Are there any special populations and risk classification of cardiovascular diseases?
Are there any special populations and risk classification of cardiovascular diseases?
- Introduction
- Severity levels of risk of developing cardiovascular disease
- Risk of Cardiovascular disease in women
- Outline of WHO risk classification of cardiovascular disease and pregnancy
- Is triglyceride/HDL ratio prediction for cardiovascular disease reliable?
- How does genetic testing help special populations and risk classification?
Introduction
India has the unenviable position of having a higher fatality rate for cardiovascular disease. Globally, the rate is 233 for every 1,00,000, while in India it is 282 for every 1,00,000 of the population. When combined with the high population levels, this works out to a very high number. Certain people are more at risk of the disease than others, and it helps to understand the people of high risk categories. Here is a detailed look at special populations and risk classification of CVD. This will help in opting for necessary screening and remedial measures to reduce the risk of a serious condition.
Severity levels of risk of developing cardiovascular disease
Before we look at the information on special populations and risk classification here is an important note. Those at high risk of CVD have a higher probability of fatalities than those with lower risk of CVD. Let’s dive into the different risk factors classified by severity.
- Hypertension – When high blood pressure is not controlled, this can result in possible heart failure and stroke. In addition to this there are other adverse effects due to hypertension.
- Hyperlipidemia – When you have high levels of cholesterol and triglycerides, this can result in possible atherosclerosis. This will, in turn put you at high risk of heart attacks and strokes.
- Blood sugar – When your diabetes is not controlled, this can cause damage to your blood vessels and nerves. This will, in turn build up increased risk of cardiovascular diseases.
- Smoking – This is a major risk factor, as smoking causes damage to your blood vessels. It brings down the levels of oxygen in the blood, and facilitates development of atherosclerosis.
- Age – Elderly people adults are more at risk, and this is mainly because of the possible comorbid factors from advancing age. This causes increase risk of cardiovascular disease, with elevated risk of fatality.
- Gender – While men are known to be at higher risk for CVD, women are exposed to higher risk post-menopause. When women end up in the stage of high risk, this is comparably higher than that of men.
7. Genetic factors – If you have a family history of CVD, you are at higher risk due to the genetic component
Risk of Cardiovascular disease in women
Women are known to be at higher risk of CVD than men, and this risk increases post menopause. In terms of risk category, women can be considered as part of special populations and risk classification. There are two main reasons for high higher risk in women. The first is the biological reason, and the second is certain health conditions and changes post-menopause.
- One of the main biological reasons is smaller sized heart and narrow blood vessels, when compared with those of men.
- Health conditions can be broadly classified into the following:
- Changes in hormones – Estrogen plays an important role by ensuring health of blood vessels, and helps in regulating cholesterol levels. It also possesses anti-inflammatory properties, that is good for heart health. After menopause, estrogen levels reduce, and this removes the protective effects, exposing women to higher risk of CVD.
- Changes in metabolism – After menopause, women end up with higher low-density lipoprotein cholesterol, resulting in atherosclerosis. Similarly, menopause is linked to weight gain and abdominal fat. This, in turn causes insulin resistance, exposing women to higher risk of diabetes, that contributes to CVD risk.
- Blood pressure – After menopause, women end up with high blood pressure levels. This damages arteries, increasing the risk of heart disease, stroke.
- Sedentary lifestyle – Post menopause, women tend to lead a sedentary lifestyle, resulting in weight gain.
- Stress – One of the outcomes of menopause, is increased stress and depression. These are known to be responsible for higher risk of CVD
Outline of WHO risk classification of cardiovascular disease and pregnancy
As outlined above, women are at higher risk of cardiovascular disease post-menopause. Women are also at risk of CVD during pregnancy, and can be considered as part of special populations and risk classification. The World Health Organization has a risk classification system in place for cardiovascular disease during pregnancy. This is in four different categories, on the basis of type and severity of the underlying cardiovascular condition.
- WHO Class I – When pregnant women are at low risk, due to small conditions, like mild pulmonary stenosis, patent ductus arteriosus, mitral valve prolapse.
- WHO Class II – When there is slightly increased risk due to conditions. These include unoperated atrial or ventricular septal defect, arrhythmias, mild left ventricular impairment.
- WHO Class II-III – This refers to pregnant women who are at risk levels classified as moderate to severe due to certain conditions. This includes mild left ventricular dysfunction, hypertrophic cardiomyopathy, and Marfan syndrome with mild aortic dilation.
- WHO Class III – This applies to pregnant women who are at significantly higher risk from conditions. These include, mechanical heart valve, systemic right ventricle, Fontan circulation and complex congenital heart diseases.
- WHO Class IV – Refers to women who are at very high risk due to specific conditions. This includes pulmonary arterial hypertension, systemic ventricular dysfunction, aortic dilation, and coarctation of the aorta
Is triglyceride/HDL ratio prediction for cardiovascular disease reliable?
Yes, triglyceride/HDL ratio is regarded as a reliable indicator of special populations and risk classification of cardiovascular disease. The ratio helps assess insulin resistance and metabolic syndrome. These are regarded as serious risk factors for heart diseases, like hypertension, diabetes, abdominal fat, and high cholesterol levels.
When the TG/HDL ratio is high, it essentially indicates that the person has high triglycerides, and low HDL cholesterol. This puts the person at higher risk of developing atherosclerosis, slowly and steadily. This makes the TG/HDL ratio, an effective and reliable predictor of future risk.
How does genetic testing help special populations and risk classification?
Genetic testing helps people of special populations in screening for conditions that could pose future or lifetime risk. Advanced genetic testing facilities are presently available in Tamil Nadu, where you can provide a sample of blood or saliva for genetic analysis. This will reveal if you are genetically predisposed to certain conditions, either by birth defects or by inherited genes. Genetic factors are one of the many reasons for high risk of CVD, and genetic testing reveals this risk.
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Education: Master of Public Health (MPH) from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh Experience: A dedicated health writer with 8 years of experience covering a range of health topics, including public health and nutrition. His work has appeared on reputable Indian health websites and journals such as India Health Journal and The Health Times. Ravi also collaborates with Indian health agencies on public health campaigns.