best one to be considered for an investigation, analysis and review. In view of this, various articles have been identified that would be highlighted to support the description of the paper.

Introduction

The role of an introduction in a research paper is to present a background of the information related to the proposed area of investigation. This could begin with the particular area from where the research has initiated, data on earlier studies accumulated to date. Then the next aspect is to highlight the problems like controversies, debates or uncertainties that were entangling the area for a certain period. Then emphasize this problem by establishing a connection with the objective or aim. Therefore, the hypothesis or aim of a paper/research project is to give precise information on the problem and state the feasibility of whether it could be addressed or not with a suitable approach. The objective then becomes clear with a statement that an appropriate strategy or investigation was chosen to determine the problem. The chosen paper is in agreement with the role and purpose of the introduction. This could be because the paper has very well highlighted the background information and uncertainties.

It has made an in-depth analysis of earlier studies by giving the time period (1999-2000) and the findings obtained at that time. In addition, it has also provided basic information with regard to the subject by suggesting that vitamins E, C, and other antioxidants would minimize cardiovascular disease (CVD) by blocking organic free radicals and/or inactivating oxygen molecules to inhibit tissue injury. The structure of the paper is well represented. It has given a good beginning to the paper by highlighting the debate regarding the intake of vitamins in the face of uncertainties, and information on the role of vitamins and their antioxidant properties and their relevance to cardiovascular problems. The structure has also emphasized the priority that should be given to the study. Therefore, the quality of the introduction in the paper is deeply rooted in that it has furnished better insights on the functional aspects of vitamins C and E, their public health implications. The connection between the research problem and the objectives could seem to further strengthen the quality of the introduction. The chosen paper has a clearly set out aim.

Keeping in view of the background information and the problem, the researchers have perfectly designed the Study known as the Physicians Health Study II (PHS II) in order to give new and clinically reliable information on the individual effects of vitamin E and vitamin C supplementation on the risk of major cardiovascular events among 14,641 male physicians at lower initial risk of CVD in contrast to the earlier experiments. The aim of the paper is to furnish useful information on the beneficial role of vitamin E and vitamin C supplementation by relating with the major cardiovascular problems. The presented literature adequately supports the presented aim. This is because it has initially provided functional relevance of vitamins C and E to draw attention and made an association with the earlier controversies. This probably has not only shed light on the subsequent parts of the literature but also established a tight connection with the scientific description imminent in the aim.

Methodology and analysis

The method that has been used as part of the research design is that quantitative one that has a randomized, double-blind, placebo-controlled factorial trial. This was done to determine the balance of harmful and beneficial role of vitamins E,C and multivitamins in the prevention of cancer and CVD in 14,641 U.S. male physicians. The method known as the Physicians Health Study (PHS) II study design was undertaken in two phases. The method included was the eligibility condition where the men participants should have a history of cardiovascular events with stroke for PHS II.

This is the most appropriate methodology to be used. This could be because of reliability in designing the study and the time period set for the data collection. Earlier a study conducted to determine the Association of, vitamins C and E supplementation with that of ischemic heart disease (IHD) and stroke has yielded inconsistent information (Dagenais, et a., 2000). These controversies are better addressed with the present methodology. Hence, the type of data that was collected was of follow- up one related to ten years, and outcome of events of men. This was related to major cardiovascular events, total myocardial infarction, total stroke, cardiovascular mortality, baseline characteristics as per vitamin C and E treatment plan, and overall association of vitamins to the cardiovascular events.

The experimental data was represented as totals and percentages in parentheses for several baseline characteristics. For representing the association between randomized vitamin E and vitamin C assignment and the risk of major cardiovascular events and mortality, the data was focused on the outcome of events under investigation and a comparison between active and placebo groups. A 95% CI analysis was done for assessing the hazard ratio. This was also done for obtaining information on the outcome of events according to baseline characteristics and treatment assignment in the study. A 95% CI analysis was done for assessing hazard ratio but with P interaction.

As such, the analysis is in agreement with the study design and hence is appropriate. The analysis has been undertaken well as it incorporated tools like 95 % CI and P interaction in assessing the cardiovascular risk in active and placebo groups. The analysis revealed no significant association between the vitamins E, C and the risk of cardiovascular events and mortality. However, the analysis could have been improved by incorporating additional parameters like C  reactive protein (CRP) which is widely considered as the good marker of cardiovascular inflammation. A correlation with CRP could have yielded significant information on the role of vitamins C and E with reference to cardiovascular

Inflammation

Next, validity and reliability are important for the research. This is to generate scientific cogency presented in the paper which plays important role in strengthening the data. This would be accepted by a wide group of audience who may evaluate the paper critically in terms of risk-benefit ratio, controversies addressed, reproducibility and its future implications. Hence, in the chosen paper, the validity and reliability stem from the large sample size and the time period that have become an integral part. Secondly, the basic information on the functional properties of vitamin C and E, comparison between active and placebo groups, the CI levels, etc have made the paper valid and reliable. More probably, the study treatment, follow-up, and compliance were well set and reliable. This was made feasible through recently known risk contributors, novel endpoints that take place and questionnaires. The therapy that began in the blinded fashion of the vitamin E and C components of PHS II has a follow-up and validated report of endpoints through September 2008.

Therefore, the validity and reliability of the paper were very well presented. The method/methodology that has been used as part of the research design is that of recruitment, enrollment of participants and randomization of men. The methodology employed informing the placebo and active group of participants about daily and alternative intake of vitamin E and C through calendar packs annually.

The method of interviewing through questionnaires is a vital component of the methodology part.

Next, the method also consisted of a follow-up program which has yielded vital information on the continuity of vitamins intake, potential adverse events, the occurrence of new endpoints, and updated risk factors.

Conclusion

The conclusion of the paper is in agreement with the data presented in the paper. This was revealed from the findings that supplementation of vitamins E and C did not produce any significant reduction of major cardiovascular events in the long-term Randomized Trials of male physicians. Similarly, from the data, the vitamins have no effect on myocardial infarction, total stroke, cardiovascular death, congestive heart failure, and total mortality. The researcher has also concluded well on vitamin E due to its increasing effect on hemorrhagic stroke. Therefore, the conclusion of the paper has the right information in addressing the aim. This could be justified from the concluding remarks that long-term supplementation of vitamins E or C did not produce a lessening effect on major cardiovascular events among men. This was strongly connected to the objective under investigation.

Further, the ethical issues raised by the paper have no connection with the resources or any funding bias. The participants have been provided informed consent and there was no external pressure of any kind to draw the attention of participants for the study. Hence, ethical issues have not been highlighted. The results of the research have shed light with regard to the baseline characteristics. This could be due to the fact that the theses are essential to undertake the study in long-term randomized clinical trials similar to that of the present study. Especially, this has indicated that there is a need to consider earlier drug history specific to Aspirin, smoking, exercise, and alcohol consumption. Since these components may interfere with the results, their evaluation is necessary. Similarly, the role of hypertension, cholesterol, diabetes has also yielded good information indicating that their inclusion is a must in studies the focus on the major cardiovascular events.

The information obtained from the paper could be utilized well for reproducing the experiment in our clinic. For example, the patients attending the routine diabetic clinic have been ruled out for cardiovascular risk. These patients could be selected and an intervention program could be devised to look for the beneficial effects of vitamin C and E supplementation. Screening of patients who run a high risk of cardiovascular complications would be given prior importance in our clinic. This makes our eligibility criteria reliable and valid. This could be reflected as a personal reflection. This is because the outcome of the study is reliable and has future implications on the role of vitamins E and C in a good number of participants (Jha, et al., 1995).

Earlier findings have been under debate whether vitamins E and C have beneficial or no effect on cardiovascular events (Dagenais, et al., 2000). In an epidemiologic study, it was suggested that vitamins with antioxidant properties lessen cardiovascular disease especially with regard to vitamin E(Jha, et al., 1995). But Full randomized trials do not support this research. Hence, controversy has been initiated and need to be addressed should by a large-scale and long-term randomized trial set particularly to determine the role of vitamins E and C in cardiovascular disease (Jha, et al., 1995).

References

Dagenais, G.R., Marchioli, R., Yusuf, S., Tognoni, G. 2000. Beta-carotene, vitamin C, and vitamin E and cardiovascular diseases. Curr Cardiol Rep,2(4),pp. 293-9. Web.

Jha, P., Flather, M., Lonn, E., Farkouh, M., Yusuf, S. 2000. The antioxidant vitamins and cardiovascular disease. A critical review ofepidemiologic and clinical trial data. Ann Intern Med, 123(11), pp. 860-72. Web.

Lynn Yeen Goh, Agnes I Vitry, Susan J Semple, Adrian Esterman, Mary A Luszcz. 2009. Self-medication with over-the-counter drugs and complementary medications in South Australias elderly population. BMC Complementary and Alternative Medicine, 9: 42.

The three main risk factors for cardiovascular disease include hypertension, diabetes, and obesity (World Heart Federation, 2014). The three risk factors are modifiable since they are treatable and we can change them. Diabetes, especially Type2 diabetes, is a major risk factor for coronary heart disease and stroke (World Heart Federation, 2014). Medical research proves that a person with diabetes is more likely to develop cardiovascular disease than a person with no diabetes is (World Heart Federation, 2014). More specifically, failure to control diabetes leads to the development of cardiovascular disease at an earlier age (World Heart Federation, 2014). Diabetes fosters hypertension and type 2 diabetes is prominent in overweight or obese people, which is also a risk factor for cardiovascular disease (National Institutes of Health, 2011). More so, premenopausal women with diabetes are more prone to cardiovascular disease (World Heart Federation, 2014).

Ideally, uncontrolled diabetes damages our bodys blood vessels subjecting them to damage from atherosclerosis and hypertension (World Heart Federation, 2014). Moreover, Type 1 diabetes or type 2 diabetes can damage the arteries (NHS, 2014) and diabetes can develop silent heart attacks, because diabetes damages the nerves and blood vessels (World Heart Federation, 2014). Luckily, we can control diabetes through a recommended management plan. For a patient, who is yet to develop a heart disease, I will advise to control their blood sugar, maintain a healthy diet, and lose weight to improve their health and reduce the risk of a cardiovascular disease (World Heart Federation, 2014). Such patients should also stop smoking, take diabetes medicine metformin, engage in physical activity, make lifestyle changes, and receive education about diabetes. An education plan with these components will reduce the risk of developing cardiovascular disease in my diabetic patients.

Hypertension is seemingly the greatest modifiable risk factor for cardiovascular disease. Indeed, hypertension is the biggest risk factor for stroke and plays a significant role in heart attacks. Hypertension can distort the artery walls and constrain the bodys blood vessels, causing them to clog or weaken thus developing a blood clot (World Heart Federation, 2014). Notably, hypertension in people less than 50 years old has a great risk for cardiovascular disease (National Institutes of Health, 2011). Ideally, 50% of ischemic and hemorrhagic strokes result from hypertension (World Heart Federation, 2014). As such, hypertension derives the greatest risk for cardiovascular disease. Nevertheless, we can control hypertension through a recommended management plan. For a patient who is yet to develop a heart disease, I will advise to maintain a healthy low salt diet, quit smoking, maintain healthy weight, engage in physical activity, and learn to manage stress. Furthermore, I will also advise them to limit their alcohol uptake. These aspects control high blood pressure thus reducing the risk for other health problems like cardiovascular disease.

Obesity is another modifiable risk factor for cardiovascular disease. Indeed, obesity or being overweight increases the risk of developing diabetes, high blood pressure, and atherosclerosis (NHS, 2014). Obese people have intra-abdominal fat that affects their blood pressure, blood lipid levels, and alters their capacity to consume insulin effectively (World Heart Federation, 2014). Ideally, effective use of insulin plays a fundamental role in processing glucose derived from food. As such, patients who fail to use insulin properly are prone to diabetes, which propagates cardiovascular disease (World Heart Federation, 2014). However, we can prevent obesity through a recommended management plan. For a patient who is yet to develop a heart disease, I will advise to follow a healthy eating plan, engage in physical activity, and maintain healthy weight, body mass index, and waist circumference. I will also advise them to reduce the screen time by limiting the use of televisions, computers, and other electrical devices, which reduce our commitment to physical activity. In including these aspects in the education plan, I will significantly help my obese patient to reduce their risk for cardiovascular disease.

References

National Institutes of Health. (2011). What Are Coronary Heart Disease Risk Factors? Web.

NHS. (2014). Cardiovascular disease  Risk factors. Web.

World Heart Federation. (2014). Cardiovascular disease risk factors. Web.

Specific Objective & Current Data

Cardiovascular diseases (CVD) stand among the leading death causes in the U.S. and the world. According to Pescatello et al. (2019), it accounts for approximately every third death in both cases (30.8% in the U.S. and 31% globally). Hypertension is the most common CVD risk factor, which often increases the probability of potential coronary heart disease development and strokes. In addition, Albus et al. (2019) note that psychosocial factors indirectly contribute to CVD development. They can decrease the organisms ability to suppress other direct factors. Consequently, Healthy People 2030 develop programs and interventions to address the CVD issue from different angles simultaneously. Their objective of reducing coronary heart disease death rates is set to achieve 71.1 deaths per 100,000 population, and its actual state is currently improving (Healthy People 2030, n.d.). Numerous evidence-based resources provided on the topic support this fact.

Evidence-Based Resource

For instance, the resource depicting team-based care approach showcases a successful multi-faceted healthcare intervention. According to The Community Guide (2020), it increases the proportion of patients who can control their blood pressure and is also economically cost-effective. At its core, the intervention represents a multidisciplinary team of healthcare professionals who complement each other in patients medication management, follow-ups, adherence, and support of self-management measures (The Community Guide, 2020). The team addresses the issue of CVD prevention by systematically facilitating communication, coordination, and patient engagement.

Implementation into Practice

Interventions implementation into practice varies depending on the particular CVD developmental factors. For example, in the case of hypertension, physical exercise as a part of self-management helps reduce blood pressure levels (Pescatello et al., 2019). Mainly, it allows for equalizing the hypertensive level to the normal one, decreasing potential exacerbations. Regarding psychological CVD causes, the intervention team provides educational and behavioral change support (The Community Guide, 2020). It shows the understanding and care which addresses the patients feeling of isolation and helplessness.

As a healthcare provider, I highlighted three notions I deem vital for my future practice. Firstly, it is important not to focus solely on physical disease factors, as you might limit the number of potential solutions. Secondly, psychosocial factors affecting the patient might be easily overlooked during treatment, reducing treatment effectiveness. Finally, the interdisciplinary approach allows healthcare professionals to cover each others weak sides while utilizing strengths to develop the best solution.

References

Albus, C., Waller, C., Fritzsche, K., Gunold, H., Haass, M., Hamann, B., Kindermann, I., Kollner, V., Leithauser, B., Marx, N., Meesmann, M., Michal, M., Ronel, J., Scherer, M., Schrader, V., Schwaab, B., Weber, C. S. & Herrmann-Lingen, C. (2019). Significance of psychosocial factors in cardiology: Update 2018. Clinical Research in Cardiology, 108(11), 1175-1196. Web.

Healthy People 2030. (n.d.) Browse objectives. ODPHP. Web.

Pescatello, L. S., Buchner, D. M., Jakicic, J. M., Powell, K. E., Kraus, W. E., Bloodgood, B., Campbell, W.W., Dietz, S., Dipietro, L., George, S. M., Macko, R. F., McTiernan, A., Pate, R. R. & Piercy, K. L. (2019). Physical activity to prevent and treat hypertension: A systematic review. Med Sci Sports Exerc, 51(6), 1314-1323. Web.

The Community Guide. (2020). Heart disease and stroke prevention: Team-based care to improve blood pressure control. Web.