DEBRE MARKOS UNI VERSI TY

NATURAL AND COMPUTATI ONAL SCI ENCES COLLEGE

SPORT SCI ENCE DEPART MENT

POSTGRAGUTE PROGRAM

Indi vi dual Assi gn me nt on:

Met aboli c Syndro mes: Cardi ovascul ar Di sease

By: Ti gist Asrat

Sub mi t to: Tari ku Assefa ( PhD)

January/ 2023

De bre Markos Uni versity

 Tabl e of content
Cont ents page nu mber

Tabl e of cont ent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

CARDI OVASCULAR DI SEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. 1. Introducti on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. 2. Pat hol ogy of Car di ovascul ar Di sease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1. 3. Causes of Car di ovascul ar Di sease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. 3. 1. Modi fi abl e risk fact ors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. 3. 2. Non- modifi abl e risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1. 4. Types of car di ovascul ar di sease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1. 4. 1. Cor onar y heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1. 4. 2. St r oke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1. 4. 3. Peri pheral art eri al disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1. 4. 4. Aorti c disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1. 5. Sy mpt o m and si gn of cardi ovascul ar disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1. 6. Effect of exercise on cardi ovascul ar disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ref erence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

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 CARDI OVAS CULAR DI SEASE

1. 1. Introducti on

Car di ovascul ar di sease (CVD) i s t he l eadi ng cause of mor bi dit y and mort alit y worl dwi de. I n t he
Unit ed St at es, CVD account s f or ~600, 000 deat hs ( 25 %) each year ( Benj ami n et al., 2017), and
aft er a conti nuous decli ne over t he l ast 5 decades, its i nci dence i s i ncreasing agai n ( Rot h et al.,
2015). Among t he many ri sk fact ors t hat predi spose t o CVD devel op ment and pr ogressi on, a
sedent ar y lifest yl e, charact eri zed by consi st entl y l ow l evel s of physical acti vit y, i s no w
recogni zed as a l eadi ng contri but or t o poor car diovascul ar healt h. Conversel y, regul ar exerci se
and physi cal acti vit y are associ at ed wit h remar kabl e wi despread healt h benefits a nd a
si gnifi cantl y l ower CVD ri sk. Several l ong-t erm st udi es have shown t hat i ncreased physi cal
acti vit y i s associ at ed wi t h a r educti on i n all-cause mort alit y and may modestl y i ncrease life
expect ancy, an effect whi ch i s strongl y li nked t o a decli ne i n t he risk of devel opi ng
car di ovascul ar and r espirat or y di seases ( Paffenbarger, Hyde, Wi ng, & Hsi eh, 1986). Consi st ent
wi t h t hi s noti on, deat h rat es a mong men and wome n have been f ound t o be i nversel y rel at ed t o
car di orespirat or y fit ness l evel s, even i n t he presence of ot her pr edi ctors of car di ovascul ar
mort alit y such as s moki ng, hypert ensi on, and hyperli pi de mi a ( Bl air et al., 1996). Mor eover,
bett er fit ness l evels i n bot h men and wo men can parti all y reverse t he el evat ed rat es of all -cause
mort alit y as well as CVD mort alit y associ at ed wi t h hi gh body mass i ndex ( Hu et al., 2004).
Recent wor k fr o m car diovascul ar cohorts shows t hat sust ai ned physi cal acti vit y i s associ at ed
wi t h a mor e favorabl e i nfl a mmat or y mar ker pr ofile, decreases heart failure risk, and i mpr oves
sur vi val at 30 years f ollo w- up i n i ndi vi dual s with cor onar y art ery di sease ( Mohol dt, Lavi e, &
Nau man, 2018).

Several previ ous st udi es have i nvesti gat ed t he effects of di et and exercise, i ndependentl y or i n
co mbi nati on, on met abol ic and car di ovascul ar healt h and have det er mi ned t hat di et, exerci se, or
a co mbi nati on of di et and exercise i nduces wei ght l oss, decreases vi sceral adi posit y, l owers
pl as ma t ri gl yceri des, pl as ma gl ucose, HDL l evels, and bl ood pressure, and i mpr oves VO2 ma x
( Angadi et al., 2015). Import antl y, several of t hese benefi ci al effects of exercise are evi dent
i ndependent of wei ght l oss ( Gaesser, Angadi, & Sa wyer, 2011). St udies have shown t hat
exercise can i mpr ove met aboli c and car di ovascul ar healt h i ndependent of changes i n body

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wei ght, i ncl udi ng i mpr oved gl ucose ho meost asis , endot heli al f uncti on ( Swi ft, Ear nest, Bl air, &
Chur ch, 2012), bl ood pressure, and HDL l evel s ( Cor nelissen & Fagar d, 2005; Koda ma et al.,
2007). These dat a i ndi cate exercise, i ndependent of changes i n body mass, results i n si gnifi cant
i mpr ove ment s i n car di ovascul ar and met aboli c healt h. Alt hough a det ail ed anal ysis of t he vast
i mpact of di et on car di o met aboli c healt h i s out side t he scope of t his revie w, t he i mport ance of
di et and exercise i n t ande m s houl d not be i gnored, as many st udi es have shown t hat car di o
met aboli c healt h i s i mproved t o a hi gher ext ent i n r esponse t o a co mbi ned di et and exerci se
pr ogra ms co mpared t o eit her i nt erventi on al one ( Sanchez- Aguader o et al., 2016).

1. 2. Pat hol ogy of Cardi ovascul ar Di sease

Car di ovascul ar di sease, incl udi ng heart att ack, stroke and heart fail ure ( HF), i s t he l eadi ng cause
of di sease and deat h i n t he devel oped worl d, and is poi sed t o beco me t he most si gnifi cant healt h
pr obl e m worl dwi de ( Fr ostegår d, 2013).

Thi s report concentrat es on t he pat hogenesis of at her oscl erosis as a di sease dri ven by oxi dati ve
stress and enhanced i nfla mmati on i n t he art ery wall. The r ol e of i nfla mmati on i n l esi on
pr ogressi on and i n current and e mer gi ng treat ment measures is descri bed.

At her oscl erosis i s t he pat hogeni c pr ocess i n t he arteri es and t he aort a t hat can pot enti all y cause
di sease as a consequence of decreased or absent bl ood fl ow fr o m st enosis of t he bl ood vessel s
( Li bby, Ri dker, & Hansson, 2011).

It i nvol ves multi pl e f act ors dysli pi de mi a, i mmunol ogi c phenome na, i nfl a mmati on,
and endot heli al dysf uncti on. These fact ors are believed t o tri gger t he f ormati on of fatt y streak,
whi ch i s t he hall mar k i n t he devel op ment of t he at her oscl eroti c pl aque ( Davi es, Woolf, Ro wl es,
& Pepper, 1988); a pr ogressi ve pr ocess t hat may occur as earl y as i n t he chil dhood ( Mc Gill,
Mc Ma han, Zi eske, et al., 2000). Thi s pr ocess co mpri ses i nti mal t hi ckeni ng wit h subsequent
accu mul ati on of li pi d-l aden macr ophages (f oa m cells) and extracell ul ar mat ri x, f oll owed by
aggregati on and pr oliferati on of s moot h muscl e cells constit uti ng t he f or mati on of t he at her o ma
pl aque ( Sat a et al., 2002). As t hese l esi ons conti nue t o expand, apopt osis of t he deep l ayers can
occur, preci pit ati ng f urt her macr ophage r ecr uit ment t hat can beco me cal cified and transiti on t o
at her oscl er oti c pl aques (St ar y et al., 1995).

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1. 3. Causes of Cardi ovascul ar Di sease

1. 3. 1. Mo di fi abl e risk fact ors

The good ne ws i s t hat t he effect of many ri sk f act ors can be changed ( you cannot
change t he risk fact or, onl y its effect). The effect of t hese modifi abl e risk fact ors
can be r educed if you ma ke lifest yl e changes. modifi abl e maj or car diovascul ar risk fact ors
i ncl ude

 Tobacco expos ure

Che mi cal s i n ci garett e smoke cause t he cells t hat li ne bl ood vessels t o beco me s woll en and
i nfl a med. Thi s can narro w t he bl ood vessels and can l ead t o many cardi ovascul ar conditi ons
(Jabbour, Reddy, Muna, & Achutti, 2002).
 physi cal i nacti vity
Regul ar physi cal acti vit y r educes t he risk of dyi ng pre mat urel y fr om CVD. It al so hel ps pr event
t he devel op ment of di abetes, hel ps mai nt ai n wei ght l oss, and r educes hypertensi on, whi ch are all
i ndependent risk fact ors for CVD. Less acti ve, l ess fit persons have a 30-50 percent great er ri sk
of devel opi ng hi gh bl ood pr essure. Physi cal i nacti vit y i s a si gnifi cant risk f act or f or CVD it self.
It ranks si mil arl y t o ci garett e s moki ng, hi gh bl ood pr essure, and el evat ed chol est erol. One r eason
it has such a l ar ge affect on mort alit y i s because of its preval ence. Twi ce as many adults i n t he
Unit ed St at es are physi call y i nacti ve t han s moke ci garett es. Regul ar physical acti vit y has been
shown t o hel p pr ot ect agai nst first car di ac epi sode, hel p pati ents' recover y fr om cor onar y
sur geri es, and will reduce t he risk of recurrent cardi ac event s ( Car net hon, 2009).
 Increased body wei ght
Moder at e-t o-severe obesit y i s an i mport ant risk fact or f or heart di seases, directl y or i ndirectl y
t hrough i nt erveni ng risk f act ors, such as hypertensi on, dysli pi de mi a, and di abet es. Obesit y
constit ut es one of t he most i mport ant i ndependent CVD ri sk fact or, and positi ve r el ati onshi ps
bet ween CVD mort alit y and BMI has been sho wn i n many l ar ge-scale st udi es ( Val avani s,
Mougi akakou, Gri mal di, & Ni kit a, 2010). Obesity has many adverse effect s on car di ovascul ar
functi on and struct ure. The t ot al bl ood vol u me and car di ac out put are i ncreased i n obesit y and
car di ac wor kl oad i s usuall y great er because of t his it i ncrease t he risk of car di o vascul ar di sease
( Lavi e, Mil ani, & Vent ura, 2009).
 Hi gh bl ood pressure

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Hypert ensi on i s quantitati vel y t he most i mportant modifi abl e risk fact or f or pr e mat ure
car di ovascul ar di sease; it i s mor e co mmon t han ci garett e s moki ng, dyslipi de mi a, and di abet es.
Hypert ensi on account s for an esti mat ed 54 percent of all strokes and 47 percent of all i sche mi c
heart disease event s gl oball y ( La wes, Vander Hoorn, & Rodgers, 2008).
 Dysli pi de mi a
Dysli pi de mi a i s known t o pr o mot e at her oscl erosis. It i s a co mpl ex di sease and i s a maj or ri sk
fact or f or adverse car di ovascul ar event s. Hi gh l evel s of l ow‐ densit y li poprot ei n ( LDL) and l ow
levels of hi gh‐ densit y lipopr ot ei n ( HDL) are directl y or i ndirectl y associat ed wit h myocar di al
i nfarcti on ( MI) and stroke ( Mill er, 2009).
 Di abetes
Over ti me, hi gh bl ood sugar can da mage bl ood vessels and t he ner ves t hat control your heart.
Peopl e wit h di abet es are al so mor e li kel y t o have ot her conditi ons t hat rai se t he risk f or heart
di sease:
o Hi gh bl ood pr essure i ncreases t he f orce of bl ood t hr ough your art eri es and can
da mage art ery walls. Havi ng bot h hi gh bl ood pressure and di abet es can gr eatl y
i ncrease your risk for heart disease.
o Too much LDL (‘ ‘bad’ ’) chol est erol i n your bl oodstrea m can f or m pl aque on
da maged art ery walls.
o Hi gh t ri gl yceri des (a t ype of f at i n your bl ood) and l ow HDL (‘ ‘good’ ’) cholest er ol
or hi gh LDL chol est erol is t hought t o contri but e t o har deni ng of t he art eri es.
 Un proper di et
Eati ng a di et hi gh i n sat urat ed fats, trans fat, and chol est erol has been li nked t o heart di sease and
rel at ed conditi ons, such as at her oscl erosis. Al so, t oo much salt (sodi um) i n t he di et can r ai se
bl ood pressure and it greatl y i ncreases t he cause of heart disease ( Anand et al., 2015).

1. 3. 2. Non- modi fi abl e risk factors

Age

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The ol der you are, t he more li kel y you are t o devel op cor onar y heart di sease or t o have a car di ac
event (angi na, heart attack or stroke) ( Rodgers et al., 2019).

Et hni c background

So me t ype of car di ovascul ar di seases has been shown t o affect so me et hni c mi norit y gr oups
di spr oporti onat el y. Sout h Asi ans li vi ng i n t he UK ar e t wi ce as li kel y t o devel op cor onar y heart
di sease co mpared t o t he rest of t he UK popul ati on (Jal al et al., 2019). Al so, peopl e fr o m Afri can
Cari bbean backgr ounds have a hi gher t han average risk of devel opi ng hi gh bl ood pr essure
( Schofi el d, Saka, & Ashwort h, 2011).

But r e me mber t hat you can still reduce your risk as much as possi bl e by controlli ng your ot her
risk fact ors.

Fa mi l y hi story

Your o wn ri sk of devel opi ng cor onar y heart di sease i s i ncreased if: your fat her or br ot her was
di agnosed wit h t he di sease, or had a car di ac event under t he age of 55 your mot her or si st er was
di agnosed wit h t he disease or had a car di ac event under 65.

1. 4. Types of cardi ovascul ar di sease

1. 4. 1. Coronary heart di sease

Cor onar y heart di sease ( CHD) occurs when your heart muscl e' s bl ood s uppl y i s bl ocked or
i nt errupt ed by a buil d- up of f att y subst ances (ather o ma) i n t he cor onar y art eri es. The cor onar y
art eri es are t he maj or bl ood vessels t hat suppl y your heart wit h bl ood.

If your cor onar y art eri es beco me narr ow due t o a buil d- up of at her o ma, t he bl ood suppl y t o your
heart muscl e will be r estrict ed. Thi s can cause angi na (chest pai ns). If a coronar y art er y beco mes
co mpl et el y bl ocked, it can cause a heart attack ( Mc Gill, Mc Mahan, Her derick, et al., 2000).

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1. 4. 2. St roke

A stroke i s a seri ous me di cal conditi on t hat occurs when t he bl ood suppl y t o t he br ai n i s
di st ur bed.

Li ke all or gans, your brai n needs a const ant suppl y of oxygen and nutri ents t o f uncti on pr operl y.
Thi s i s pr ovi ded by t he bl ood, so if your bl ood fl ow i s restrict ed or st opped, brai n cells will begi n
t o di e. Thi s can l ead t o brai n da mage and possibl y deat h ( Doyl e- Baker, Mi t chell, & Hayden,
2021).

Accor di ng t o CDC report, t he mai n stroke sympt oms are:

 Face: t he face may have dr ooped on one si de, t he person may not be abl e t o s mil e or t heir
mout h or eye may have drooped
 Ar ms: t he person wit h suspect ed stroke may not be abl e t o lift t heir ar m and keep it
raised due t o weakness or nu mbness
 Speech: t he person' s speech may be sl urred or garbl ed, or t hey may not be abl e t o t al k at
all despit e appeari ng t o be a wake

1. 4. 3. Peri pheral arteri al disease

Peri pheral art eri al di sease, al so kno wn as peri pheral vascul ar di sease, occurs when t here i s a
bl ockage i n t he art eri es t o your li mbs ( usuall y your l egs). The most co mmon sy mpt o m of
peri pheral art eri al di sease i s pai n i n your l egs when wal ki ng. Thi s i s usuall y i n one or bot h of
your t hi ghs, hi ps or cal ves ( Sant or o et al., 2018).

The pai n can f eel li ke cra mp, a dull pai n or a sensati on of heavi ness i n t he muscl es of your l egs.
It usuall y co mes and goes and get s worse duri ng exercise t hat uses your l egs, such as wal ki ng or
cli mbi ng st airs.

1. 4. 4. Aorti c disease

The aort a i s t he l ar gest bl ood vessel i n t he body. It carri es bl ood fr o m your heart t o t he r est of
your body. The most common t ype of aorti c di sease i s aorti c aneur ys m, whi ch i s where t he wall

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of t he aort a beco mes weakened and bul ges out war ds. You will usuall y experi ence pai n i n your
chest, back or abdo men (t ummy) ( Bossone & Eagle, 2021).

1. 5. Sy mpt o m and si gn of cardi ovascul ar di sease

Car di ovascul ar di sease sy mpt o ms can var y dependi ng on t he cause. Ol der adults and peopl e
assi gned f e mal e at birt h ma y have mor e subtl e sy mpt o ms. Ho wever, t hey can still have seri ous
car di ovascul ar di sease. Accor di oni ng t o 2011 WHO non co mmuni cable di sease report t he
foll owi ng short list ed are t he sympt o m of car di ovascul ar disease.

Sy mpt o ms of heart issues

 Chest pai n (angi na).
 Chest pressure, heavi ness or di scomf ort, someti mes descri bed as a ‘ ‘belt around t he chest’ ’
or a ‘ ‘ wei ght on t he chest.’ ’
 Short ness of breat h (dyspnea).
 Di zzi ness or fai nti ng.
 Fati gue or exhausti on.
Sy mpt o ms of bl ockages i n bl ood vessels t hroughout your body
 Pai n or cra mps i n your legs when you wal k.
 Leg sores t hat aren’t heali ng.
 Cool or red ski n on your legs.
 Swelli ng i n your legs.
 Nu mbness i n your face or a li mb. Thi s may be on onl y one si de of your body.
 Di ffi cult y wit h tal ki ng, seei ng or wal ki ng.

1. 6. Eff ect of exerci se on cardi ovascul ar di sease

There are several risk fact ors l eadi ng t o t he devel op ment and pr ogressi on of CVD, but one of t he
most pr o mi nent i s a sedent ar y lifest yl e ( Associ ati on, 2018). A sedent ar y lifest yl e can be
charact eri zed by bot h obesit y and consi st entl y l o w l evel s of physi cal acti vit y. Thus, lifest yl e
i nt erventi ons t hat ai mt o i ncrease physi cal acti vit y and decrease obesit y ar e attracti ve t herapeuti c
met hods t o co mbat most non-congenit al t ypes of CVD ( Young et al., 2016).

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In a cr oss-secti onal st udy of 580 Fi nni sh men by Kuj al a et al, t he associ ati ons of aer obi c fit ness
and muscul ar strengt h wi t h measures of t he car diovascul ar met abolis m were assessed ( Kuj al a et
al., 2019). The aut hors obser ved associ ati ons of aer obi c fit ness wit h met abolis m mar kers of
car di ovascul ar healt h t hat were l ar gel y att enuated aft er accounti ng f or body f at percent age.
Si mil ar associ ati ons of ma xi mal muscul ar strengt h wit h met abolis m ma rkers of car di ovascul ar
healt h wer e not obser ved. Acti vities t o mai nt ai n muscul ar strengt h are i mport ant t o mai nt ai n
physi cal f uncti on, and pri or st udi es of i ndi vi duals wit h di abet es suggest r esist ance trai ni ng i n
co mbi nati on wit h aer obic trai ni ng l eads t o greater i mpr ove ment s i n bl ood gl ucose l evel s t han
eit her trai ni ng al one ( Si gal et al., 2007). Ho wever, t he st udy by Kuj al a et al suggests t hat aer obi c
fit ness i s t he stronger contri but or t o mar kers of car di ovascul ar healt h f or most i ndi vi dual s
( Kuj al a et al., 2019).

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