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{{Ficha de enfermedad
| nombre = Enfermedades cardiovasculares |
| imagen = Cardiac amyloidosis very high mag movat.jpg
| pie = [[Micrografía]] de un corazón con [[fibrosis]] (amarillo) y [[amiloidosis]] (marrón). [[Tinción de Movat]].
| DiseasesDB = 28808
| CIE-10 = {{CIE-10|I|51|6|i|30}}
| CIE-9 = {{CIE-9|429.2}}
| CIE-O =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D002318
}}




== Prevención ==
Hasta el 90% de las enfermedades cardiovasculares se pueden prevenir si se evitan los factores de riesgo establecidos. <ref name="McGill2008">{{cite journal|title=Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study|date=March 2008|journal=Circulation|volume=117|issue=9|pages=1216–27|doi=10.1161/CIRCULATIONAHA.107.717033|pmid=18316498|vauthors=McGill HC, McMahan CA, Gidding SS|doi-access=free}}</ref><ref>{{cite journal|title=Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study|date=August 2016|journal=Lancet|volume=388|issue=10046|pages=761–75|doi=10.1016/S0140-6736(16)30506-2|pmid=27431356|display-authors=6|vauthors=O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P, Damasceno A, Langhorne P, McQueen MJ, Rosengren A, Dehghan M, Hankey GJ, Dans AL, Elsayed A, Avezum A, Mondo C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Magazi D, Nilanont Y, Ferguson J, Pare G, Yusuf S|s2cid=39752176}}</ref><ref>{{cite journal|title=Hypercholesterolemia in youth: opportunities and obstacles to prevent premature atherosclerotic cardiovascular disease|date=January 2010|journal=Current Atherosclerosis Reports|volume=12|issue=1|pages=20–8|doi=10.1007/s11883-009-0072-0|pmid=20425267|vauthors=McNeal CJ, Dajani T, Wilson D, Cassidy-Bushrow AE, Dickerson JB, Ory M|s2cid=37833889}}</ref> Las medidas que se practican actualmente para prevenir las enfermedades cardiovasculares incluyen:


* Reducción del consumo de [[grasas saturadas]]: existe evidencia de calidad moderada de que la reducción de la proporción de grasas saturadas en la dieta y su sustitución por [[Ácido graso insaturado|grasas insaturadas]] o [[Glúcido|carbohidratos]] durante un período de al menos dos años conduce a una reducción del riesgo de enfermedad cardiovascular.<ref name="HooperMartin2020">{{cite journal|title=Reduction in saturated fat intake for cardiovascular disease|journal=Cochrane Database of Systematic Reviews|volume=5|pages=CD011737|issn=1465-1858|doi=10.1002/14651858.CD011737.pub2|pmid=32428300|year=2020|vauthors=Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS|type=Systematic review}}</ref>
Las '''enfermedades cardiovasculares''' (ECV), también denominadas '''cardiovasculopatías''', son todas aquellas enfermedades que afectan el [[corazón]] o los [[Vaso sanguíneo|vasos sanguíneos]].<ref name="WHO2011">{{cite book|first1=Shanthi|last1=Mendis|first2=Pekka|last2=Puska|first3=Bo|last3=Norrving|title=Global Atlas on Cardiovascular Disease Prevention and Control|url=http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|year=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|pages=3–18|isbn=978-92-4-156437-3|url-status=live|archive-url=https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|archive-date=2014-08-17}}</ref><ref>{{Cita web|url=https://dtme.ranm.es/buscador.aspx?NIVEL_BUS=3&LEMA_BUS=enfermedad%20cardiovascular|título=Real Academia Nacional de Medicina: Buscador|fechaacceso=2020-11-02|sitioweb=dtme.ranm.es}}</ref> Las enfermedades cardiovasculares también incluyen las cardiopatías, que son las enfermedades que afectan al corazón pero no a los vasos sanguíneos, y las enfermedades de las [[arterias coronarias]] como la [[Angina de pecho|angina]] y el [[Infarto agudo de miocardio|infarto de miocardio]] (comúnmente conocido como ataque al corazón).<ref name="WHO2011" /> Otras enfermedades cardiovasculares son el [[accidente cerebrovascular]], la [[insuficiencia cardíaca]], la [[enfermedad cardíaca hipertensiva]], la [[fiebre reumática]], la [[miocardiopatía]], el [[Trastornos del ritmo cardíaco|trastorno del ritmo cardíaco]], la [[cardiopatía congénita]], las [[Valvulopatía|valvulopatías]], la [[carditis]], el [[Aneurisma de aorta|aneurisma de aorta,]] la [[enfermedad vascular periférica]] y las [[trombosis]].<ref name="WHO2011" /><ref name="GDB2013">{{cite journal|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013|date=January 2015|journal=Lancet|volume=385|issue=9963|pages=117–71|doi=10.1016/S0140-6736(14)61682-2|pmc=4340604|pmid=25530442|authors=Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal}}</ref>
* [[Dejar de fumar]] y evitar el humo indirecto.<ref name="NHS Direct">{{cite web|url=https://www.nhs.uk/conditions/heart-attack/prevention/|title=Heart Attack&mdash;Prevention|date=28 November 2019|publisher=NHS Direct}}</ref> Dejar de fumar reduce el riesgo en aproximadamente un 35%.<ref>{{cite journal|title=Smoking cessation for the secondary prevention of coronary heart disease|date=2004-01-01|journal=The Cochrane Database of Systematic Reviews|issue=1|pages=CD003041|editor1-last=Critchley|editor1-first=Julia A|doi=10.1002/14651858.CD003041.pub2|pmid=14974003|vauthors=Critchley J, Capewell S}} {{Retracted|intentional=yes|doi=10.1002/14651858.cd003041.pub3}}</ref>
* Mantener una [[Dieta sana|dieta saludable]], como la [[dieta mediterránea]].<ref name="NHS Direct" /> Las intervenciones enfocadas en la dieta son efectivas para reducir los factores de riesgo cardiovascular cuando se aplican durante un año, pero la efectividad a largo plazo de tales intervenciones y su impacto en las enfermedades cardiovasculares son inciertos.<ref>{{cite journal|url=http://orca.cf.ac.uk/57922/1/CD002128.pdf|title=Dietary advice for reducing cardiovascular risk|date=December 2013|journal=The Cochrane Database of Systematic Reviews|issue=12|pages=CD002128|editor1-last=Brunner|editor1-first=Eric|doi=10.1002/14651858.CD002128.pub5|pmid=24318424|vauthors=Rees K, Dyakova M, Wilson N, Ward K, Thorogood M, Brunner E}}</ref>
* Al menos 150 minutos (2 horas y 30 minutos) de ejercicio moderado por semana.<ref>{{Cite web|url=https://health.gov/paguidelines/guidelines/chapter4.aspx|title=Chapter 4: Active Adults|website=health.gov|archive-url=https://web.archive.org/web/20170313131518/https://health.gov/paguidelines/guidelines/chapter4.aspx|archive-date=2017-03-13|url-status=live}}</ref><ref>{{Cite web|url=http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx|title=Physical activity guidelines for adults|date=2018-04-26|website=NHS Choices|archive-url=https://web.archive.org/web/20170219235702/http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx|archive-date=2017-02-19|url-status=live}}</ref>
* Ceñir el consumo de alcohol a los límites diarios recomendados;<ref name="NHS Direct" /> Las personas que tienen un consumo moderado o bajo de alcohol tienen entre un 25% y un 35% menos de riesgo de enfermedad cardiovascular. Sin embargo, las personas que están genéticamente predispuestas a consumir menos alcohol tienen tasas más bajas de enfermedad cardiovascular, lo que sugiere que el alcohol en sí puede no ser protector. La ingesta excesiva de alcohol aumenta el riesgo de enfermedad cardiovascular y el consumo de alcohol se asocia con un mayor riesgo de un evento cardiovascular en el día siguiente al consumo.
* Presión arterial más baja, si está elevada. Una reducción de 10 mmHg en la presión arterial reduce el riesgo en aproximadamente un 20%.
* Disminuye el colesterol no HDL. El tratamiento con estatinas reduce la mortalidad cardiovascular en aproximadamente un 31%.
* Disminuya la grasa corporal si tiene sobrepeso o es obeso. El efecto de la pérdida de peso a menudo es difícil de distinguir del cambio en la dieta, y la evidencia sobre las dietas reductoras de peso es limitada. En estudios observacionales de personas con obesidad severa, la pérdida de peso después de la cirugía bariátrica se asocia con una reducción del 46% en el riesgo cardiovascular.
* Disminuye el estrés psicosocial. Esta medida puede complicarse por definiciones imprecisas de lo que constituyen intervenciones psicosociales. La isquemia miocárdica inducida por estrés mental se asocia con un mayor riesgo de problemas cardíacos en personas con enfermedades cardíacas previas. El estrés emocional y físico severo conduce a una forma de disfunción cardíaca conocida como síndrome de Takotsubo en algunas personas. El estrés, sin embargo, juega un papel relativamente menor en la hipertensión. Las terapias de relajación específicas tienen un beneficio poco claro.


Las enfermedades cardiovasculares son tratadas por [[cardiólogo]]s, cirujanos cardiotorácicos, [[neurólogo]]s, y [[radiólogo]]s, dependiendo del sistema y [[órgano (biología)|órgano]] tratado; aunque debido a la naturaleza de las causas que las provocan a menudo el ámbito de intervención es mucho más amplio, incluyendo profesionales de la psicología o la nutrición, entre otras. Existe un considerable enlace entre estas especialidades, y es común que incluyan diferentes especialistas del mismo hospital.<ref>Maton, Anthea (1993). Human Biology and Health. Englewood Cliffs, New Jersey: Prentice Hall. ISBN 0-13-981176-1.</ref><!-- Tipos -->


* Limit alcohol consumption to the recommended daily limits; People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease.<ref>{{cite journal|title=Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis|date=February 2011|journal=BMJ|volume=342|pages=d671|doi=10.1136/bmj.d671|pmc=3043109|pmid=21343207|vauthors=Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA}}</ref><ref name="Mostofsky 979–987">{{cite journal|title=Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis|date=March 2016|journal=Circulation|volume=133|issue=10|pages=979–87|doi=10.1161/CIRCULATIONAHA.115.019743|pmc=4783255|pmid=26936862|vauthors=Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA}}</ref> However, people who are genetically predisposed to consume less alcohol have lower rates of cardiovascular disease<ref>{{cite journal|title=Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data|date=July 2014|journal=BMJ|volume=349|pages=g4164|doi=10.1136/bmj.g4164|pmc=4091648|pmid=25011450|display-authors=6|vauthors=Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, Engmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques-Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH, Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hyppönen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjønneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Watkins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP}}</ref> suggesting that alcohol itself may not be protective. Excessive alcohol intake increases the risk of cardiovascular disease<ref>{{cite journal|title=Alcohol and cardiovascular diseases|date=May 2009|journal=Expert Review of Cardiovascular Therapy|volume=7|issue=5|pages=499–506|doi=10.1586/erc.09.22|pmid=19419257|vauthors=Klatsky AL|s2cid=23782870}}</ref><ref name="Mostofsky 979–987" /> and consumption of alcohol is associated with increased risk of a cardiovascular event in the day following consumption.<ref name="Mostofsky 979–987" />
Los mecanismos subyacentes varían según la enfermedad. La [[enfermedad de las arterias coronarias]], el [[Accidente cerebrovascular|ictus]] y la [[enfermedad vascular periférica]] implican [[Ateroesclerosis|aterosclerosis]]. Esto suele ser causado por [[hipertensión arterial]], [[tabaquismo]], [[diabetes mellitus]], [[Sedentarismo (estilo de vida)|sedentarismo]], [[obesidad]], [[Hipercolesterolemia|colesterol alto en sangre]], mala alimentación y consumo excesivo de alcohol, entre otros. Se estima que la presión arterial alta representa aproximadamente el 13% de las muertes por enfermedades cardiovasculares, mientras que el tabaco representa el 9%, la diabetes el 6%, la falta de ejercicio el 6% y la obesidad el 5%.<ref name="WHO2011" /> La [[Fiebre reumática|enfermedad cardíaca reumática]] puede aparecer después de una faringitis estreptocócica no tratada.<ref name="WHO2011" /><!-- Prevención y tratamiento -->
* Lower blood pressure, if elevated. A 10&nbsp;mmHg reduction in blood pressure reduces risk by about 20%.<ref name="Ettehad 957–967">{{cite journal|title=Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis|date=March 2016|journal=Lancet|volume=387|issue=10022|pages=957–967|doi=10.1016/S0140-6736(15)01225-8|pmid=26724178|display-authors=6|vauthors=Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K|doi-access=free}}</ref>
* Decrease non-[[High-density lipoprotein|HDL cholesterol]].<ref>{{cite journal|title=Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis|date=October 2006|journal=Pediatrics|volume=118|issue=4|pages=1447–55|doi=10.1542/peds.2006-0970|pmid=17015535|vauthors=McMahan CA, Gidding SS, Malcom GT, Tracy RE, Strong JP, McGill HC|s2cid=37741456}}</ref><ref>{{cite journal|title=Endothelial function in healthy 11-year-old children after dietary intervention with onset in infancy: the Special Turku Coronary Risk Factor Intervention Project for children (STRIP)|date=December 2005|journal=Circulation|volume=112|issue=24|pages=3786–94|doi=10.1161/CIRCULATIONAHA.105.583195|pmid=16330680|display-authors=6|vauthors=Raitakari OT, Rönnemaa T, Järvisalo MJ, Kaitosaari T, Volanen I, Kallio K, Lagström H, Jokinen E, Niinikoski H, Viikari JS, Simell O|doi-access=free}}</ref> [[Statin]] treatment reduces cardiovascular mortality by about 31%.<ref>{{cite journal|title=Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force|date=November 2016|journal=JAMA|volume=316|issue=19|pages=2008–2024|doi=10.1001/jama.2015.15629|pmid=27838722|vauthors=Chou R, Dana T, Blazina I, Daeges M, Jeanne TL}}</ref>
* Decrease body fat if overweight or obese.<ref>{{cite journal|title=Obesity in older adults: a systematic review of the evidence for diagnosis and treatment|date=September 2006|journal=Obesity|volume=14|issue=9|pages=1485–97|doi=10.1038/oby.2006.171|pmid=17030958|vauthors=McTigue KM, Hess R, Ziouras J}}</ref> The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited.<ref>{{cite journal|title=Long-term effects of weight-reducing diets in people with hypertension|date=March 2016|journal=The Cochrane Database of Systematic Reviews|volume=3|pages=CD008274|doi=10.1002/14651858.CD008274.pub3|pmc=7154764|pmid=26934541|vauthors=Semlitsch T, Jeitler K, Berghold A, Horvath K, Posch N, Poggenburg S, Siebenhofer A}}</ref> In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk.<ref>{{cite journal|title=Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis|date=April 2014|journal=International Journal of Cardiology|volume=173|issue=1|pages=20–8|doi=10.1016/j.ijcard.2014.02.026|pmid=24636546|display-authors=6|vauthors=Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, Mamas MA, Loke YK|hdl=2164/3181|hdl-access=free}}</ref>
* Decrease [[Stress (psychological)|psychosocial stress]].<ref>{{cite journal|title=Psychosocial interventions for patients with coronary artery disease: a meta-analysis|date=April 1996|journal=Archives of Internal Medicine|volume=156|issue=7|pages=745–52|doi=10.1001/archinte.1996.00440070065008|pmid=8615707|vauthors=Linden W, Stossel C, Maurice J|s2cid=45312858}}</ref> This measure may be complicated by imprecise definitions of what constitute psychosocial interventions.<ref name="ThompsonSki2013">{{cite journal|url=https://espace.library.uq.edu.au/view/UQ:304930/Thompson_David_staffdata.pdf|title=Psychosocial interventions in cardiovascular disease--what are they?|date=December 2013|journal=European Journal of Preventive Cardiology|volume=20|issue=6|pages=916–7|doi=10.1177/2047487313494031|pmid=24169589|vauthors=Thompson DR, Ski CF|s2cid=35497445}}</ref> Mental stress–induced [[myocardial ischemia]] is associated with an increased risk of heart problems in those with previous heart disease.<ref>{{cite journal|title=Meta-analysis of mental stress-induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease|date=July 2014|journal=The American Journal of Cardiology|volume=114|issue=2|pages=187–92|doi=10.1016/j.amjcard.2014.04.022|pmc=4126399|pmid=24856319|display-authors=6|vauthors=Wei J, Rooks C, Ramadan R, Shah AJ, Bremner JD, Quyyumi AA, Kutner M, Vaccarino V}}</ref> Severe emotional and physical stress leads to a form of heart dysfunction known as [[Takotsubo syndrome]] in some people.<ref>{{cite journal|title=Takotsubo syndrome (stress cardiomyopathy): an intriguing clinical condition in search of its identity|date=August 2014|journal=The American Journal of Medicine|volume=127|issue=8|pages=699–704|doi=10.1016/j.amjmed.2014.04.004|pmid=24754972|vauthors=Pelliccia F, Greco C, Vitale C, Rosano G, Gaudio C, Kaski JC}}</ref> Stress, however, plays a relatively minor role in hypertension.<ref>{{cite journal|title=Lay perspectives on hypertension and drug adherence: systematic review of qualitative research|date=July 2012|journal=BMJ|volume=345|pages=e3953|doi=10.1136/bmj.e3953|pmc=3392078|pmid=22777025|vauthors=Marshall IJ, Wolfe CD, McKevitt C}}</ref> Specific relaxation therapies are of unclear benefit.<ref name="Relax2006">{{cite journal|title=Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials|date=February 2006|journal=Journal of Hypertension|volume=24|issue=2|pages=215–33|doi=10.1097/01.hjh.0000199800.72563.26|pmid=16508562|display-authors=6|vauthors=Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA|s2cid=9125890}}</ref><ref>{{cite journal|title=Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomised controlled trials|date=May 2014|journal=Journal of Psychosomatic Research|volume=76|issue=5|pages=341–51|doi=10.1016/j.jpsychores.2014.02.012|pmid=24745774|display-authors=6|vauthors=Abbott RA, Whear R, Rodgers LR, Bethel A, Thompson Coon J, Kuyken W, Stein K, Dickens C|doi-access=free}}</ref>


Most guidelines recommend combining preventive strategies. A 2015 Cochrane Review found some evidence that interventions aiming to reduce more than one cardiovascular risk factor may have beneficial effects on blood pressure, body mass index and waist circumference; however, evidence was limited and the authors were unable to draw firm conclusions on the effects on cardiovascular events and mortality.<ref>{{cite journal|url=https://researchonline.lshtm.ac.uk/2274289/1/Multiple%20risk%20factor%20interventions%20for%20primary_GREEN%20VoR.pdf|title=Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries|date=August 2015|journal=The Cochrane Database of Systematic Reviews|issue=8|pages=CD011163|doi=10.1002/14651858.CD011163.pub2|pmc=6999125|pmid=26272648|vauthors=Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A}}</ref> For adults without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease, routine counseling to advise them to improve their diet and increase their physical activity has not been found to significantly alter behavior, and thus is not recommended.<ref>{{cite journal|title=Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement|date=September 2012|journal=Annals of Internal Medicine|volume=157|issue=5|pages=367–71|doi=10.7326/0003-4819-157-5-201209040-00486|pmid=22733153|vauthors=Moyer VA|doi-access=free}}</ref> Another Cochrane review suggested that simply providing people with a cardiovascular disease risk score may reduce cardiovascular disease risk factors by a small amount compared to usual care.<ref>{{cite journal|title=Risk scoring for the primary prevention of cardiovascular disease|date=March 2017|journal=The Cochrane Database of Systematic Reviews|volume=3|pages=CD006887|doi=10.1002/14651858.CD006887.pub4|pmc=6464686|pmid=28290160|vauthors=Karmali KN, Persell SD, Perel P, Lloyd-Jones DM, Berendsen MA, Huffman MD}}</ref> However, there was some uncertainty as to whether providing these scores had any effect on cardiovascular disease events. It is unclear whether or not dental care in those with [[periodontitis]] affects their risk of cardiovascular disease.<ref>{{Cite journal|title=Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis|last1=Liu|first1=Wei|last2=Cao|first2=Yubin|date=31 December 2019|journal=The Cochrane Database of Systematic Reviews|volume=12|pages=CD009197|issn=1469-493X|doi=10.1002/14651858.CD009197.pub4|pmc=6953391|pmid=31887786|last3=Dong|first3=Li|last4=Zhu|first4=Ye|last5=Wu|first5=Yafei|last6=Lv|first6=Zongkai|last7=Iheozor-Ejiofor|first7=Zipporah|last8=Li|first8=Chunjie}}</ref>
Se estima que hasta el 90% de las enfermedades cardiovasculares podrían llegar a prevenirse,<ref name="McGill2008">{{cite journal|title=Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study|date=March 2008|journal=Circulation|volume=117|issue=9|pages=1216–27|doi=10.1161/CIRCULATIONAHA.107.717033|pmid=18316498|vauthors=McGill HC, McMahan CA, Gidding SS|doi-access=free}}</ref><ref>{{cite journal|title=Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study|date=August 2016|journal=Lancet|volume=388|issue=10046|pages=761–75|doi=10.1016/S0140-6736(16)30506-2|pmid=27431356|display-authors=6|vauthors=O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P, Damasceno A, Langhorne P, McQueen MJ, Rosengren A, Dehghan M, Hankey GJ, Dans AL, Elsayed A, Avezum A, Mondo C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Magazi D, Nilanont Y, Ferguson J, Pare G, Yusuf S|s2cid=39752176}}</ref> lo cual implicaría modificar los siguientes factores de riesgo: alimentación saludable, ejercicio, evitar el consumo del tabaco y limitar la ingesta de alcohol. También resulta beneficioso tratar los factores de riesgo, como la presión arterial alta, los lípidos en sangre y la diabetes.<ref name="WHO2011" /> Tratar a las personas que tienen faringitis estreptocócica con antibióticos puede reducir el riesgo de enfermedad cardíaca reumática. El uso de aspirina en personas que por lo demás están sanas no tiene un beneficio claro.<ref>{{cite journal|title=Aspirin in primary prevention of cardiovascular disease and cancer: a systematic review of the balance of evidence from reviews of randomized trials|date=2013|journal=PLOS ONE|volume=8|issue=12|pages=e81970|bibcode=2013PLoSO...881970S|doi=10.1371/journal.pone.0081970|pmc=3855368|pmid=24339983|display-authors=6|vauthors=Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Ngianga-Bakwin K, Grove A, Gurung B, Morrow S, Stranges S, Clarke A}}</ref><ref>{{cite journal|title=Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews|date=September 2013|journal=Health Technology Assessment|volume=17|issue=43|pages=1–253|doi=10.3310/hta17430|pmc=4781046|pmid=24074752|display-authors=6|vauthors=Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, Grove A, Gurung B, Morrow S, Clarke A}}</ref> La [[celiaquía|enfermedad celíaca]] no diagnosticada se ha relacionado con numerosas afecciones cardiovasculares. <ref name="CiaccioLewis2017" /><!-- Epidemiología -->


=== Diet ===
Las enfermedades cardiovasculares son la principal causa de muerte en todo el mundo, excepto en África.<ref name="WHO2011" /> En conjunto, las ECV provocaron 17,9 millones de muertes (32,1%) en 2015, frente a 12,3 millones (25,8%) en 1990.<ref name="GBD2015De">{{cite journal|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015|date=October 2016|journal=Lancet|volume=388|issue=10053|pages=1459–1544|doi=10.1016/S0140-6736(16)31012-1|pmc=5388903|pmid=27733281|vauthors=Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal|collaboration=GBD 2015 Mortality and Causes of Death Collaborators}}</ref><ref name="GDB2013" /> Las muertes por ECV son más comunes y han ido en aumento en gran parte de los [[País en vías de desarrollo|países con ingresos bajos y medios]], mientras que las tasas han disminuido en la mayor parte de los países desarrollados desde la década de 1970.<ref name="IOM2010">{{cite book|title=Promoting cardiovascular health in the developing world : a critical challenge to achieve global health|year=2010|publisher=National Academies Press|location=Washington, DC|isbn=978-0-309-14774-3|chapter=Epidemiology of Cardiovascular Disease|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK45688/|editor-last1=Fuster|editor-first1=Valentin|editor-last2=Kelly|editor-first2=Bridget B.|author=Institute of Medicine of the National Academies|url-status=live|archive-url=https://web.archive.org/web/20170908144309/https://www.ncbi.nlm.nih.gov/books/NBK45688/|archive-date=2017-09-08}}</ref><ref>{{cite journal|title=Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study|date=April 2014|journal=Circulation|volume=129|issue=14|pages=1483–92|doi=10.1161/circulationaha.113.004042|pmc=4181359|pmid=24573352|vauthors=Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ, Naghavi M}}</ref> La [[enfermedad de las arterias coronarias]] y el [[Accidente cerebrovascular|ictus]] representan el 80% de las muertes por ECV en los hombres y el 75% de las muertes por ECV en las mujeres, siendo la mayoría personas en edad adulta.<ref name="WHO2011" /> En Estados Unidos, el 11% de las personas entre 20 y 40 tienen algún tipo de enfemedad cardiovascular, mientras que el 37% entre 40 y 60, el 71% de las personas entre 60 y 80 y el 85% de las personas mayores de 80 tienen ECV.<ref name="Go2013">{{cite journal|title=Heart disease and stroke statistics--2013 update: a report from the American Heart Association|date=January 2013|journal=Circulation|volume=127|issue=1|pages=e6–e245|doi=10.1161/cir.0b013e31828124ad|pmc=5408511|pmid=23239837|display-authors=6|vauthors=Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB}}</ref> La edad promedio de muerte por enfermedad de las arterias coronarias en los países desarrollados es de alrededor de 80 años, mientras que en el mundo en desarrollo es de alrededor de 68 años.<ref name="IOM2010" /> El diagnóstico de la enfermedad suele ocurrir de siete a diez años antes en los hombres que en las mujeres.<ref name="WHO2011pg48">{{cite book|last1=Mendis|first1=Shanthi|last2=Puska|first2=Pekka|last3=Norrving|first3=Bo|title=Global atlas on cardiovascular disease prevention and control|date=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|location=Geneva|isbn=978-92-4-156437-3|pages=48|edition=1}}</ref>
{{See also|Lipid hypothesis|Saturated fat and cardiovascular disease|Salt and cardiovascular disease}}A diet high in fruits and vegetables decreases the risk of cardiovascular disease and [[death]].<ref name="ReferenceB">{{cite journal|title=Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies|date=July 2014|journal=BMJ|volume=349|pages=g4490|doi=10.1136/bmj.g4490|pmc=4115152|pmid=25073782|vauthors=Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB}}</ref> Evidence suggests that the [[Mediterranean diet]] may improve cardiovascular outcomes.<ref>{{cite journal|title=Diets for cardiovascular disease prevention: what is the evidence?|date=April 2009|journal=American Family Physician|volume=79|issue=7|pages=571–8|doi=|pmid=19378874|vauthors=Walker C, Reamy BV}}</ref> There is also evidence that a Mediterranean diet may be more effective than a [[low-fat diet]] in bringing about long-term changes to cardiovascular risk factors (e.g., lower [[cholesterol level]] and [[blood pressure]]).<ref>{{cite journal|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/featuredreviews/mediterraneandiet-2012/%20%20|title=Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors|date=September 2011|journal=The American Journal of Medicine|volume=124|issue=9|pages=841–51.e2|doi=10.1016/j.amjmed.2011.04.024|pmid=21854893|vauthors=Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M|archive-url=https://web.archive.org/web/20131220200912/http://www.ncbi.nlm.nih.gov/pubmedhealth/featuredreviews/mediterraneandiet-2012/|url-status=live|archive-date=2013-12-20}}</ref> The [[DASH diet]] (high in nuts, fish, fruits and vegetables, and low in sweets, red meat and fat) has been shown to reduce blood pressure,<ref>{{cite journal|title=Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group|date=January 2001|journal=The New England Journal of Medicine|volume=344|issue=1|pages=3–10|doi=10.1056/NEJM200101043440101|pmid=11136953|display-authors=6|vauthors=Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH}}</ref> lower total and low density lipoprotein cholesterol<ref>{{cite journal|title=Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial|date=July 2001|journal=The American Journal of Clinical Nutrition|volume=74|issue=1|pages=80–9|doi=10.1093/ajcn/74.1.80|pmid=11451721|display-authors=6|vauthors=Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA|doi-access=free}}</ref> and improve [[metabolic syndrome]];<ref>{{cite journal|title=Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome|date=December 2005|journal=Diabetes Care|volume=28|issue=12|pages=2823–31|doi=10.2337/diacare.28.12.2823|pmid=16306540|vauthors=Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F|doi-access=free}}</ref> but the long-term benefits have been questioned.<ref>{{cite journal|title=DASH Diet: time for a critical appraisal?|date=March 2007|journal=American Journal of Hypertension|volume=20|issue=3|pages=223–4|doi=10.1016/j.amjhyper.2006.10.006|pmid=17324730|vauthors=Logan AG|doi-access=free}}</ref> A [[high fiber diet]] is associated with lower risks of cardiovascular disease.<ref>{{Cite journal|title=Cereal Fibre Intake and Risk of Mortality From All Causes, CVD, Cancer and Inflammatory Diseases: A Systematic Review and Meta-Analysis of Prospective Cohort Studies|last1=M|first1=Hajishafiee|last2=P|first2=Saneei|date=July 2016|journal=The British Journal of Nutrition|volume=116|issue=2|pages=343–52|language=en|doi=10.1017/S0007114516001938|pmid=27193606|last3=S|first3=Benisi-Kohansal|last4=A|first4=Esmaillzadeh|doi-access=free}}</ref><!-- Fat -->Worldwide, dietary guidelines recommend a reduction in [[saturated fat]],<ref name="BMJ2013">{{cite journal|title=Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis|date=February 2013|journal=BMJ|volume=346|pages=e8707|doi=10.1136/bmj.e8707|pmc=4688426|pmid=23386268|display-authors=6|vauthors=Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR}}</ref> and although the role of dietary fat in cardiovascular disease is complex and controversial there is a long-standing consensus that replacing saturated fat with unsaturated fat in the diet is sound medical advice.<ref name=":1">{{cite journal|url=https://academic.oup.com/advances/article/10/Supplement_4/S332/5624058|title=Dietary Fat and Cardiovascular Disease: Ebb and Flow Over the Last Half Century|date=November 2019|journal=Advances in Nutrition|volume=10|issue=Suppl_4|pages=S332–S339|doi=10.1093/advances/nmz024|pmc=6855944|pmid=31728492|vauthors=Lichtenstein AH}}</ref> Total fat intake has not been found to be associated with cardiovascular risk.<ref>{{cite web|url=https://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/|title=Fats and fatty acids in human nutrition Report of an expert consultation|website=World Health Organization|publisher=WHO/FAO|archive-url=https://web.archive.org/web/20141228005244/http://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/|archive-date=28 December 2014|access-date=20 December 2014|url-status=live}}</ref><ref name="Will2012">{{cite journal|title=Dietary fats and coronary heart disease|date=July 2012|journal=Journal of Internal Medicine|volume=272|issue=1|pages=13–24|doi=10.1111/j.1365-2796.2012.02553.x|pmid=22583051|vauthors=Willett WC|s2cid=43493760}}</ref> A 2020 systematic review found moderate quality evidence that reducing saturated fat intake for at least 2 years caused a reduction in cardiovascular events.<ref>{{cite journal|title=Reduction in saturated fat intake for cardiovascular disease|date=May 2020|journal=The Cochrane Database of Systematic Reviews|volume=5|pages=CD011737|doi=10.1002/14651858.cd011737.pub2|pmc=7388853|pmid=32428300|vauthors=Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/32827219|date=October 2020}} A 2015 meta-analysis of observational studies however did not find a convincing association between saturated fat intake and cardiovascular disease.<ref name="BMJ2015">{{cite journal|title=Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies|date=August 2015|journal=BMJ|volume=351|issue=h3978|pages=h3978|doi=10.1136/bmj.h3978|pmc=4532752|pmid=26268692|display-authors=6|vauthors=de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schünemann H, Beyene J, Anand SS}}</ref> Variation in what is used as a substitute for saturated fat may explain some differences in findings.<ref name=":1" /> The benefit from replacement with [[Polyunsaturated fat|polyunsaturated fats]] appears greatest,<ref name="Sacks_2017">{{cite journal|title=Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association|date=July 2017|journal=Circulation|volume=136|issue=3|pages=e1–e23|doi=10.1161/CIR.0000000000000510|pmid=28620111|display-authors=6|vauthors=Sacks FM, Lichtenstein AH, Wu JH, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV|s2cid=367602}}</ref> while replacement of saturated fats with [[carbohydrates]] does not appear to have a beneficial effect.<ref name="Sacks_2017" /> A diet high in [[trans fatty acids]] is associated with higher rates of cardiovascular disease,<ref name="Chow2014">{{cite journal|title=Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis|date=March 2014|journal=Annals of Internal Medicine|volume=160|issue=6|pages=398–406|doi=10.7326/M13-1788|pmid=24723079|display-authors=6|vauthors=Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, Khaw KT, Mozaffarian D, Danesh J, Di Angelantonio E|s2cid=52013596}}</ref> and in 2015 the Food and Drug Administration (FDA) determined that there was 'no longer a consensus among qualified experts that partially hydrogenated oils (PHOs), which are the primary dietary source of industrially produced trans fatty acids (IP-TFA), are generally recognized as safe (GRAS) for any use in human food'.<ref>{{Cite journal|title=Final Determination Regarding Partially Hydrogenated Oils. Notification; Declaratory Order; Extension of Compliance Date|last1=Food Drug Administration|first1=HHS|date=2018-05-21|journal=Federal Register|volume=83|issue=98|pages=23358–9|language=en|pmid=30019869}}</ref> There is conflicting evidence concerning dietary supplements of [[Omega-3 fatty acid|omega-3 fatty acids]] (a type of polysaturated fat in oily fish) added to diet improve cardiovascular risk.<ref>{{Cite journal|title=Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease|last1=Abdelhamid|first1=Asmaa S.|last2=Brown|first2=Tracey J.|date=29 February 2020|journal=The Cochrane Database of Systematic Reviews|volume=3|pages=CD003177|issn=1469-493X|doi=10.1002/14651858.CD003177.pub5|pmc=7049091|pmid=32114706|last3=Brainard|first3=Julii S.|last4=Biswas|first4=Priti|last5=Thorpe|first5=Gabrielle C.|last6=Moore|first6=Helen J.|last7=Deane|first7=Katherine Ho|last8=Summerbell|first8=Carolyn D.|last9=Worthington|first9=Helen V.|first11=Lee|last11=Hooper|first10=Fujian|last10=Song}}</ref><ref>{{cite journal|title=Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals|date=March 2018|journal=JAMA Cardiology|volume=3|issue=3|pages=225–234|doi=10.1001/jamacardio.2017.5205|pmc=5885893|pmid=29387889|display-authors=6|vauthors=Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, Geleijnse JM, Rauch B, Ness A, Galan P, Chew EY, Bosch J, Collins R, Lewington S, Armitage J, Clarke R}}</ref><!-- Salt -->


A 2014 [[Cochrane review]] found unclear benefit of recommending a [[low-salt diet]] in people with high or normal blood pressure.<ref>{{cite journal|title=Reduced dietary salt for the prevention of cardiovascular disease|date=December 2014|journal=The Cochrane Database of Systematic Reviews|issue=12|pages=CD009217|doi=10.1002/14651858.CD009217.pub3|pmc=6483405|pmid=25519688|vauthors=Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S}}</ref> In those with heart failure, after one study was left out, the rest of the trials show a trend to benefit.<ref name="He2011">{{cite journal|url=http://www.actiononsalt.org.uk/news/Salt%20in%20the%20news/2011/58301.pdf|title=Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials|date=July 2011|journal=Lancet|volume=378|issue=9789|pages=380–2|doi=10.1016/S0140-6736(11)61174-4|pmid=21803192|vauthors=He FJ, MacGregor GA|s2cid=43795786|archive-url=https://web.archive.org/web/20131220235208/http://www.actiononsalt.org.uk/news/Salt%20in%20the%20news/2011/58301.pdf|url-status=dead|archive-date=2013-12-20|access-date=2013-08-23}}</ref><ref name="Paterna2008">{{cite journal|title=Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?|date=February 2008|journal=Clinical Science|volume=114|issue=3|pages=221–30|doi=10.1042/CS20070193|pmid=17688420|vauthors=Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P|s2cid=2248777|df=}}</ref> Another review of dietary salt concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; both as a result of the increased blood pressure ''and'', quite likely, through other mechanisms.<ref name="Bochud2011">{{cite journal|url=http://www.publichealthreviews.eu/show/f/85|title=Dietary Salt Intake and Cardiovascular Disease: Summarizing the Evidence|journal=Public Health Reviews|volume=33|issue=2|pages=530–52|doi=10.1007/BF03391649|year=2012|vauthors=Bochud M, Marques-Vidal P, Burnier M, Paccaud F|url-status=live|archive-url=https://web.archive.org/web/20131221091620/http://www.publichealthreviews.eu/show/f/85|archive-date=2013-12-21|doi-access=free}}</ref><ref name="Cook2007">{{cite journal|title=Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)|date=April 2007|journal=BMJ|volume=334|issue=7599|pages=885–8|doi=10.1136/bmj.39147.604896.55|pmc=1857760|pmid=17449506|display-authors=6|vauthors=Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK}}</ref> Moderate evidence was found that high salt intake increases cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes, and [[left ventricular hypertrophy]].<ref name="Bochud2011" />
{{TOC limit|3}}


=== Medication ===
Blood pressure medication reduces cardiovascular disease in people at risk,<ref name="Ettehad 957–967" /> irrespective of age,<ref>{{cite journal|title=Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials|date=May 2008|journal=BMJ|volume=336|issue=7653|pages=1121–3|doi=10.1136/bmj.39548.738368.BE|pmc=2386598|pmid=18480116|display-authors=6|vauthors=Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, Bulpitt C, Chalmers J, Fagard R, Gleason A, Heritier S, Li N, Perkovic V, Woodward M, MacMahon S}}</ref> the baseline level of cardiovascular risk,<ref>{{cite journal|title=Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data|date=August 2014|journal=Lancet|volume=384|issue=9943|pages=591–598|doi=10.1016/S0140-6736(14)61212-5|pmid=25131978|author1=Blood Pressure Lowering Treatment Trialists' Collaboration}}</ref> or baseline blood pressure.<ref>{{cite journal|title=The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials|date=January 2011|journal=Journal of Hypertension|volume=29|issue=1|pages=4–16|doi=10.1097/HJH.0b013e32834000be|pmid=20881867|display-authors=6|vauthors=Czernichow S, Zanchetti A, Turnbull F, Barzi F, Ninomiya T, Kengne AP, Lambers Heerspink HJ, Perkovic V, Huxley R, Arima H, Patel A, Chalmers J, Woodward M, MacMahon S, Neal B|s2cid=10374187}}</ref> The commonly-used drug regimens have similar efficacy in reducing the risk of all major cardiovascular events, although there may be differences between drugs in their ability to prevent specific outcomes.<ref name=":02">{{cite journal|url=https://lirias.kuleuven.be/handle/123456789/270351|title=Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials|date=November 2003|journal=Lancet|volume=362|issue=9395|pages=1527–35|doi=10.1016/s0140-6736(03)14739-3|pmid=14615107|vauthors=Turnbull F|type=Submitted manuscript}}</ref> Larger reductions in blood pressure produce larger reductions in risk,<ref name=":02" /> and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure.<ref>{{cite journal|title=An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention|date=April 2014|journal=Hypertension|volume=63|issue=4|pages=878–85|doi=10.1161/HYP.0000000000000003|pmid=24243703|vauthors=Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E|doi-access=free}}</ref> Adherence to medications is often poor and while mobile phone text messaging has been tried to improve adherence, there is insufficient evidence that it alters secondary prevention of cardiovascular disease.<ref>{{cite journal|title=Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease|date=April 2017|journal=The Cochrane Database of Systematic Reviews|volume=4|pages=CD011851|doi=10.1002/14651858.CD011851.pub2|pmc=6478182|pmid=28455948|display-authors=6|vauthors=Adler AJ, Martin N, Mariani J, Tajer CD, Owolabi OO, Free C, Serrano NC, Casas JP, Perel P|collaboration=Cochrane Heart Group}}</ref>


[[Statins]] are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease.<ref name="Statins20122">{{cite journal|title=Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis|date=June 2012|journal=Archives of Internal Medicine|volume=172|issue=12|pages=909–19|doi=10.1001/archinternmed.2012.2145|pmid=22732744|vauthors=Gutierrez J, Ramirez G, Rundek T, Sacco RL|doi-access=free}}</ref> As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women.<ref name="Statins20122" /> In those at risk, but without a history of cardiovascular disease (primary prevention), statins decrease the risk of death and combined fatal and non-fatal cardiovascular disease.<ref>{{cite journal|url=http://researchonline.lshtm.ac.uk/1496197/1/bmj.g280.full.pdf|title=Statins for the primary prevention of cardiovascular disease|date=January 2013|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1|pages=CD004816|doi=10.1002/14651858.CD004816.pub5|pmc=6481400|pmid=23440795|display-authors=6|vauthors=Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, Ward K, Ebrahim S}}</ref> The benefit, however, is small.<ref>{{cite journal|url=http://english.prescrire.org/en/81/168/55118/0/NewsDetails.aspx|title=Statins in primary cardiovascular prevention?|date=July–August 2018|journal=Prescrire International|volume=27|issue=195|pages=183|access-date=4 August 2018}}</ref> A United States guideline recommends statins in those who have a 12% or greater risk of cardiovascular disease over the next ten years.<ref>{{cite journal|title=Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline|date=August 2015|journal=Annals of Internal Medicine|volume=163|issue=4|pages=291–7|doi=10.7326/m15-0840|pmid=26099117|vauthors=Downs JR, O'Malley PG|doi-access=free}}</ref> [[Niacin]], [[fibrates]] and [[CETP Inhibitors]], while they may increase [[HDL cholesterol]] do not affect the risk of cardiovascular disease in those who are already on statins.<ref>{{cite journal|title=Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients|date=July 2014|journal=BMJ|volume=349|pages=g4379|doi=10.1136/bmj.g4379|pmc=4103514|pmid=25038074|vauthors=Keene D, Price C, Shun-Shin MJ, Francis DP}}</ref> Fibrates lower the risk of cardiovascular and coronary events, but there is no evidence to suggest that they reduce all-cause mortality.<ref>{{cite journal|title=Fibrates for primary prevention of cardiovascular disease events|date=November 2016|journal=The Cochrane Database of Systematic Reviews|volume=11|pages=CD009753|doi=10.1002/14651858.CD009753.pub2|pmc=6464497|pmid=27849333|vauthors=Jakob T, Nordmann AJ, Schandelmaier S, Ferreira-González I, Briel M|collaboration=Cochrane Heart Group}}</ref>
==Tipos==
[[File:Inflammatory heart diseases world map - DALY - WHO2004.svg|thumb|upright=1.4|[[Años de vida ajustados por discapacidad]] para las cardiopatías inflamatorias cada 100,000&nbsp;habitantes en 2004<ref name="World Health Organization">{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |access-date=Nov 11, 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=2009-11-11 }}</ref>{{refbegin|2}}
{{legend|#b3b3b3|sin datos}}
{{legend|#ffff65|menos de 70}}
{{legend|#fff200|70–140}}
{{legend|#ffdc00|140–210}}
{{legend|#ffc600|210–280}}
{{legend|#ffb000|280–350}}
{{legend|#ff9a00|350–420}}
{{legend|#ff8400|420–490}}
{{legend|#ff6e00|490–560}}
{{legend|#ff5800|560–630}}
{{legend|#ff4200|630–700}}
{{legend|#ff2c00|700–770}}
{{legend|#cb0000|mas de 770}}
{{refend}}]]
Hay numerosas enfermedades cardiovasculares que afectan a los vasos sanguíneos, las cuales se denominan [[enfermedades vasculares]].
* [[Enfermedad de las arterias coronarias]] - La más comón de las ECV. Ocurre cuando el flujo sanguíneo que llega al corazón se ve afectado por la acumulación de placa.
* [[Enfermedad vascular periférica]] - Enfermedad de los vasos sanguíneos que irrigan los brazos y las piernas.
* [[Enfermedad cerebrovascular]] - Trastornos de los vasos sanguíneos que suministran sangre al cerebro (incluyendo el [[Accidente cerebrovascular|ictus]])
* [[Estenosis de la arteria renal]] - Alteración de la luz de la arteria renal.
* [[Aneurisma de aorta]] - Es una dilatación localizada que produce una debilidad en la pared de una [[arteria]].


[[Anti-diabetic medication]] may reduce cardiovascular risk in people with Type 2 Diabetes, although evidence is not conclusive.<ref>{{cite journal|title=Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes|date=June 2014|journal=Lancet|volume=383|issue=9933|pages=2008–17|doi=10.1016/s0140-6736(14)60794-7|pmid=24910232|vauthors=Holman RR, Sourij H, Califf RM|s2cid=5064731}}</ref> A meta-analysis in 2009 including 27,049 participants and 2,370 major vascular events showed a 15% [[relative risk reduction]] in cardiovascular disease with more-intensive glucose lowering over an average follow-up period of 4.4 years, but an increased risk of major [[hypoglycemia]].<ref>{{cite journal|title=Intensive glucose control and macrovascular outcomes in type 2 diabetes|date=November 2009|journal=Diabetologia|volume=52|issue=11|pages=2288–98|doi=10.1007/s00125-009-1470-0|pmid=19655124|display-authors=6|vauthors=Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, Evans GW, Gerstein HC, Holman RR, Moritz TE, Neal BC, Ninomiya T, Patel AA, Paul SK, Travert F, Woodward M|doi-access=free}}</ref>
Por otro lado están las enfermedades que afectan al corazón, las cuales se denominan [[Cardiopatía|cardiopatías]].
* [[Miocardiopatía]] - Enfermedad del músculo cardíaco.
* [[Enfermedad cardíaca hipertensiva]] - Es la hipertrofia patológica de las células cardíacas del corazón.
* [[Insuficiencia cardíaca]] - Incapacidad del corazón para suministrar suficiente sangre a los tejidos.
* [[Cor pulmonale]] - Insuficiencia en el lado derecho del corazón con afectación del sistema respiratorio.
* [[Trastornos del ritmo cardíaco]] - Anomalías en el ritmo cardíaco.
* Cardiopatías inflamatorias
** [[Endocarditis]] – Inflamación de la capa interna del corazón, el endocardio.
** [[Cardiomegalia]] - Define un agrandamiento anormal del corazón
** [[Miocarditis]] – Inflamación del [[miocardio]], en general debida a un patógeno externo.
** [[Miocarditis eosinofílica]] - Inflamación del miocardio causada por glóbulos blancos [[Eosinofílico|eosinofílicos]] patológicamente activados.
* [[Valvulopatía]] - Enfermedad de las valvulas del corazón.
* [[Cardiopatía congénita|Enfermedad cardíaca congénita]] - Malformaciones de la estructura cardíaca existentes al nacer.
* Enfermedad cardíaca reumática - Daño de los músculos y las válvulas cardíacas debido a la [[fiebre reumática]] causada por el [[streptococcus pyogenes]].


[[Aspirin]] has been found to be of only modest benefit in those at low risk of heart disease as the risk of serious bleeding is almost equal to the benefit with respect to cardiovascular problems.<ref>{{cite journal|title=Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials|date=July 2011|journal=American Heart Journal|volume=162|issue=1|pages=115–24.e2|doi=10.1016/j.ahj.2011.04.006|pmid=21742097|vauthors=Berger JS, Lala A, Krantz MJ, Baker GS, Hiatt WR}}</ref> In those at very low risk, including those over the age of 70, it is not recommended.<ref>{{cite web|url=http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication|title=Final Recommendation Statement Aspirin for the Prevention of Cardiovascular Disease: Preventive Medication|date=March 2009|archive-url=https://web.archive.org/web/20150110041518/http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication|archive-date=10 January 2015|access-date=15 January 2015|url-status=live}}</ref><ref>{{cite journal|title=2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines|date=March 2019|journal=Journal of the American College of Cardiology|volume=74|issue=10|pages=e177–e232|doi=10.1016/j.jacc.2019.03.010|pmid=30894318|display-authors=6|vauthors=Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B|doi-access=free}}</ref> The [[United States Preventive Services Task Force]] recommends against use of aspirin for prevention in women less than 55 and men less than 45 years old; however, in those who are older it is recommends in some individuals.<ref>{{cite journal|title=Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement|date=March 2009|journal=Annals of Internal Medicine|volume=150|issue=6|pages=396–404|doi=10.7326/0003-4819-150-6-200903170-00008|pmid=19293072|author1=US Preventive Services Task Force|doi-access=free}}</ref>
==Factores de riesgo==
Existen muchos factores de riesgo para las enfermedades cardíacas: edad, sexo, tabaquismo, inactividad física, consumo excesivo de alcohol, dietas poco saludables, obesidad, predisposición genética y antecedentes familiares de enfermedades cardiovasculares, presión arterial elevada ([[Hipertensión arterial|hipertensión]]), aumento de azúcar en sangre ([[diabetes mellitus]]), colesterol alto en sangre ([[hiperlipidosis]]), enfermedad celíaca no diagnosticada, factores psicosociales, pobreza y bajo nivel educativo y [[contaminación atmosférica]].<ref name = Fuster>{{cite book | first1 = Bridget B. | last1 = Kelly | last2 = Fuster | first2 = Valentin |title=Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health |publisher=National Academies Press |location=Washington, DC |year=2010 |isbn=978-0-309-14774-3 }}</ref><ref>{{cite journal | vauthors = Finks SW, Airee A, Chow SL, Macaulay TE, Moranville MP, Rogers KC, Trujillo TC | title = Key articles of dietary interventions that influence cardiovascular mortality | journal = Pharmacotherapy | volume = 32 | issue = 4 | pages = e54-87 | date = April 2012 | pmid = 22392596 | doi = 10.1002/j.1875-9114.2011.01087.x }}</ref><ref name="MichaMichas2012"/><ref name="MendisPuska2011">{{cite book| first1 = Shanthi | last1 = Mendis | first2 = Pekka | last2 = Puska| first3 = Bo | last3 = Norrving |title=Global Atlas on Cardiovascular Disease Prevention and Control|url=https://books.google.com/books?id=ZRbKygAACAAJ|year=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|isbn=978-92-4-156437-3|url-status=live|archive-url=https://web.archive.org/web/20160506235630/https://books.google.com/books?id=ZRbKygAACAAJ|archive-date=2016-05-06}}</ref><ref name="CiaccioLewis2017">{{cite journal | vauthors = Ciaccio EJ, Lewis SK, Biviano AB, Iyer V, Garan H, Green PH | title = Cardiovascular involvement in celiac disease | journal = World Journal of Cardiology | volume = 9 | issue = 8 | pages = 652–666 | date = August 2017 | pmid = 28932354 | pmc = 5583538 | doi = 10.4330/wjc.v9.i8.652 | type = Review }}</ref> Si bien la contribución individual de cada factor de riesgo varía entre diferentes comunidades o grupos étnicos y enfermedad cardíaca, la contribución general de estos factores de riesgo es muy constante.<ref name = interheart>{{cite journal | vauthors = Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L | display-authors = 6 | title = Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study | journal = Lancet | volume = 364 | issue = 9438 | pages = 937–52 | year = 2004 | pmid = 15364185 | doi = 10.1016/S0140-6736(04)17018-9 | s2cid = 30811593 }}</ref> Algunos de estos factores de riesgo, como la edad, el sexo o la predisposición genética son inmutables; sin embargo, muchos factores de riesgo cardiovascular importantes se pueden modificar mediante cambios en el estilo de vida, cambios sociales, tratamiento farmacológico (por ejemplo, prevención de la hipertensión, hiperlipidemia y diabetes).<ref name = McPhee2012>{{cite book | last = McPhee | first = Stephen | title = Current medical diagnosis & treatment | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 978-0-07-176372-1 | pages = [https://archive.org/details/currentmedicaldi00step/page/430 430] | url-access = registration | url = https://archive.org/details/currentmedicaldi00step/page/430 }}</ref>


The use of [[vasoactive]] agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense.<ref name="ACCPandATSfive2">{{Citation|title=Five Things Physicians and Patients Should Question|author1=American College of Chest Physicians|author1-link=American College of Chest Physicians|url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/|access-date=6 January 2013|date=September 2013|publisher=American College of Chest Physicians and American Thoracic Society|work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]]|author2=American Thoracic Society|author2-link=American Thoracic Society|url-status=live|archive-url=https://web.archive.org/web/20131103063427/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/|archive-date=3 November 2013}}</ref>
===Edad===
La edad es el factor de riesgo más importante en el desarrollo de enfermedades cardiovasculares, llegando a triplicar el riesgo con cada década de vida cumplida.<ref name="Finegold">{{cite journal | vauthors = Finegold JA, Asaria P, Francis DP | title = Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations | journal = International Journal of Cardiology | volume = 168 | issue = 2 | pages = 934–45 | date = September 2013 | pmid = 23218570 | pmc = 3819990 | doi = 10.1016/j.ijcard.2012.10.046 }}</ref> Al mismo tiempo, el riesgo de [[accidente cerebrovascular]] se duplica cada década después de los 55 años.<ref>Mackay, Mensah, Mendis, et al. The Atlas of Heart Disease and Stroke. World Health Organization. January 2004.</ref> Aunque el 82 por ciento de las personas que mueren de enfermedad coronaria tienen 65 años o más <ref>"Understand Your Risk of Heart Attack". American Heart Association.http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeartAttack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp#</ref> las acumulaciones de grasa en los vasos sanguíneos pueden empezar a formarse en la adolescencia.<ref>{{cite journal | vauthors = D'Adamo E, Guardamagna O, Chiarelli F, Bartuli A, Liccardo D, Ferrari F, Nobili V | title = Atherogenic dyslipidemia and cardiovascular risk factors in obese children | journal = International Journal of Endocrinology | volume = 2015 | pages = 912047 | date = 2015 | pmid = 25663838 | pmc = 4309297 | doi = 10.1155/2015/912047 }}</ref>


=== Physical activity ===
Se han propuesto múltiples explicaciones para explicar por qué la edad aumenta el riesgo de enfermedades cardiovasculares. Uno de ellos se relaciona con el nivel de colesterol en sangre.<ref name="Jou99">{{cite journal | vauthors = Jousilahti P, Vartiainen E, Tuomilehto J, Puska P | title = Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland | journal = Circulation | volume = 99 | issue = 9 | pages = 1165–72 | date = March 1999 | pmid = 10069784 | doi = 10.1161/01.cir.99.9.1165 | doi-access = free }}</ref> En la mayoría de las poblaciones, el nivel de colesterol total en sangre aumenta con la edad. En los hombres, este aumento se estabiliza entre los 45 y los 50 años pero en las mujeres el aumento continúa hasta los 60 a 65 años.<ref name="Jou99" />
Exercise-based cardiac rehabilitation following a heart attack reduces the risk of death from cardiovascular disease and leads to less hospitalizations.<ref name="AndersonThompson2016">{{cite journal|title=Exercise-based cardiac rehabilitation for coronary heart disease|date=January 2016|journal=The Cochrane Database of Systematic Reviews|issue=1|pages=CD001800|doi=10.1002/14651858.CD001800.pub3|pmc=6491180|pmid=26730878|vauthors=Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, Taylor RS}}</ref> There have been few high quality studies of the benefits of exercise training in people with increased cardiovascular risk but no history of cardiovascular disease.<ref>{{cite journal|title=Exercise for people with high cardiovascular risk|date=August 2014|journal=The Cochrane Database of Systematic Reviews|issue=8|pages=CD009387|doi=10.1002/14651858.CD009387.pub2|pmc=6669260|pmid=25120097|vauthors=Seron P, Lanas F, Pardo Hernandez H, Bonfill Cosp X}}</ref>


A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide.<ref>{{cite journal|title=Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy|date=July 2012|journal=Lancet|volume=380|issue=9838|pages=219–29|doi=10.1016/S0140-6736(12)61031-9|pmc=3645500|pmid=22818936|vauthors=Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT}}</ref> The authors estimated that 121,000 deaths from coronary heart disease could have been averted in Europe in 2008, if physical inactivity had been removed. A Cochrane review found some evidence that yoga has beneficial effects on blood pressure and cholesterol, but studies included in this review were of low quality.<ref>{{cite journal|url=http://wrap.warwick.ac.uk/61873/1/WRAP_Clarke_CD010072.pdf|title=Yoga for the primary prevention of cardiovascular disease|date=May 2014|journal=The Cochrane Database of Systematic Reviews|issue=5|pages=CD010072|doi=10.1002/14651858.CD010072.pub2|pmid=24825181|vauthors=Hartley L, Dyakova M, Holmes J, Clarke A, Lee MS, Ernst E, Rees K}}</ref> Tentative evidence suggests that home-based exercise programs may be more efficient at improving exercise adherence.<ref>{{cite journal|title=Home versus center based physical activity programs in older adults|date=January 2005|journal=The Cochrane Database of Systematic Reviews|issue=1|pages=CD004017|doi=10.1002/14651858.cd004017.pub2|pmc=6464851|pmid=15674925|vauthors=Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC}}</ref>
El envejecimiento también se asocia con cambios en las propiedades mecánicas y estructurales de las paredes vasculares, lo que conduce a la pérdida de elasticidad arterial y a una [[Distensión (Medicina)|distensibilidad]] arterial reducida y, posteriormente, puede conducir a una [[enfermedad de las arterias coronarias]].<ref name="autogenerated357">{{cite journal | vauthors = Jani B, Rajkumar C | title = Ageing and vascular ageing | journal = Postgraduate Medical Journal | volume = 82 | issue = 968 | pages = 357–62 | date = June 2006 | pmid = 16754702 | pmc = 2563742 | doi = 10.1136/pgmj.2005.036053 }}</ref>


=== Dietary supplements ===
===Factores genéticos===
While a [[healthy diet]] is beneficial, the effect of [[antioxidant]] supplementation ([[vitamin E]], [[vitamin C]], etc.) or vitamins has not been shown to protect against cardiovascular disease and in some cases may possibly result in harm.<ref>{{cite journal|title=Vitamin C supplementation for the primary prevention of cardiovascular disease|date=March 2017|journal=The Cochrane Database of Systematic Reviews|volume=3|pages=CD011114|doi=10.1002/14651858.CD011114.pub2|pmc=6464316|pmid=28301692|vauthors=Al-Khudairy L, Flowers N, Wheelhouse R, Ghannam O, Hartley L, Stranges S, Rees K}}</ref><ref>{{cite journal|title=Coronary heart disease prevention: nutrients, foods, and dietary patterns|date=August 2011|journal=Clinica Chimica Acta; International Journal of Clinical Chemistry|volume=412|issue=17–18|pages=1493–514|doi=10.1016/j.cca.2011.04.038|pmc=5945285|pmid=21575619|vauthors=Bhupathiraju SN, Tucker KL}}</ref><ref>{{cite journal|title=Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials|date=January 2013|journal=BMJ|volume=346|pages=f10|doi=10.1136/bmj.f10|pmc=3548618|pmid=23335472|vauthors=Myung SK, Ju W, Cho B, Oh SW, Park SM, Koo BK, Park BJ}}</ref><ref>{{cite journal|title=Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis|date=July 2018|journal=Circulation: Cardiovascular Quality and Outcomes|volume=11|issue=7|pages=e004224|doi=10.1161/CIRCOUTCOMES.117.004224|pmid=29991644|display-authors=6|vauthors=Kim J, Choi J, Kwon SY, McEvoy JW, Blaha MJ, Blumenthal RS, Guallar E, Zhao D, Michos ED|s2cid=51615818}}</ref> Mineral supplements have also not been found to be useful.<ref>{{cite journal|title=Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force|date=December 2013|journal=Annals of Internal Medicine|volume=159|issue=12|pages=824–34|doi=10.7326/0003-4819-159-12-201312170-00729|pmid=24217421|vauthors=Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP|doi-access=free}}</ref> [[Niacin]], a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk.<ref>{{cite journal|title=Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis|date=June 2010|journal=Atherosclerosis|volume=210|issue=2|pages=353–61|doi=10.1016/j.atherosclerosis.2009.12.023|pmid=20079494|vauthors=Bruckert E, Labreuche J, Amarenco P}}</ref><ref>{{cite journal|title=The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression|date=January 2013|journal=Journal of the American College of Cardiology|volume=61|issue=4|pages=440–446|doi=10.1016/j.jacc.2012.10.030|pmid=23265337|vauthors=Lavigne PM, Karas RH|doi-access=free}}</ref> [[Magnesium]] supplementation lowers high blood pressure in a dose dependent manner.<ref name="Jee2002">{{cite journal|title=The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials|date=August 2002|journal=American Journal of Hypertension|volume=15|issue=8|pages=691–6|doi=10.1016/S0895-7061(02)02964-3|pmid=12160191|vauthors=Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ|doi-access=free}}</ref> Magnesium therapy is recommended for people with ventricular [[Heart arrhythmia|arrhythmia]] associated with [[torsades de pointes]] who present with [[long QT syndrome]] as well as for the treatment of people with digoxin intoxication-induced arrhythmias.<ref name="Zipes2006">{{cite journal|title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society|date=September 2006|journal=Circulation|volume=114|issue=10|pages=e385-484|doi=10.1161/CIRCULATIONAHA.106.178233|pmid=16935995|display-authors=6|vauthors=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL|doi-access=free}}</ref> There is no evidence to support [[omega-3 fatty acid]] supplementation.<ref>{{cite journal|title=Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials|date=May 2012|journal=Archives of Internal Medicine|volume=172|issue=9|pages=686–94|doi=10.1001/archinternmed.2012.262|pmid=22493407|vauthors=Kwak SM, Myung SK, Lee YJ, Seo HG|doi-access=free}}</ref>
Los factores genéticos influyen en el desarrollo prematuro de enfermedades cardiovasculares sobretodo en hombres antes de los 55 años y en mujeres antes de los 65 años.<ref name = McPhee2012/> La presencia de antecedentes en enfermedades cardiovasculares en los padres multiplica por tres el riesgo de padecerlas.<ref>{{cite journal | vauthors = Kathiresan S, Srivastava D | title = Genetics of human cardiovascular disease | journal = Cell | volume = 148 | issue = 6 | pages = 1242–57 | date = March 2012 | pmid = 22424232 | pmc = 3319439 | doi = 10.1016/j.cell.2012.03.001 }}</ref> En estudios de [[asociación genética]] se ha encontrado que múltiples [[Polimorfismo de nucleótido único|polimorfismos puntuales]] están asociados con enfermedades cardiovasculares,<ref>{{cite journal | vauthors = Nikpay M, Goel A, Won HH, Hall LM, Willenborg C, Kanoni S, Saleheen D, Kyriakou T, Nelson CP, Hopewell JC, Webb TR, Zeng L, Dehghan A, Alver M, Armasu SM, Auro K, Bjonnes A, Chasman DI, Chen S, Ford I, Franceschini N, Gieger C, Grace C, Gustafsson S, Huang J, Hwang SJ, Kim YK, Kleber ME, Lau KW, Lu X, Lu Y, Lyytikäinen LP, Mihailov E, Morrison AC, Pervjakova N, Qu L, Rose LM, Salfati E, Saxena R, Scholz M, Smith AV, Tikkanen E, Uitterlinden A, Yang X, Zhang W, Zhao W, de Andrade M, de Vries PS, van Zuydam NR, Anand SS, Bertram L, Beutner F, Dedoussis G, Frossard P, Gauguier D, Goodall AH, Gottesman O, Haber M, Han BG, Huang J, Jalilzadeh S, Kessler T, König IR, Lannfelt L, Lieb W, Lind L, Lindgren CM, Lokki ML, Magnusson PK, Mallick NH, Mehra N, Meitinger T, Memon FU, Morris AP, Nieminen MS, Pedersen NL, Peters A, Rallidis LS, Rasheed A, Samuel M, Shah SH, Sinisalo J, Stirrups KE, Trompet S, Wang L, Zaman KS, Ardissino D, Boerwinkle E, Borecki IB, Bottinger EP, Buring JE, Chambers JC, Collins R, Cupples LA, Danesh J, Demuth I, Elosua R, Epstein SE, Esko T, Feitosa MF, Franco OH, Franzosi MG, Granger CB, Gu D, Gudnason V, Hall AS, Hamsten A, Harris TB, Hazen SL, Hengstenberg C, Hofman A, Ingelsson E, Iribarren C, Jukema JW, Karhunen PJ, Kim BJ, Kooner JS, Kullo IJ, Lehtimäki T, Loos RJ, Melander O, Metspalu A, März W, Palmer CN, Perola M, Quertermous T, Rader DJ, Ridker PM, Ripatti S, Roberts R, Salomaa V, Sanghera DK, Schwartz SM, Seedorf U, Stewart AF, Stott DJ, Thiery J, Zalloua PA, O'Donnell CJ, Reilly MP, Assimes TL, Thompson JR, Erdmann J, Clarke R, Watkins H, Kathiresan S, McPherson R, Deloukas P, Schunkert H, Samani NJ, Farrall M | display-authors = 6 | title = A comprehensive 1,000 Genomes-based genome-wide association meta-analysis of coronary artery disease | journal = Nature Genetics | volume = 47 | issue = 10 | pages = 1121–1130 | date = October 2015 | pmid = 26343387 | pmc = 4589895 | doi = 10.1038/ng.3396 }}</ref><ref name="MacRae 2634–2639">{{cite journal | vauthors = MacRae CA, Vasan RS | title = The Future of Genetics and Genomics: Closing the Phenotype Gap in Precision Medicine | journal = Circulation | volume = 133 | issue = 25 | pages = 2634–9 | date = June 2016 | pmid = 27324359 | pmc = 6188655 | doi = 10.1161/CIRCULATIONAHA.116.022547 }}</ref> pero por lo general, su influencia individual es pequeña y las contribuciones genéticas a las enfermedades cardiovasculares son poco conocidas.<ref name="MacRae 2634–2639"/>


===Sexo===
== Tratamiento ==
Los hombres tienen un mayor riesgo de padecer enfermedades cardíacas que las mujeres [[Menopausia|premenopáusicas]].<ref name="Finegold" /><ref name="WHF">{{cite web |url=http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors |title=Risk factors |access-date=2012-05-03 |url-status=live |archive-url=https://web.archive.org/web/20120510135600/http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/ |archive-date=2012-05-10 }}</ref> Una vez pasada la menopausia, se ha argumentado que el riesgo de una mujer es similar al del hombre,<ref name="WHF" /> aunque datos más recientes de la OMS y la ONU lo contradicen.<ref name="Finegold" /> Por otro lado, si una mujer tiene diabetes, es más probable que desarrolle una enfermedad cardíaca que un hombre con diabetes.<ref>{{cite web|url=https://www.npr.org/blogs/health/2014/05/22/314869923/diabetes-raises-womens-risk-of-heart-disease-more-than-for-men|title=Diabetes raises women's risk of heart disease more than for men|work=NPR.org|date=May 22, 2014|access-date=May 23, 2014|url-status=live|archive-url=https://web.archive.org/web/20140523093525/http://www.npr.org/blogs/health/2014/05/22/314869923/diabetes-raises-womens-risk-of-heart-disease-more-than-for-men|archive-date=May 23, 2014}}</ref>


Las enfermedades coronarias son de 2 a 5 veces más comunes entre los hombres de mediana edad que entre las mujeres.<ref name="Jou99" /> En un estudio realizado por la Organización Mundial de la Salud, el sexo contribuye a aproximadamente el 40% de la variación en las proporciones de la mortalidad por enfermedades coronarias.<ref>Jackson R, Chambles L, Higgins M, Kuulasmaa K, Wijnberg L, Williams D (WHO MONICA Project, and ARIC Study.) Sex difference in ischaemic heart disease mortality and risk factors in 46 communities: an ecologic analysis. Cardiovasc Risk Factors. 1999; 7:43–54.</ref> Otro estudio informa resultados similares y encuentra que las diferencias de sexo explican casi la mitad del riesgo asociado con las enfermedades cardiovasculares.<ref name="Jou99" /> Una de las explicaciones propuestas para las diferencias de sexo en las enfermedades cardiovasculares es la diferencia hormonal.<ref name="Jou99" /> Entre las mujeres, el [[estrógeno]] es la hormona sexual predominante. El estrógeno puede tener efectos protectores sobre el [[Glucólisis|metabolismo de la glucosa]] y el [[Hemostasia|sistema hemostático]], y puede tener un efecto directo en la mejora de la función de las [[Célula endotelial|células endoteliales]].<ref name="Jou99" /> La producción de estrógeno disminuye después de la menopausia, y esto podría cambiar el metabolismo de los lípidos femeninos hacia una forma más [[Aterogenicidad|aterogénica]] al disminuir el nivel de colesterol HDL mientras aumenta los niveles de colesterol LDL y totales.<ref name="Jou99" />

Entre hombres y mujeres, existen diferencias en el peso corporal, la altura, la distribución de la grasa corporal, la frecuencia cardíaca, el [[volumen sistólico]] y la distensibilidad arterial.<ref name="autogenerated357" /> En las personas de la [[tercera edad]], la pulsatilidad y la rigidez de las arterias relacionadas con la edad es más pronunciada entre las mujeres que entre los hombres.<ref name="autogenerated357" /> Esto puede deberse al tamaño corporal más pequeño de la mujer y a las dimensiones arteriales, que son factores independientes de la menopausia.<ref name="autogenerated357" />

===Consumo de tabaco===
Los cigarrillos son la forma principal de consumo de tabaco.<ref name="WHO2011" /> Los riesgos para la salud derivados del consumo de tabaco se derivan no solo del consumo directo de tabaco, sino también de la exposición al humo de tabaco ajeno.<ref name="WHO2011" /> Aproximadamente el 10% de las enfermedades cardiovasculares se atribuyen al tabaquismo;<ref name="WHO2011" /> sin embargo, las personas que dejan de fumar a los 30 años tienen un riesgo de muerte casi tan bajo como los que nunca han fumado.<ref>{{cite journal | vauthors = Doll R, Peto R, Boreham J, Sutherland I | title = Mortality in relation to smoking: 50 years' observations on male British doctors | journal = BMJ | volume = 328 | issue = 7455 | pages = 1519 | date = June 2004 | pmid = 15213107 | pmc = 437139 | doi = 10.1136/bmj.38142.554479.AE }}</ref>

===Sedentarismo===
La [[Sedentarismo (estilo de vida)|actividad física insuficiente]] (definida como menos de 5 sesiones de 30 minutos de actividad moderada por semana, o menos de 3 sesiones de 20 minutos de actividad intensa por semana) es el cuarto factor de riesgo principal de mortalidad en todo el mundo.<ref name="WHO2011" /> En 2008, el 31,3% de los adultos de 15 años o más (28,2% hombres y 34,4% mujeres) no realizaban suficiente actividad física.<ref name="WHO2011" /> El riesgo de cardiopatía isquémica y diabetes mellitus se reduce en casi un tercio en los adultos que realizan unos 150 minutos de actividad física moderada cada semana (o equivalente).<ref name="OrganizationUNAIDS2007">{{cite book|author1=World Health Organization|author2=UNAIDS|title=Prevention of Cardiovascular Disease|url=https://books.google.com/books?id=AS2RmtQVuLwC&pg=PT3|year=2007|publisher=World Health Organization|isbn=978-92-4-154726-0|pages=3–|url-status=live|archive-url=https://web.archive.org/web/20160427013804/https://books.google.com/books?id=AS2RmtQVuLwC&pg=PT3|archive-date=27 April 2016}}</ref> Además, la actividad física ayuda a perder peso y mejora el control de la glucosa en sangre, la presión arterial, el [[Perfil lipídico|perfil de lípidos]] y la [[Resistencia a la insulina|sensibilidad a la insulina]]. Estos efectos pueden, al menos en parte, explicar sus beneficios en la actividad cardiovascular.<ref name="WHO2011" />

===Dieta===
Una dieta con alto contenido en [[grasas saturadas]], [[Ácido graso trans|grasas trans]] y sal, y una baja ingesta de frutas, verduras y pescado están relacionadas con el riesgo cardiovascular, aunque se discute si es suficiente para explicar las causas. La Organización Mundial de la Salud atribuye aproximadamente 1,7 millones de muertes en todo el mundo al bajo consumo de frutas y verduras.<ref name="WHO2011" /> El consumo frecuente de alimentos con alto contenido calórico, como los alimentos procesados ​​con alto contenido de grasas y azúcares, promueve la obesidad y puede aumentar el riesgo de enfermedades cardiovasculares.<ref name="WHO2011" /> La [[Consumo de sal y riesgo de enfermedad cardiovascular|cantidad consumida de sal]] también puede ser un determinante importante de los niveles de presión arterial y el riesgo cardiovascular.<ref name="WHO2011" /> Los datos apuntan que la reducción de la ingesta de grasas saturadas durante al menos dos años reduce el riesgo de enfermedad cardiovascular.<ref>{{Cite journal|last=Hooper|first=Lee|last2=Martin|first2=Nicole|last3=Jimoh|first3=Oluseyi F.|last4=Kirk|first4=Christian|last5=Foster|first5=Eve|last6=Abdelhamid|first6=Asmaa S.|date=21 August 2020|title=Reduction in saturated fat intake for cardiovascular disease|url=https://www.ncbi.nlm.nih.gov/pubmed/32827219|journal=The Cochrane Database of Systematic Reviews|volume=8|pages=CD011737|doi=10.1002/14651858.CD011737.pub3|issn=1469-493X|pmid=32827219|via=}}</ref> La ingesta elevada de grasas trans tiene efectos adversos sobre los [[Lípido|lípidos]] y los marcadores inflamatorios en sangre,<ref name="BookerMann2008">{{cite journal | vauthors = Booker CS, Mann JI | title = Trans fatty acids and cardiovascular health: translation of the evidence base | journal = Nutrition, Metabolism, and Cardiovascular Diseases | volume = 18 | issue = 6 | pages = 448–56 | date = July 2008 | pmid = 18468872 | doi = 10.1016/j.numecd.2008.02.005 }}</ref> y se ha recomendado ampliamente la eliminación de las [[Ácido graso trans|grasas trans]] de las dietas.<ref name="RemigFranklin2010">{{cite journal | vauthors = Remig V, Franklin B, Margolis S, Kostas G, Nece T, Street JC | title = Trans fats in America: a review of their use, consumption, health implications, and regulation | journal = Journal of the American Dietetic Association | volume = 110 | issue = 4 | pages = 585–92 | date = April 2010 | pmid = 20338284 | doi = 10.1016/j.jada.2009.12.024 | hdl-access = free | hdl = 2097/6377 }}</ref><ref name="WHO2018">{{cite web|title=WHO plan to eliminate industrially-produced trans-fatty acids from global food supply|url=https://www.who.int/news-room/detail/14-05-2018-who-plan-to-eliminate-industrially-produced-trans-fatty-acids-from-global-food-supply|website=World Health Organization|access-date=15 May 2018}}</ref> En 2018, la Organización Mundial de la Salud estimó que las grasas trans eran la causa de más de medio millón de muertes al año.<ref name="WHO2018" /> Existe evidencia de que un mayor consumo de azúcar se asocia con una presión arterial más alta, con una mayor concentración de lípidos desfavorables en sangre,<ref name="Te MorengaHowatson2014">{{cite journal | vauthors = Te Morenga LA, Howatson AJ, Jones RM, Mann J | title = Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids | journal = The American Journal of Clinical Nutrition | volume = 100 | issue = 1 | pages = 65–79 | date = July 2014 | pmid = 24808490 | doi = 10.3945/ajcn.113.081521 | doi-access = free }}</ref> y con un aumento del riesgo de diabetes mellitus.<ref>"Wylie-Rosett2002"</ref> Un mayor consumo de carnes procesadas se asocia con un mayor riesgo de enfermedades cardiovasculares, posiblemente en parte debido a un mayor consumo de sal en la dieta.<ref name="MichaMichas2012">{{cite journal | vauthors = Micha R, Michas G, Mozaffarian D | title = Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes--an updated review of the evidence | journal = Current Atherosclerosis Reports | volume = 14 | issue = 6 | pages = 515–24 | date = December 2012 | pmid = 23001745 | pmc = 3483430 | doi = 10.1007/s11883-012-0282-8 }}</ref> Las personas con obesidad tienen un mayor riesgo de aterosclerosis de las arterias coronarias.<ref>{{cite journal | vauthors = Eckel RH | title = Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association | journal = Circulation | volume = 96 | issue = 9 | pages = 3248–50 | date = November 1997 | pmid = 9386201 | doi = 10.1161/01.CIR.96.9.3248 | df = }}</ref>

=== Alcohol ===
La relación entre el consumo de alcohol y las enfermedades cardiovasculares es compleja aunque parece que depende de la cantidad de alcohol consumida.<ref>{{cite journal | vauthors = Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H | display-authors = 6 | title = Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records | journal = BMJ | volume = 356 | pages = j909 | date = March 2017 | pmid = 28331015 | pmc = 5594422 | doi = 10.1136/bmj.j909 }}</ref> Existe una relación directa entre los altos niveles de consumo de alcohol y las enfermedades cardiovasculares.<ref name="WHO2011" /> Un consumo bajo de alcohol sin episodios de consumo excesivo puede estar asociado con un menor riesgo de enfermedad cardiovascular,<ref name="MukamalChen2010">{{cite journal | vauthors = Mukamal KJ, Chen CM, Rao SR, Breslow RA | title = Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002 | journal = Journal of the American College of Cardiology | volume = 55 | issue = 13 | pages = 1328–35 | date = March 2010 | pmid = 20338493 | pmc = 3865979 | doi = 10.1016/j.jacc.2009.10.056 }}</ref> y hay evidencia de que las asociaciones entre el consumo moderado de alcohol y la protección contra un [[accidente cerebrovascular]] no son causales.<ref>{{cite journal | vauthors = Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, Bennett DA, Chen Y, Dong C, Hu R, Zhou G, Yu B, Jia W, Parish S, Clarke R, Davey Smith G, Collins R, Holmes MV, Li L, Peto R, Chen Z | display-authors = 6 | title = Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China | journal = Lancet | volume = 393 | issue = 10183 | pages = 1831–1842 | date = May 2019 | pmid = 30955975 | pmc = 6497989 | doi = 10.1016/S0140-6736(18)31772-0 }}</ref> Pese a estos datos, a nivel poblacional, los riesgos para la salud del consumo de alcohol superan cualquier beneficio potencial.<ref name="WHO2011" /><ref name="Organization2011">{{cite book|author=World Health Organization|title=Global Status Report on Alcohol and Health|url=https://books.google.com/books?id=ktyfuAAACAAJ|year=2011|publisher=World Health Organization|isbn=978-92-4-156415-1|url-status=live|archive-url=https://web.archive.org/web/20160507000025/https://books.google.com/books?id=ktyfuAAACAAJ|archive-date=2016-05-07}}</ref>

===Celiaquía===
La [[celiaquía|enfermedad celíaca]] no diagnosticada se ha relacionado con numerosas afecciones cardiovasculares, la mayor parte de las cuales mejoran si se sigue una [[dieta sin gluten]]. Sin embargo, el retraso en el reconocimiento y el diagnóstico del celiaquismo pueden provocar daños cardiovasculares irreversibles.<ref name="CiaccioLewis2017" />

===Hábitos del sueño===
Los trastornos del sueño, como el [[síndrome de apnea-hipopnea durante el sueño]] o el [[insomnio]], así como una duración del sueño particularmente corta o larga, se asocian con un riesgo cardiometabólico más alto.<ref name="pmid27647451">{{cite journal | vauthors = St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL | title = Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 134 | issue = 18 | pages = e367–e386 | date = November 2016 | pmid = 27647451 | pmc = 5567876 | doi = 10.1161/CIR.0000000000000444 | type = Review }}</ref>

===Situación socioeconómica===
Las enfermedades cardiovasculares afectan más a los países de ingresos bajos y medios que a los países de ingresos altos.<ref name = "Di Cesare 2013">{{cite journal | vauthors = Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, Guerrero R, Ikeda N, Kyobutungi C, Msyamboza KP, Oum S, Lynch JW, Marmot MG, Ezzati M | display-authors = 6 | title = Inequalities in non-communicable diseases and effective responses | journal = Lancet | volume = 381 | issue = 9866 | pages = 585–97 | date = February 2013 | pmid = 23410608 | doi = 10.1016/S0140-6736(12)61851-0 | hdl = 10906/80012 | s2cid = 41892834 | hdl-access = free }}</ref> Hay relativamente poca información sobre los patrones sociales de las enfermedades cardiovasculares en los países de ingresos bajos y medios; pero en los [[Países de ingresos altos|países con mayores ingresos]], las rentas bajas y un nivel educativo bajo se asocian sistemáticamente con un mayor riesgo de enfermedad cardiovascular.<ref>{{cite journal | vauthors = Mackenbach JP, Cavelaars AE, Kunst AE, Groenhof F | title = Socioeconomic inequalities in cardiovascular disease mortality; an international study | journal = European Heart Journal | volume = 21 | issue = 14 | pages = 1141–51 | date = July 2000 | pmid = 10924297 | doi = 10.1053/euhj.1999.1990 }}</ref> Las políticas que han dado lugar a un aumento de las desigualdades socioeconómicas se han asociado con mayores .<ref name="Di Cesare 2013" /> Los factores psicosociales, las exposición a ciertos contaminantes ambientales, los hábitos relacionados con la salud y el acceso y la calidad de la atención médica contribuyen a las diferencias socioeconómicas en las enfermedades cardiovasculares, siendo necesaria una disminución de las diferencias en el nivel de vida dentro de una población para abordar las desigualdades en las enfermedades cardiovasculares y otras enfermedades no transmisibles.<ref name="Alexander 2009">{{cite journal | vauthors = Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A | title = Socioeconomic status and cardiovascular disease: risks and implications for care | journal = Nature Reviews. Cardiology | volume = 6 | issue = 11 | pages = 712–22 | date = November 2009 | pmid = 19770848 | doi = 10.1038/nrcardio.2009.163 | s2cid = 21835944 }}</ref><ref name="CSDoH2008">{{cite book|author=World Health Organization|title=Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health : Commission on Social Determinants of Health Final Report|url=https://books.google.com/books?id=zc_VfH7wfV8C&pg=PA26|year=2008|publisher=World Health Organization|isbn=978-92-4-156370-3|pages=26–|url-status=live|archive-url=https://web.archive.org/web/20160501062510/https://books.google.com/books?id=zc_VfH7wfV8C&pg=PA26|archive-date=2016-05-01}}</ref>

===Contaminación ambiental===
La [[contaminación por partículas]] se ha estudiado por sus efectos sobre las enfermedades cardiovasculares en la exposición a corto y largo plazo. Actualmente, las partículas en el aire de menos de 2,5 micrómetros de diámetro (PM<sub>2.5</sub>) son el foco principal de atención, en el que se utilizan [[Gradiente de concentración|gradientes]] para determinar el riesgo de enfermedad cardiovascular. En general, la exposición prolongada a la contaminación por partículas tanto a largo plazo como a corto plazo aumenta la tasa de [[Ateroesclerosis|aterosclerosis]] e [[inflamación sistémica]] entre otras afecciones cardiovasculares, llegando incluso a aumentar el número de ingresos hospitalarios y muertes por enfermedades cardiovasculares y pulmonares el día siguiente de un episodio de contaminación ambiental. <ref name="DOIthromres">{{cite journal|title=Air pollution and cardiovascular disease|date=March 2012|journal=Thrombosis Research|volume=129|issue=3|pages=230–4|doi=10.1016/j.thromres.2011.10.030|pmid=22113148|vauthors=Franchini M, Mannucci PM}}</ref><ref name="Doicirculationaha">{{cite journal | vauthors = Sun Q, Hong X, Wold LE | title = Cardiovascular effects of ambient particulate air pollution exposure | journal = Circulation | volume = 121 | issue = 25 | pages = 2755–65 | date = June 2010 | pmid = 20585020 | pmc = 2924678 | doi = 10.1161/CIRCULATIONAHA.109.893461 }}</ref>

=== Depresión y estrés traumático ===
Existe evidencia de que los problemas de salud mental, en particular la [[depresión]] y el [[estrés traumático]], están relacionados con las enfermedades cardiovasculares. Si bien se sabe que los problemas de salud mental están asociados con factores de riesgo de enfermedades cardiovasculares como el tabaquismo, la mala alimentación y un estilo de vida sedentario, estos factores por sí solos no explican el mayor riesgo de enfermedades cardiovasculares que se observa en la depresión, el estrés y la ansiedad.<ref>{{cite journal | vauthors = Cohen BE, Edmondson D, Kronish IM | title = State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular Disease | journal = American Journal of Hypertension | volume = 28 | issue = 11 | pages = 1295–302 | date = November 2015 | pmid = 25911639 | pmc = 4612342 | doi = 10.1093/ajh/hpv047 }}</ref> Además, el [[trastorno por estrés postraumático]] se asocia de forma independiente con un mayor riesgo de enfermedad coronaria incidente, incluso después de ajustar la depresión y otras covariables.<ref>{{cite journal | vauthors = Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM | title = Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review | journal = American Heart Journal | volume = 166 | issue = 5 | pages = 806–14 | date = November 2013 | pmid = 24176435 | pmc = 3815706 | doi = 10.1016/j.ahj.2013.07.031 }}</ref>

=== Riesgo laboral ===
Aunque todavía es necesario investigar con profundidad la relación entre el riesgo de enfermedades cardiovasculares y el trabajo, se han establecido vínculos entre estos y [[Límite de exposición ocupacional|ciertas toxinas]], el calor y el frío extremos, la exposición al humo del tabaco y problemas de salud mental como el estrés y la depresión.<ref>{{Cite web|url=https://www.cdc.gov/niosh/programs/crcd/|title=CDC - NIOSH Program Portfolio : Cancer, Reproductive, and Cardiovascular Diseases : Program Description|website=www.cdc.gov|access-date=2016-06-07|url-status=live|archive-url=https://web.archive.org/web/20160515221455/http://www.cdc.gov/niosh/programs/crcd/|archive-date=2016-05-15}}</ref>

====Riesgos psicológicos====
Se han encontrado situaciones que aumentan el riesgo a sufrir problemas cardiovasculares como en trabajos mentalmente estresantes, en situaciones de inseguridad laboral o con un desequilibrio entre el esfuerzo y la recompensa, en puestos de trabajo con un bajo soporte social, en trabajos con horario nocturno, con jornadas laborales muy largas o aquellas personas expuestas a ruidos fuertes.<ref name=":2">{{Cite web|url=http://www.sbu.se/en/publications/sbu-assesses/occupational-exposures-and-cardiovascular-disease/|title=Occupational Exposures and Cardiovascular Disease|author=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|date=2015-08-26|website=www.sbu.se|language=en|archive-url=https://web.archive.org/web/20170614063247/http://www.sbu.se/en/publications/sbu-assesses/occupational-exposures-and-cardiovascular-disease/|archive-date=2017-06-14|access-date=2017-06-01|url-status=live}}</ref>

====Riesgos por exposición a sustancias químicas====
Un informe de la [[Agencia Sueca de Evaluación de Tecnologías Sanitarias y Evaluación de Servicios Sociales|agencia de salud sueca]] de 2017 encontró que la exposición en el lugar de trabajo al [[Silicosis|polvo de sílice]], al [[Gas de escape|humo de los tubos de escape]] o las emanaciones en los trabajos de soldadura están asociados con enfermedades cardíacas, como la enfermedad cardíaca pulmonar, entre otras.<ref name="SBU2017">{{Cite web|url=http://www.sbu.se/en/publications/sbu-assesses/occupational-health-and-safety--chemical-exposure/|title=Occupational health and safety – chemical exposure|author=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|website=www.sbu.se|language=en|access-date=2017-06-01|url-status=dead|archive-url=https://web.archive.org/web/20170606093333/http://www.sbu.se/en/publications/sbu-assesses/occupational-health-and-safety--chemical-exposure/|archive-date=2017-06-06}}</ref> También existen asociaciones con la exposición a [[arsénico]], [[Benzopireno|benzopirenos]], [[plomo]], [[dinamita]], [[Sulfuro de carbono|disulfuro de carbono]], [[monóxido de carbono]], [[Tara (Drina)|taladrina]] y al humo del tabaco en el trabajo.<ref name="SBU2017" /> Trabajar con la producción [[Electrolito|electrolítica]] de aluminio o en la fabricación de papel cuando se utiliza el [[proceso Kraft]] está asociado a enfermedades cardíacas como el [[Accidente cerebrovascular|ictus]].<ref name="SBU2017" /> También se encontró una asociación entre la enfermedad cardíaca y la exposición a compuestos que ya no están permitidos en ciertos entornos de trabajo, como los fenoxiácidos que contienen [[2,3,7,8-tetraclorodibenzo-p-dioxina|TCDD]] (dioxina) o [[asbesto]].<ref name="SBU2017" />

=== Hematopoyesis clonal ===
Ciertas [[Mutación|mutaciones]] asociadas a la [[leucemia]] en las [[células sanguíneas]] también pueden conducir a un mayor riesgo de enfermedad cardiovascular. Varios proyectos de investigación a gran escala que analizan datos genéticos humanos han encontrado un vínculo sólido entre la presencia de estas mutaciones, una condición conocida como [[hematopoyesis clonal]], y los incidentes y la mortalidad relacionados con enfermedades cardiovasculares.<ref>{{cite journal | vauthors = Jan M, Ebert BL, Jaiswal S | title = Clonal hematopoiesis | journal = Seminars in Hematology | volume = 54 | issue = 1 | pages = 43–50 | date = January 2017 | pmid = 28088988 | doi = 10.1053/j.seminhematol.2016.10.002 | doi-access = free }}</ref>

===Radioterapia===
La [[radioterapia]] puede aumentar el riesgo de enfermedad cardíaca y el riesgo de muerte, como se observó en regímenes de tratamiento anteriores a 1990 de radioterapia para el cáncer de mama.<ref>{{cite journal |vauthors=Taylor CW, Nisbet A, McGale P, Darby SC | title = Cardiac exposures in breast cancer radiation therapy: 1950s–1990s | journal = Int J Radiat Oncol Biol Phys. | volume = 69 | issue = 5 | pages = 1484–95 | date = Dec 2007 | pmid = 18035211 | doi = 10.1016/j.ijrobp.2007.05.034 }}</ref> La radiación terapéutica aumenta el riesgo de un transtorno cardiovascular posterior ([[Infarto agudo de miocardio|ataque cardíaco]] o [[accidente cerebrovascular]]) entre 1,5 y 4 veces la tasa normal.<ref name="pmid:20298931">{{cite journal |last1=Weintraub |first1=Neal L. |last2=Jones |first2=W. Keith |last3=Manka |first3=David |title=Understanding Radiation-Induced Vascular Disease |journal=Journal of the American College of Cardiology |date= 23 March 2010 |volume=55 |issue=12 |doi=10.1016/j.jacc.2009.11.053 |pmid=20298931}}</ref> El aumento es dependiente de la dosis, relacionado con la fuerza, el volumen y la ubicación de la dosis de la radiación.

Los efectos secundarios tardíos cardiovasculares se han denominado [[enfermedad cardíaca inducida por radiación]] (RIHD) y [[enfermedad vascular inducida por radiación]] (RIVD).<ref name="pmid:28911261">{{cite journal |last1=Klee |first1=Nicole S. |last2=McCarthy |first2=Cameron G. |last3=Martinez-Quinones |first3=Patricia |last4=Webb |first4=R. Clinton |title=Out of the frying pan and into the fire: damage-associated molecular patterns and cardiovascular toxicity following cancer therapy |journal=Therapeutic Advances in Cardiovascular Disease |date=Nov 2017 |volume=11 |issue=11 |pages=297–317 |doi=10.1177/1753944717729141 |pmid=28911261}}</ref> Los síntomas dependen de la dosis e incluyen [[Miocardiopatía|cardiomiopatía]], [[fibrosis miocárdica]], [[valvulopatía]], [[enfermedad de las arterias coronarias]], [[Trastornos del ritmo cardíaco|arritmia cardíaca]] y [[enfermedad vascular periférica]]. La fibrosis inducida por la radiación, el [[Disfunción endotelial|daño de las células vasculares]] y el [[estrés oxidativo]] pueden provocar estos y otros fectos secundarios tardíos.<ref name="pmid:28911261" />



== Biomarcadores ==

Algunos [[Biomarcadores]] están hechos con el propósito de brindar detalladamente los riesgos de una enfermedad cardiovascular. Sin embargo, el valor clínico de estos biomarcadores no es defintivo por lo que las agencias de salud cardiovascular europea, canadiense y norteamericana siguen criterios distintos en algunos de ellos.<ref name="EckelCornier2014">{{cite journal|title=Update on the NCEP ATP-III emerging cardiometabolic risk factors|date=August 2014|journal=BMC Medicine|volume=12|issue=1|pages=115|doi=10.1186/1741-7015-12-115|pmc=4283079|pmid=25154373|vauthors=Eckel RH, Cornier MA}} {{open access}}</ref> Actualmente los biomarcadores que pueden reflejar un mayor riesgo de enfermedades cardiovasculares incluyen el [[Índice tobillo-brazo|índice tobillo brazo]], la [[Proteína C reactiva|proteína C reactiva (hs-CRP)]] relacionada con los procesos inflamatorios, la concentración en sangre de [[fibrinógeno]], de [[homocisteína]], de [[PAI-1]], de [[dimetilarginina asimétrica]] y de [[péptido natriurético cerebral]], las [[Apolipoproteína|apolipoproteinas]] A-I y B, y la [[lipoproteína]] (a) o la [[hiperfosfatemia]].<ref>{{cite journal|title=Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis|date=October 2016|journal=Clinica Chimica Acta; International Journal of Clinical Chemistry|volume=461|pages=76–82|doi=10.1016/j.cca.2016.07.020|pmid=27475981|vauthors=Bai W, Li J, Liu J}}</ref><ref name="HlatkyGreenland2009">{{cite journal|title=Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association|date=May 2009|journal=Circulation|volume=119|issue=17|pages=2408–16|doi=10.1161/CIRCULATIONAHA.109.192278|pmc=2956982|pmid=19364974|display-authors=6|vauthors=Hlatky MA, Greenland P, Arnett DK, Ballantyne CM, Criqui MH, Elkind MS, Go AS, Harrell FE, Hong Y, Howard BV, Howard VJ, Hsue PY, Kramer CM, McConnell JP, Normand SL, O'Donnell CJ, Smith SC, Wilson PW}}</ref>

== Fisiopatología ==
[[File:Cardiovascular calcification - Sergio Bertazzo.tif|thumbnail|right|Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material)<ref name="Bertazzo">{{cite journal | vauthors = Bertazzo S, Gentleman E, Cloyd KL, Chester AH, Yacoub MH, Stevens MM | title = Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification | journal = Nature Materials | volume = 12 | issue = 6 | pages = 576–83 | date = June 2013 | pmid = 23603848 | pmc = 5833942 | doi = 10.1038/nmat3627 | bibcode = 2013NatMa..12..576B }}</ref>]]
Los [[Estudio basado ​​en la población|estudios basados ​​en la población]] muestran que la aterosclerosis, el principal precursor de la enfermedad cardiovascular, comienza en la niñez. El estudio de Determinantes patobiológicos de la aterosclerosis en la juventud (PDAY) demostró que las lesiones de la íntima aparecen en todas las aortas y en más de la mitad de las arterias coronarias derechas de los jóvenes de 7 a 9 años. <ref>{{cite journal | vauthors = Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA | title = Awareness, knowledge, and perception of heart disease among adolescents | journal = European Journal of Cardiovascular Prevention and Rehabilitation | volume = 13 | issue = 5 | pages = 718–23 | date = October 2006 | pmid = 17001210 | doi = 10.1097/01.hjr.0000214611.91490.5e | s2cid = 36312234 }}</ref>

Esto es extremadamente importante teniendo en cuenta que 1 de cada 3 personas mueren por complicaciones atribuibles a la aterosclerosis. Para detener la marea, se debe educar y tomar conciencia de que las enfermedades cardiovasculares representan la mayor amenaza y se deben tomar medidas para prevenir o revertir esta enfermedad.

La obesidad y la [[diabetes mellitus]] a menudo se relacionan con enfermedades cardiovasculares, <ref>{{cite journal | vauthors = Highlander P, Shaw GP | title = Current pharmacotherapeutic concepts for the treatment of cardiovascular disease in diabetics | journal = Therapeutic Advances in Cardiovascular Disease | volume = 4 | issue = 1 | pages = 43–54 | date = February 2010 | pmid = 19965897 | doi = 10.1177/1753944709354305 | s2cid = 23913203 }}</ref> al igual que un historial de [[enfermedad renal]] e [[hipercolesterolemia]] crónica. <ref name="nps01">{{cite web |title=NPS Prescribing Practice Review 53: Managing lipids |url=http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/prescribing_practice_review_53 |author=NPS Medicinewise |access-date=1 August 2011 |date=1 March 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110319103522/http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/prescribing_practice_review_53 |archive-date=19 March 2011 }}</ref> De hecho, la enfermedad cardiovascular es la más potencialmente mortal de las complicaciones diabéticas y los diabéticos tienen entre dos y cuatro veces más probabilidades de morir por causas cardiovasculares que los no diabéticos. <ref>{{cite journal | authors = Kvan E, Pettersen KI, Sandvik L, Reikvam A | title = High mortality in diabetic patients with acute myocardial infarction: cardiovascular co-morbidities contribute most to the high risk | journal = International Journal of Cardiology | volume = 121 | issue = 2 | pages = 184–8 | date = October 2007 | pmid = 17184858 | doi = 10.1016/j.ijcard.2006.11.003 }}</ref><ref>{{cite journal | authors = Norhammar A, Malmberg K, Diderholm E, Lagerqvist B, Lindahl B, Rydén L, Wallentin L | title = Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization | journal = Journal of the American College of Cardiology | volume = 43 | issue = 4 | pages = 585–91 | date = February 2004 | pmid = 14975468 | doi = 10.1016/j.jacc.2003.08.050 | doi-access = free }}</ref><ref>{{cite journal | author = DECODE, European Diabetes Epidemiology Group | title = Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe | journal = Lancet | volume = 354 | issue = 9179 | pages = 617–21 | date = August 1999 | pmid = 10466661 | doi = 10.1016/S0140-6736(98)12131-1 | s2cid = 54227479 }}</ref>

== Tratamiento ==


Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.<ref name="WHO2011" /> [[Influenza]] may make heart attacks and strokes more likely and therefore [[influenza vaccination]] may decrease the chance of cardiovascular events and death in people with heart disease.<ref>{{cite journal|title=Influenza vaccines for preventing cardiovascular disease|date=May 2015|journal=The Cochrane Database of Systematic Reviews|issue=5|pages=CD005050|doi=10.1002/14651858.CD005050.pub3|pmid=25940444|authors=Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K}}</ref>
A diferencia de las otras condiciones médicas crónicas, las enfermedades cardiovasculares son tratables y reversibles, incluso después de llevar un largo tiempo con la enfermedad. El tratamiento está enfocado en la [[dieta]], actividad física regulada y la reducción del [[estrés]].Si la enfermedad es muy grave puede llegar a una cirugía, y en extremo a la muerte.


Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle-income levels.<ref name=":0">{{Cite book|title=Braunwald's heart disease : a textbook of cardiovascular medicine|first5=Eugene|oclc=890409638|location=Philadelphia|edition=Tenth|isbn=978-1-4557-5133-4|last5=Braunwald|last4=Bonow|first1=Douglas L|first4=Robert O|last3=Libby|first3=Peter|last2=Zipes|first2=Douglas P|last1=Mann|year=2014}}</ref> Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for quality-adjusted life-year (QALY) in regions of low and middle income. The costs for a single QALY for aspirin and atenolol were less than $25, streptokinase was about $680, and t-PA was $16,000.<ref name="Zip2018">{{cite book|last1=Zipes|url=https://books.google.com/books?id=LwBGDwAAQBAJ&pg=PA15|page=15|isbn=9780323555937|publisher=Elsevier Health Sciences|date=2018|title=Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine|first5=Gordon F.|first1=Douglas P.|last5=Tomaselli|first4=Douglas L.|last4=Mann|first3=Robert O.|last3=Bonow|first2=Peter|last2=Libby|language=en}}</ref> Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350.<ref name="Zip2018" />
== Iniciación joven ==


A 2020 Cochrane review did not find any additional benefit in terms of mortality and serious adverse events when blood pressure targets were lowered to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg.<ref>{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/32905623|title=Blood pressure targets for the treatment of people with hypertension and cardiovascular disease|last2=Gorricho|first2=Javier|date=9 September 2020|journal=The Cochrane Database of Systematic Reviews|volume=9|pages=CD010315|issn=1469-493X|doi=10.1002/14651858.CD010315.pub4|pmid=32905623|last3=Garjón|first3=Javier|last4=Celaya|first4=Mª Concepción|last5=Erviti|first5=Juan|last6=Leache|first6=Leire|last=Saiz|first=Luis Carlos|via=}}</ref>
Estudios basados en la población joven muestran que los predecesores de las enfermedades de corazón empiezan en la [[adolescencia]]. El proceso de [[Arteriosclerosis]] se desarrolla en décadas, y comienza en la infancia. Las determinantes patobiológicas de la arteriosclerosis en estudios basados en jóvenes demostraron que las lesiones internas aparecieron en todas las aortas y más de la mitad de las [[Arteria coronaria derecha|arterias coronarias derecha]] de infantes de 7 a 9 años. Sin embargo, la mayoría de los adolescentes están más preocupados por otras enfermedades como el [[VIH]], accidentes, y cáncer que por las enfermedades cardiovasculares. Es extremadamente importante considerar que 1 de 3 personas mueren de complicaciones atribuidas a la arteriosclerosis. Con el fin de detener la marea de las enfermedades cardiovasculares, la prevención primaria es necesaria. Ésta se inicia con la concientización de que la enfermedad cardiovascular representa la mayor amenaza y la educación en las medidas para prevenir o revertir esta enfermedad.


== Detección ==
== Detección ==

Revisión del 16:35 14 nov 2020


Prevención

Hasta el 90% de las enfermedades cardiovasculares se pueden prevenir si se evitan los factores de riesgo establecidos. [1][2][3]​ Las medidas que se practican actualmente para prevenir las enfermedades cardiovasculares incluyen:

  • Reducción del consumo de grasas saturadas: existe evidencia de calidad moderada de que la reducción de la proporción de grasas saturadas en la dieta y su sustitución por grasas insaturadas o carbohidratos durante un período de al menos dos años conduce a una reducción del riesgo de enfermedad cardiovascular.[4]
  • Dejar de fumar y evitar el humo indirecto.[5]​ Dejar de fumar reduce el riesgo en aproximadamente un 35%.[6]
  • Mantener una dieta saludable, como la dieta mediterránea.[5]​ Las intervenciones enfocadas en la dieta son efectivas para reducir los factores de riesgo cardiovascular cuando se aplican durante un año, pero la efectividad a largo plazo de tales intervenciones y su impacto en las enfermedades cardiovasculares son inciertos.[7]
  • Al menos 150 minutos (2 horas y 30 minutos) de ejercicio moderado por semana.[8][9]
  • Ceñir el consumo de alcohol a los límites diarios recomendados;[5]​ Las personas que tienen un consumo moderado o bajo de alcohol tienen entre un 25% y un 35% menos de riesgo de enfermedad cardiovascular. Sin embargo, las personas que están genéticamente predispuestas a consumir menos alcohol tienen tasas más bajas de enfermedad cardiovascular, lo que sugiere que el alcohol en sí puede no ser protector. La ingesta excesiva de alcohol aumenta el riesgo de enfermedad cardiovascular y el consumo de alcohol se asocia con un mayor riesgo de un evento cardiovascular en el día siguiente al consumo.
  • Presión arterial más baja, si está elevada. Una reducción de 10 mmHg en la presión arterial reduce el riesgo en aproximadamente un 20%.
  • Disminuye el colesterol no HDL. El tratamiento con estatinas reduce la mortalidad cardiovascular en aproximadamente un 31%.
  • Disminuya la grasa corporal si tiene sobrepeso o es obeso. El efecto de la pérdida de peso a menudo es difícil de distinguir del cambio en la dieta, y la evidencia sobre las dietas reductoras de peso es limitada. En estudios observacionales de personas con obesidad severa, la pérdida de peso después de la cirugía bariátrica se asocia con una reducción del 46% en el riesgo cardiovascular.
  • Disminuye el estrés psicosocial. Esta medida puede complicarse por definiciones imprecisas de lo que constituyen intervenciones psicosociales. La isquemia miocárdica inducida por estrés mental se asocia con un mayor riesgo de problemas cardíacos en personas con enfermedades cardíacas previas. El estrés emocional y físico severo conduce a una forma de disfunción cardíaca conocida como síndrome de Takotsubo en algunas personas. El estrés, sin embargo, juega un papel relativamente menor en la hipertensión. Las terapias de relajación específicas tienen un beneficio poco claro.


  • Limit alcohol consumption to the recommended daily limits; People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease.[10][11]​ However, people who are genetically predisposed to consume less alcohol have lower rates of cardiovascular disease[12]​ suggesting that alcohol itself may not be protective. Excessive alcohol intake increases the risk of cardiovascular disease[13][11]​ and consumption of alcohol is associated with increased risk of a cardiovascular event in the day following consumption.[11]
  • Lower blood pressure, if elevated. A 10 mmHg reduction in blood pressure reduces risk by about 20%.[14]
  • Decrease non-HDL cholesterol.[15][16]Statin treatment reduces cardiovascular mortality by about 31%.[17]
  • Decrease body fat if overweight or obese.[18]​ The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited.[19]​ In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk.[20]
  • Decrease psychosocial stress.[21]​ This measure may be complicated by imprecise definitions of what constitute psychosocial interventions.[22]​ Mental stress–induced myocardial ischemia is associated with an increased risk of heart problems in those with previous heart disease.[23]​ Severe emotional and physical stress leads to a form of heart dysfunction known as Takotsubo syndrome in some people.[24]​ Stress, however, plays a relatively minor role in hypertension.[25]​ Specific relaxation therapies are of unclear benefit.[26][27]

Most guidelines recommend combining preventive strategies. A 2015 Cochrane Review found some evidence that interventions aiming to reduce more than one cardiovascular risk factor may have beneficial effects on blood pressure, body mass index and waist circumference; however, evidence was limited and the authors were unable to draw firm conclusions on the effects on cardiovascular events and mortality.[28]​ For adults without a known diagnosis of hypertension, diabetes, hyperlipidemia, or cardiovascular disease, routine counseling to advise them to improve their diet and increase their physical activity has not been found to significantly alter behavior, and thus is not recommended.[29]​ Another Cochrane review suggested that simply providing people with a cardiovascular disease risk score may reduce cardiovascular disease risk factors by a small amount compared to usual care.[30]​ However, there was some uncertainty as to whether providing these scores had any effect on cardiovascular disease events. It is unclear whether or not dental care in those with periodontitis affects their risk of cardiovascular disease.[31]

Diet

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death.[32]​ Evidence suggests that the Mediterranean diet may improve cardiovascular outcomes.[33]​ There is also evidence that a Mediterranean diet may be more effective than a low-fat diet in bringing about long-term changes to cardiovascular risk factors (e.g., lower cholesterol level and blood pressure).[34]​ The DASH diet (high in nuts, fish, fruits and vegetables, and low in sweets, red meat and fat) has been shown to reduce blood pressure,[35]​ lower total and low density lipoprotein cholesterol[36]​ and improve metabolic syndrome;[37]​ but the long-term benefits have been questioned.[38]​ A high fiber diet is associated with lower risks of cardiovascular disease.[39]​Worldwide, dietary guidelines recommend a reduction in saturated fat,[40]​ and although the role of dietary fat in cardiovascular disease is complex and controversial there is a long-standing consensus that replacing saturated fat with unsaturated fat in the diet is sound medical advice.[41]​ Total fat intake has not been found to be associated with cardiovascular risk.[42][43]​ A 2020 systematic review found moderate quality evidence that reducing saturated fat intake for at least 2 years caused a reduction in cardiovascular events.[44]Plantilla:Update inline A 2015 meta-analysis of observational studies however did not find a convincing association between saturated fat intake and cardiovascular disease.[45]​ Variation in what is used as a substitute for saturated fat may explain some differences in findings.[41]​ The benefit from replacement with polyunsaturated fats appears greatest,[46]​ while replacement of saturated fats with carbohydrates does not appear to have a beneficial effect.[46]​ A diet high in trans fatty acids is associated with higher rates of cardiovascular disease,[47]​ and in 2015 the Food and Drug Administration (FDA) determined that there was 'no longer a consensus among qualified experts that partially hydrogenated oils (PHOs), which are the primary dietary source of industrially produced trans fatty acids (IP-TFA), are generally recognized as safe (GRAS) for any use in human food'.[48]​ There is conflicting evidence concerning dietary supplements of omega-3 fatty acids (a type of polysaturated fat in oily fish) added to diet improve cardiovascular risk.[49][50]

A 2014 Cochrane review found unclear benefit of recommending a low-salt diet in people with high or normal blood pressure.[51]​ In those with heart failure, after one study was left out, the rest of the trials show a trend to benefit.[52][53]​ Another review of dietary salt concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; both as a result of the increased blood pressure and, quite likely, through other mechanisms.[54][55]​ Moderate evidence was found that high salt intake increases cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes, and left ventricular hypertrophy.[54]

Medication

Blood pressure medication reduces cardiovascular disease in people at risk,[14]​ irrespective of age,[56]​ the baseline level of cardiovascular risk,[57]​ or baseline blood pressure.[58]​ The commonly-used drug regimens have similar efficacy in reducing the risk of all major cardiovascular events, although there may be differences between drugs in their ability to prevent specific outcomes.[59]​ Larger reductions in blood pressure produce larger reductions in risk,[59]​ and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure.[60]​ Adherence to medications is often poor and while mobile phone text messaging has been tried to improve adherence, there is insufficient evidence that it alters secondary prevention of cardiovascular disease.[61]

Statins are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease.[62]​ As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women.[62]​ In those at risk, but without a history of cardiovascular disease (primary prevention), statins decrease the risk of death and combined fatal and non-fatal cardiovascular disease.[63]​ The benefit, however, is small.[64]​ A United States guideline recommends statins in those who have a 12% or greater risk of cardiovascular disease over the next ten years.[65]Niacin, fibrates and CETP Inhibitors, while they may increase HDL cholesterol do not affect the risk of cardiovascular disease in those who are already on statins.[66]​ Fibrates lower the risk of cardiovascular and coronary events, but there is no evidence to suggest that they reduce all-cause mortality.[67]

Anti-diabetic medication may reduce cardiovascular risk in people with Type 2 Diabetes, although evidence is not conclusive.[68]​ A meta-analysis in 2009 including 27,049 participants and 2,370 major vascular events showed a 15% relative risk reduction in cardiovascular disease with more-intensive glucose lowering over an average follow-up period of 4.4 years, but an increased risk of major hypoglycemia.[69]

Aspirin has been found to be of only modest benefit in those at low risk of heart disease as the risk of serious bleeding is almost equal to the benefit with respect to cardiovascular problems.[70]​ In those at very low risk, including those over the age of 70, it is not recommended.[71][72]​ The United States Preventive Services Task Force recommends against use of aspirin for prevention in women less than 55 and men less than 45 years old; however, in those who are older it is recommends in some individuals.[73]

The use of vasoactive agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense.[74]

Physical activity

Exercise-based cardiac rehabilitation following a heart attack reduces the risk of death from cardiovascular disease and leads to less hospitalizations.[75]​ There have been few high quality studies of the benefits of exercise training in people with increased cardiovascular risk but no history of cardiovascular disease.[76]

A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide.[77]​ The authors estimated that 121,000 deaths from coronary heart disease could have been averted in Europe in 2008, if physical inactivity had been removed. A Cochrane review found some evidence that yoga has beneficial effects on blood pressure and cholesterol, but studies included in this review were of low quality.[78]​ Tentative evidence suggests that home-based exercise programs may be more efficient at improving exercise adherence.[79]

Dietary supplements

While a healthy diet is beneficial, the effect of antioxidant supplementation (vitamin E, vitamin C, etc.) or vitamins has not been shown to protect against cardiovascular disease and in some cases may possibly result in harm.[80][81][82][83]​ Mineral supplements have also not been found to be useful.[84]Niacin, a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk.[85][86]Magnesium supplementation lowers high blood pressure in a dose dependent manner.[87]​ Magnesium therapy is recommended for people with ventricular arrhythmia associated with torsades de pointes who present with long QT syndrome as well as for the treatment of people with digoxin intoxication-induced arrhythmias.[88]​ There is no evidence to support omega-3 fatty acid supplementation.[89]

Tratamiento

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.[90]Influenza may make heart attacks and strokes more likely and therefore influenza vaccination may decrease the chance of cardiovascular events and death in people with heart disease.[91]

Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle-income levels.[92]​ Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for quality-adjusted life-year (QALY) in regions of low and middle income. The costs for a single QALY for aspirin and atenolol were less than $25, streptokinase was about $680, and t-PA was $16,000.[93]​ Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350.[93]

A 2020 Cochrane review did not find any additional benefit in terms of mortality and serious adverse events when blood pressure targets were lowered to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg.[94]

Detección

Complejos de fibrina y de plaquetas pueden ser vistos con la técnica de microscopía de campo oscuro. Son mucho más grandes que los glóbulos rojos y fácilmente pueden bloquear los capilares. Estos complejos son claramente visibles en un campo oscuro, pero no en las muestras de campo teñido brillante porque los diferentes métodos de teñido los opacan. Este método de detección temprana permite identificar a las personas en situación de riesgo y tomar las medidas oportunas.

Diferentes enfermedades cardiovasculares:

Prevención

Actualmente las medidas preventivas para evitar las enfermedades cardiovasculares incluyen:

  • Conocer su presión arterial y mantenerla controlada
  • Ejercitarse regularmente
  • No fumar
  • Hacerse pruebas para detectar diabetes y si la tiene, mantenerla bajo control
  • Conocer sus niveles de colesterol y triglicéridos y mantenerlos controlados
  • Comer muchas frutas y verduras
  • Mantener un peso saludable
  • Reconocer y diagnosticar la enfermedad celíaca, que sin tratamiento puede causar varios tipos de enfermedades cardiovasculares. La mayoría de ellas mejoran o se curan completamente con la dieta sin gluten y la recuperación del intestino. No obstante, cuando el diagnóstico de la enfermedad celíaca se retrasa, los daños en el corazón pueden ser irreversibles.[95]

Investigación

Las causas, prevención y/o tratamiento de todos los tipos de enfermedades cardiovasculares son campos activos de la investigación biomédica, con cientos de artículos científicos publicados semanalmente. Un énfasis reciente es un enlace entre la inflamación de bajo grado y sus posibles intervenciones. La proteína de reactivo-C (CRP) es un marcador inflamable que puede estar presente en pacientes con riesgo a enfermedades cardiovasculares con elevados niveles en la sangre.

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