RISK FACTORS FOR THE OCCURENCE OF CARDIOVASCULAR DISEASES
Keywords:
cardiovascular diseases, risk factors, physical activity, high blood pressure
Abstract
According to the World Health Organization (WHO) report from 2018, cardiovascular diseases (CVD) with 17.9 million deaths had a share of as much as 41% among the causes of mortality from non-communicable diseases with a representation of 31% in all causes of mortality. With a share of 45% of all deaths annually, i.e. 3.9 million, CVD is the leading cause of death in Europe according to the latest data from the European Heart Disease Network. Mortality is slightly higher in the female population with 2.1 million or 49%, compared to men with 1.8 or 40% of the causes of death. According to the latest published data According to the latest published data from the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut" from 2018, mortality caused by CVD in Serbia is estimated at 51.8%, and due to poor implementation of preventive measures, Serbia is classified as a high-risk country.
Non-modifiable risk factors for CVD are: age, gender, age, ethnicity and family history. Modifiable risk factors include: high systolic blood pressure, high low-density lipoprotein (LDL), dietary risks, high glucose, tobacco smoking (active and passive), high body mass index (BMI), low level of physical activity, kidney dysfunction, excessive alcohol use, lead exposure, air pollution, high or low temperatures.
Prevention and treatment of CVD is based on lifestyle modification, dietary intervention, improvement of physical activity and eventual use of medications. A minimum intake of 500 grams of fruit and vegetables per day is recommended, limiting salt intake to less than 5 grams per day, limiting sugar and fat intake to 10% and 30% of total energy intake, as well as balancing between total energy intake and energy consumption. The results of the PRIMED study showed significant positive effects of the Mediterranean diet on the primary prevention of CVD. The recommended physical activity is 150 minutes of moderate to high intensity physical activity per week, 75 minutes of high intensity physical activity per week, or the equivalent of a combination of moderate and high intensity physical activity.
References
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28. Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF. Healthy Weight and Obesity Prevention: JACC Health Promotion Series. J Am Coll Cardiol. 2018 Sep 25; 72(13):1506-1531.
29. Marques A, Peralta M, Naia A, Loureiro N, de Matos MG. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health. 2018 Apr 1;28(2):295-300.
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32. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology consensus project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75.
33. WHO. Global Recommendations on Physical Activity for Health. Geneva: World Health Organization; 2010.
34. Di Raimondo D, Musiari G, Giuliana Rizzo G, Antonino Tuttolomondo A, Antonio Pinto A. Effects of physical inactivity in cardiovascular biomarkers. J Lab Precis Med. 2020 Jul; 5:1-9.
35. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012; 2:1143-211.
36. Lavie CJ, O'Keefe JH, Sallis RE. Exercise and the heart --the harm of too little and too much. Curr Sports Med Rep. 2015;14:104-9.
37. Paley CA, Johnson MI. Abdominal obesity and metabolic syndrome: exercise as medicine? BMC Sports Sci Med Rehabil. 2018;10:7.
38. Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16:132.
39. Balducci S, Zanuso S, Cardelli P, et al. Effect of highversus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS One. 2012;7:e49297.
40. Di Raimondo D, Miceli G, Casuccio A, et al. Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension. Hypertens Res 2016; 39:440-8.
41. Van der Vorm LN, Huskens D, Kicken CH, et al. Effects of Repeated Bouts of Exercise on the Hemostatic System. Semin Thromb Hemost 2018; 44:710-22.
42. Neelam N. S, Saina S, Senthil P, Prakash P. O. Burden of illness, risk factor and physical activity in cardiovascular disease- A review. Biomedicine [Internet]. 2023 Aug. 30; 43(4):1080-93.
43. Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review. J Clin Med. 2023; 12(13):4347.
44. Kim MK, Han K, Joung HN, Baek KH, Song KH, Kwon HS. Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease. Cardiovasc Diabetol. 2019 Oct 22;18(1):139.
45. Navarese EP, Robinson JG, Kowalewski M, Kolodziejczak M, Andreotti F, Bliden K, et al. Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis. JAMA. 2018 Apr 17;319(15):1566-1579.
46. Zhang Y, Pletcher MJ, Vittinghoff E, Clemons AM, Jacobs DR Jr, Allen NB, et al. Association Between Cumulative Low-Density Lipoprotein Cholesterol Exposure During Young Adulthood and Middle Age and Risk of Cardiovascular Events. JAMA Cardiol. 2021 Dec 1;6(12):1406-1413.
47. Schade, D, Cavanaugh B, Ramo B, Eaton RP. "The application of the LDL principle. World J Cardiovasc Dis. 2016 Jan; 6(6)109-125.
48. Mente A, de Koning L, Shannon HS, Anand SS. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Arch Intern Med. 2009;169(7):659–669.
49. World Health Organization (WHO) Healthy Diet Factsheet No. 394, http://www.who.int/nutrition/publications/nutrientrequirements/healthydiet_factsheet394.pdf.
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51. Kondo T, Nakano Y, Adachi, S, Murohara, T. Effects of Tobacco Smoking on Cardiovascular Disease. Circ J. 2019; 83(10), 1980-1985.
52. Zaid M, Miura K, Okayama A, Nakagawa H, Sakata K, Saitoh S, et al. INTERLIPID and INTERMAP Research Groups. Associations of High-Density Lipoprotein Particle and High-Density Lipoprotein Cholesterol With Alcohol Intake, Smoking, and Body Mass Index - The INTERLIPID Study. Circ J. 2018 Sep 25; 82(10):2557-2565.
53. Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018 Jan 24; 360:j5855.
54. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013 Dec 7; 382(9908):1898-955.
55. Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol. 2017 Feb 15; 6(1):8-16.
56. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, De Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2015; 132:691–718.
57. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014; 37.
58. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39:2065–2079.
2. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec 22;76(25):2982-3021. Erratum in: J Am Coll Cardiol. 2021 Apr 20;77(15):1958-1959.
3. World Health Organization (WHO). Noncommunicable diseases country profiles. 2018. [cited January 21st 2020]. Available from: https://www.who.int/nmh/publications/ncd-profiles-2018/en/.
4. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, et. al. European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels.
5. Dizdarevic-Bostandzic A, Begovic E, Burekovic A, Velija-Asimi Z, Godinjak A, Karlovic V. Cardiovascular Risk Factors in Patients with Poorly Controlled Diabetes Mellitus. Med Arch. 2018 Feb; 72(1):13-16.
6. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al; ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016 Aug 1;37(29):2315-2381.
7. Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut". Zdravstveno-statistički godišnjak Republike Srbije 2018. 2019. [cited December 21st 2019]. Available from: http://www.batut.org.rs/download/publikacije/pub2017v026.pdf
8. International Classification of Diseases, Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.
9. Vaduganathan M, Mensah G, Turco J, Fuster V, Roth G. The Global Burden of Cardiovascular Diseases and Risk. J Am Coll Cardiol. 2022 Dec; 80 (25) 2361–2371.
10. Little M P, Azizova T V, Richardson D B, Tapio S, Bernier M, Kreuzer M et al. Ionising radiation and cardiovascular disease: systematic review and meta-analysis. BMJ 2023; 380:e072924.
11. Roth GA, Nguyen G, Forouzanfar MH, Mokdad AH, Naghavi M, Murray CJ. Estimates of global and regional premature cardiovascular mortality in 2025. Circulation. 2015;132(13):1270-1282.
12. Balakumar Pitchai, Maung-U Khin, Jagadeesh Gowraganahalli. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol. Res. 2016 Nov; 113(Pt A):600-609.
13. Brown JC, Gerhardt TE, Kwon E. Risk Factors for Coronary Artery Disease. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554410/
14. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438):937-952.
15. O'Donnell, Martin J., et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016 Aug 20;388(10046):761-75.
16. Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, Mente A, Yusuf S. Reducing the Global Burden of Cardiovascular Disease, Part 1: The Epidemiology and Risk Factors. Circ Res. 2017 Sep 1;121(6):677-694.
17. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC Scientific Document Group , 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J, 2018 Sep 1; 39(33): 3021–3104.
18. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020 Mar 7; 395(10226):795-808.
19. Kokubo Y, Matsumoto C. Hypertension Is a Risk Factor for Several Types of Heart Disease: Review of Prospective Studies. Adv Exp Med Biol. 2017; 956:419-426.
20. Bolad I, Delafontaine P. Endothelial dysfunction: its role in hypertensive coronary disease. Curr Opin Cardiol. 2005 Jul; 20(4):270-4.
21. Matsuzawa Y, Lerman A. Endothelial dysfunction and coronary artery disease: assessment, prognosis, and treatment. Coron Artery Dis. 2014 Dec;25(8):713-24.
22. Summers MR, Lerman A, Lennon RJ, Rihal CS, Prasad A. Myocardial ischaemia in patients with coronary endothelial dysfunction: insights from body surface ECG mapping and implications for invasive evaluation of chronic chest pain. Eur Heart J. 2011 Nov; 32(22):2758-65.
23. Shimokawa H, Yasuda S. Myocardial ischemia: current concepts and future perspectives. J Cardiol. 2008 Oct; 52(2):67-78.
24. Jeemon P, Séverin T, Amodeo C, Balabanova D, Campbell NRC, Gaita D, et al.. World Heart Federation Roadmap for Hypertension – A 2021 Update. Glob Heart. 2021;16(1):63.
25. Poorolajal J, Zeraati F, Soltanian AR, Sheikh V, Hooshmand E, Maleki A. Oral Potassium Supplementation for Management of Essential Hypertension: A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2017; 12(4): e0174967.
26. Cornelissen VA, Smart NA. Exercise Training for Blood Pressure: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2013; 2(1): e004473.
27. Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The Effect of a Reduction in Alcohol Consumption on Blood Pressure: A Systematic Review and Meta-Analysis. Lancet Public Health. 2017; 2(2): e108–e20.
28. Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF. Healthy Weight and Obesity Prevention: JACC Health Promotion Series. J Am Coll Cardiol. 2018 Sep 25; 72(13):1506-1531.
29. Marques A, Peralta M, Naia A, Loureiro N, de Matos MG. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health. 2018 Apr 1;28(2):295-300.
30. WORLD HEALTH ORGANIZATION. Obesity: preventing and managing the global epidemic: report of a WHO consultation. 2000.
31. Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016 Feb 16; 133(7):639-49.
32. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology consensus project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75.
33. WHO. Global Recommendations on Physical Activity for Health. Geneva: World Health Organization; 2010.
34. Di Raimondo D, Musiari G, Giuliana Rizzo G, Antonino Tuttolomondo A, Antonio Pinto A. Effects of physical inactivity in cardiovascular biomarkers. J Lab Precis Med. 2020 Jul; 5:1-9.
35. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012; 2:1143-211.
36. Lavie CJ, O'Keefe JH, Sallis RE. Exercise and the heart --the harm of too little and too much. Curr Sports Med Rep. 2015;14:104-9.
37. Paley CA, Johnson MI. Abdominal obesity and metabolic syndrome: exercise as medicine? BMC Sports Sci Med Rehabil. 2018;10:7.
38. Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16:132.
39. Balducci S, Zanuso S, Cardelli P, et al. Effect of highversus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS One. 2012;7:e49297.
40. Di Raimondo D, Miceli G, Casuccio A, et al. Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension. Hypertens Res 2016; 39:440-8.
41. Van der Vorm LN, Huskens D, Kicken CH, et al. Effects of Repeated Bouts of Exercise on the Hemostatic System. Semin Thromb Hemost 2018; 44:710-22.
42. Neelam N. S, Saina S, Senthil P, Prakash P. O. Burden of illness, risk factor and physical activity in cardiovascular disease- A review. Biomedicine [Internet]. 2023 Aug. 30; 43(4):1080-93.
43. Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review. J Clin Med. 2023; 12(13):4347.
44. Kim MK, Han K, Joung HN, Baek KH, Song KH, Kwon HS. Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease. Cardiovasc Diabetol. 2019 Oct 22;18(1):139.
45. Navarese EP, Robinson JG, Kowalewski M, Kolodziejczak M, Andreotti F, Bliden K, et al. Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis. JAMA. 2018 Apr 17;319(15):1566-1579.
46. Zhang Y, Pletcher MJ, Vittinghoff E, Clemons AM, Jacobs DR Jr, Allen NB, et al. Association Between Cumulative Low-Density Lipoprotein Cholesterol Exposure During Young Adulthood and Middle Age and Risk of Cardiovascular Events. JAMA Cardiol. 2021 Dec 1;6(12):1406-1413.
47. Schade, D, Cavanaugh B, Ramo B, Eaton RP. "The application of the LDL principle. World J Cardiovasc Dis. 2016 Jan; 6(6)109-125.
48. Mente A, de Koning L, Shannon HS, Anand SS. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Arch Intern Med. 2009;169(7):659–669.
49. World Health Organization (WHO) Healthy Diet Factsheet No. 394, http://www.who.int/nutrition/publications/nutrientrequirements/healthydiet_factsheet394.pdf.
50. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34.
51. Kondo T, Nakano Y, Adachi, S, Murohara, T. Effects of Tobacco Smoking on Cardiovascular Disease. Circ J. 2019; 83(10), 1980-1985.
52. Zaid M, Miura K, Okayama A, Nakagawa H, Sakata K, Saitoh S, et al. INTERLIPID and INTERMAP Research Groups. Associations of High-Density Lipoprotein Particle and High-Density Lipoprotein Cholesterol With Alcohol Intake, Smoking, and Body Mass Index - The INTERLIPID Study. Circ J. 2018 Sep 25; 82(10):2557-2565.
53. Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018 Jan 24; 360:j5855.
54. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013 Dec 7; 382(9908):1898-955.
55. Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol. 2017 Feb 15; 6(1):8-16.
56. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, De Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2015; 132:691–718.
57. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014; 37.
58. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39:2065–2079.
Published
2026/06/16
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