Talk:Cardiovascular disease/Archive 1

Ὡ==This== This article was referred to me as part of the Cleanup. I think it may need to be reorganized. I am not certain the standard disorder "template" works well here, since CV disease is so broad. With in-depth main articles, we don't want to duplicate much here, but it may be helpful to briefly summarize the diseases. Any input would be helpful. &mdash; Knowledge Seeker &#2470; 09:14, 30 Apr 2005 (UTC)
 * Might be interesting to classify by the three disease areas covered (Heart, kidney/brain and PAD). Bakerstmd (talk) 23:57, 6 March 2014 (UTC)

and Abraham Lincoln died 0n june 21 2000 — Preceding unsigned comment added by Jjarvis4 (talk • contribs) 06:04, 14 March 2016 (UTC)

Vitamins and heart disease
Why does this article say: "the effect of antioxidant supplementation (vitamin E, vitamin C, etc.) or vitamins generally has not been shown to improve protection against cardiovascular disease"? Another wikipedia page on Niacin (Vitamin B3) contains a huge section on the cardiovascular protective effects and states, amongst other facts that : "Because niacin blocks the breakdown of fats, it causes a decrease in free fatty acids in the blood and, as a consequence, decreases the secretion of VLDL and cholesterol by the liver.[44] By lowering VLDL levels, niacin also increases the level of high-density lipoprotein (HDL) or "good" cholesterol in blood, and therefore it is sometimes prescribed for people with low HDL, who are also at high risk of a heart attack.[45][46]" - https://en.wikipedia.org/wiki/Niacin#Deficiency.--197.79.0.5 (talk) 15:07, 24 April 2013 (UTC)

So, no reply then? - and the heart disease page is still locked to unregistered users !--197.79.0.9 (talk) 21:23, 2 May 2013 (UTC)

I see the article is now unprotected. I'm going to now update it now with the info I listed above about Niacin (Vitamin B3). I will use the exact same references that the Niacin page uses for citations when it comes to it's cardiovascular protective effects. Reply here with any objections.--197.79.0.1 (talk) 13:54, 3 May 2013 (UTC)

Cardiovascular Disease merge with Coronary heart disease
I wanted to state that cardiovascular disease encompasses coronary heart disease, but this does not imply that they should be merged. Maybe we could start a title for each disease in which CV encompasses (congentical heart disease, vasculopathy, hypertension,...) and have a small paragraph about the disease with a link to the main article below the title, similar to article about history of for countries. Any feedback on this idea would appreciated. I would like to remove the merge from this page unless any objections are posted.


 * Agree. Cardiovascular dx and CHD should not be merged. CHD is highly specific, while CVD encompasses other diseases.. As mentioned elsewhere, it would be good in briefly mention the main component article like CHD with links to the main articles. BakerStMD  T&#124;C 19:06, 14 December 2014 (UTC)

I just wanted to add that both are totally and directly related to the ability of our cardiovascular system to circulate! ProArgi-9 due to research from the noble prize in 1998, has turned lives around in hours days and weeks! ProArgi-9 is the greatest health breakthrough of the 21st century using the miracle molecule called nitric oxide! Any cardiovascular related symptom or disease is no match for ProArgi-9! Watch these amazing videos by clicking HERE! Donvance (talk) 01:21, 1 March 2011 (UTC)


 * That seems like advertising. BakerStMD T&#124;C 19:06, 14 December 2014 (UTC)

Semi-protected?
Why is there a template stating that this page is semi-protected to new users? As an anon, I see the "edit this page" at the top of the article page. What is the status of this page? Thanks. 67.169.212.172 21:44, 11 August 2006 (UTC)

Cardiovascular Disease merge with Coronary heart disease
, I agree that this should stay a separate, but relatively short page, and link to other pages which provide more detail about specific issues and areas of focus within the more global topic of cardiovascular disease.

For better understanding by the general public, it is probably better to aim for definitions of global concepts before diving into the details.

In my opinion, these should be merged. Also with ischaemic heart disease. There is redundant and complementary information in the three. It is going to be some work. Miguel Andrade 01:31, 26 September 2006 (UTC)


 * Suggest that this kept as a separate article mainly for non-cardiac vascular disease, but merge CAD with IHD. Finavon 15:23, 1 October 2006 (UTC)
 * Merge them. Sort the details out later.  The categories should be merged as well.  Or cardiology should be a subcategory of cardiovascular disease.  I'm not sure which, and I'm a cardiologist. :-) Ksheka 00:42, 8 November 2006 (UTC)
 * Strong Keep - Ischaemic heart disease is part of (admittedly a large part of, but not 100%) of Coronary heart disease (which also includes coronary artery aneurysms, e.g. Kawasaki disease) in turn these are just a part of the wider cardiovascular disease (includes cardiac valve and aorta disorders). Whilst yes there may be overlap or some duplication, that is merely to invite a cleanup across the articles (with clarification of the differences in the terms obviously needed), but they are not the same thing (even if terms wrongly and loosely used interchangeably for atherosclerotic coronary artery disease by many doctors when talking to their patients) David Ruben Talk 01:25, 8 November 2006 (UTC)
 * Keep - Merging would require a very long article on a wide range of related issues. My suggestion is to Clean and improve those articles as a cluster, but not treat it as a singular topic, which it isn't. 87.78.151.16 00:39, 10 November 2006 (UTC)
 * Keep, but consider merging ischemic heart disease with coronary artery disease. CVD is a very big topic, and could well serve as a placeholder that splits off into the relevant subarticles. Stroke, coronary artery disease, peripheral vascular disease, renovascular disease, retinal artery disease, mesenteric ischaemia are all part of the huge topic. Merging with CAD/IHD is very much over the top. JFW | T@lk  19:52, 11 November 2008 (UTC)
 * Keep. Because there is more to cardiovascular disease than the heart (like the diseases treated by the entire field of vascular surgery) but agree with JFW] to consider merging coronary artery disease and ischemic heart disease.  [[user:Bakerstmd|BakerStMD  T&#124;C 19:08, 14 December 2014 (UTC)
 * The last two have been merged about a year ago. --WS (talk) 19:46, 14 December 2014 (UTC)

Wrong Focus
I'm new here, but it seems to me that this page, as it now reads, IS about IHD/CAD, to the exclusion of the remainder of cardiovascular disease. While it may be true that the term "is usually used to refer to those [diseases] related to atherosclerosis (arterial disease)," I would suggest that this is careless usage, to which this page need not subscribe. So how should the article be structured? I'd say look to the table of contents of a textbook of CV disease for a model, with the change that I would pull out all atherosclerotic vascular disease into its own section, with links in the relevant anatomic regions. Other headings might include Congenital Heart Disease, Valvular Heart Disease, Cardiomyopathies, Dysrhythmias and Conduction Abnormalities, Diseases of the Coronary Arteries, Diseases of the Pericardium, Diseases of the Aorta and Great vessels, Brachiocephalic and Cerebrovascular Disease, Other Peripheral Vascular Disease, Arteritides, Systemic Hypertension, Thrombosis and Embolic Disease, Other Venous System Disease, Diseases of the Pulmonary Vasculature, and Heart Failure and Transplantation. Some discussion of cardiovascular anatomy, physiology,diagnosis, and therapy would also be germane. Although each of these would basically be a definition with a link to its own page, I think the result would be to give the reader a better picture of the vast scope of cardiovascular disease. Moioci 06:19, 10 April 2007 (UTC) UPDATE: talking about already exists at Cardiology. I propose that Cardiovascular Disease redirect to Cardiology. Moioci 05:19, 22 May 2007 (UTC)

Heart disease
I just wanted to make sure that all of the editors of this article were aware that there's a highly related article at heart disease. WhatamIdoing (talk) 01:59, 17 February 2008 (UTC)

Oral hygiene?
Is there a reason the "See also" section has several links to oral care? If not, I'm not sure it should remain... —Preceding unsigned comment added by 58.171.143.208 (talk) 10:40, 18 June 2008 (UTC)

Proposed move
I propose to move this article to cardiovascular diseases: since it refers to a class of diseases, rather than a single disease, then it should be in the plural. NerdyNSK (talk) 20:35, 14 September 2008 (UTC)

Vote for merging it
It's disorganized and incomplete. Other pages cover the information better. Most importantly it does not seem to get much attention, so things have crept in that are dubious at best - e.g. the low salt study which links to a press release, not a peer reviewed paper. Equally, the biomarkers section seems out of place.

Needs more expert commentary
Not a lot of objective information here, though a fine introduction to the concept.

The random paragraph about Dean Ornish studies should probably be removed - doesn't reflect the uncertainties about those data or the fact that a dozen different diets are apparently equally protective against CVD. The line about virtually all CVD' can be eliminated... has some truth to it but is misleading as written.

Needs a more organized review of the role of lifestyle in prevention to replace this. —Preceding unsigned comment added by 128.174.14.55 (talk) 14:15, 29 April 2009 (UTC)

Prevention sources
The link between CV disease and secondhand smoke/emotional stress is a currently contentious topic. The other items on the list of "risk factors" seem sensible but the entire list really should be sourced with medical research rather than advocacy group websites which are themselves unsourced. Miraculouschaos (talk) 02:06, 31 May 2011 (UTC)

For people who are carrying a lot of body fat (including a big belly, which is a risk factor for heart disease), it can help reduce fat and create leaner muscle mass. Research shows that a combination of aerobic exercise and resistance work may help raise HDL (good) cholesterol and lower LDL (bad) cholesterol. How much: At least two nonconsecutive days per week of resistance training is a good rule of thumb, according to the American College of Sports Medicine. Examples: Working out with free weights (such as hand weights, dumbbells), on weight machines, with resistance bands or through body-resistance exercises, such as push-ups and squats. — Preceding unsigned comment added by Marcela48923 (talk • contribs) 02:37, 18 March 2020 (UTC)

Should discuss recent research showing over-consumption of fructose is primary cause of metabolic syndrome
Most of the commonly cited diet research prior to the 1990s was seriously flawed, the 1980 Ancel Keys "Seven Countries Study" in particular. A "low fat" diet per recommendations by medical and government leaders led to a large increase in fructose-containing caloric sweeteners such as sucrose and high-fructose corn syrup in virtually all packaged and restaurant prepared food. This trend is very likely the direct cause of the subsequent increase in the rate of obesity in America from 15% to 70% of the population and the corresponding increases in the prevalence of metabolic syndrome along with the associated increase in heart disease and possibly cancer. Discussed at length with numerous citations in the 2009 lecture "Sugar The Bitter Truth" by Robert Lustig M.D. http://www.youtube.com/watch?v=dBnniua6-oM  A discussion and survey of current research and thinking is "Fructose, insulin resistance, and metabolic dyslipidemia" http://www.nutritionandmetabolism.com/content/2/1/5  — Preceding unsigned comment added by Binnacle (talk • contribs) 22:40, 9 July 2011 (UTC)

I have added some citations and text to cover this, though not restricted to fructose, but to refined carbohydrates (or sometimes referred to as food with a high glycaemic index) that the WHO meta-study refers to as "free sugars". The fructose discussions can be misleading since they refer to refined fructose, and are comparitors with other carbohydrates, so should be part of the carbohydrate links (though I agree they should be there, with the appropriate text to ensure understanding). Since different types of carbohydrates can either be viewed (in some cases) as beneficial while others have negative impacts, it is important to ensure that this distinction is clear for readers who may otherwise miss such a distinction.--Ged Sparrowhawk (talk) 20:40, 18 September 2011 (UTC)

The "seven country study" by Ancel Keys has been the critical target of only low carb promoters who routinely misconstrue his data, findings, and when his discoveries were made. Criticisms claiming that his findings are "seriously flawed" are not readily found in mainstream nutrition-science. These unconfirmed conspiracy theories about fructose are not encyclopedic. In short, these views make entertaining lay-nutrition books, have made a lot of people rich form selling those books to desperate fat people, but do not pass consensus scientific muster. Lustig, is a complete clown, you should research some of the claims that he as a scientist has made as definitive. Look into his overstatement of the K-Ration containing 12,000 calories (they had just under 3, and weren't meant to be eaten but when soldiers were in combat). Or how about when he said no naturally occurring food has both fat and carbohydrate. Avocado? Cocoanut? Olives? One can reference him, but his thoughts reflect a very narrow view (some might say, just his view) of nutrition science. Read: Atherosclerosis: a problem in newer public health. A. Keys — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 17:36, 16 April 2013 (UTC)

Reference Links
I added in the same citation multiple times, but I am not sure how to get the text to refer to it only once. I hope someone is able to fix it, please. Thanks. --Ged Sparrowhawk (talk) 20:40, 18 September 2011 (UTC)

Merger
We already call this part heart disease in the lead. And these terms are frequently used interchangeable thus I think they should be merged.-- Doc James (talk · contribs · email) 08:57, 17 December 2011 (UTC)

Reviews
Doc James (talk · contribs · email) 09:54, 13 June 2012 (UTC)
 * Doc James (talk · contribs · email) 07:23, 4 January 2012 (UTC)

Gender/Sex question
Would it be proper to change all "gender" to "sex" in section Risk factors and subsection Sex?

Can I re-add the formatting that was reverted without getting it trouble? I see there is a bit of an IP storm going on there at the moment; I do not want to get wet. 71.234.215.133 (talk) 18:43, 20 July 2012 (UTC)
 * Yes thanks for posting here. I would be happy if you changed "gender" to "sex". As mentioned on your talk page "gender" is more psychological while "sex" is more genetic and thus typically the correct term. Might be best to wait until this IP issue is dealt with first though. Doc James  (talk · contribs · email) (if I write on your talk page please reply on mine) 18:46, 20 July 2012 (UTC)


 * Agree. While there is some overlap in the usage of the terms sex and gender (as the dictionary definitions show), sex is the more accurate term for the cardiovascular risk factor. BakerStMD T&#124;C 19:13, 14 December 2014 (UTC)
 * Do you have any reliable source supporting this nonsense jmh649? Last time I looked at the dictionary, gender is a synonym of sex, and gender is not a verb, which sex is. Since I saw your edit history, it is obvious that you just look for an excuse to revert. — Preceding unsigned comment added by 79.182.196.246 (talk • contribs) 18:55, 20 July 2012‎
 * See Gender, and the sources there. As for James reverting all the time; I'm afraid 60 to 80% of all changes to Wikipedia medical articles need to be reverted or significantly amended due to inaccuracies, vandalism, irrelevance, etc. That's just the way it is. --Anthonyhcole (talk) 19:03, 20 July 2012 (UTC)
 * Just reading Wikitionary supports not using "gender" in the article, although I did not know that with my first edit. Something new I learned today, right up there with how to call a brand. Thank you, Doc (for the word, not the livestock).
 * With the umbrella over the article, I will check back tomorrow. 71.234.215.133 (talk) 19:07, 20 July 2012 (UTC)

Yea, right. Don't believe anything you see in the weaktionary. Search google for gender:

gen·der noun /ˈjendər/ genders, plural


 * 1)    (in languages such as Latin, Greek, Russian, and German) Each of the classes (typically masculine, feminine, common, neuter) of nouns and pronouns distinguished by the different inflections that they have and require in words syntactically associated with them. Grammatical gender is only very loosely associated with natural distinctions of sex
 * 2)    The property (in nouns and related words) of belonging to such a class  - adjectives usually agree with the noun in gender and number
 * 3)    The state of being male or female (typically used with reference to social and cultural differences rather than biological ones)     - traditional concepts of gender        - gender roles
 * 4)    The members of one or other sex       - differences between the genders are encouraged from an early age

Definition #4 is adequate. jmh649 is just looking for an excuse, and try to piggy back other edits on that excuse. — Preceding unsigned comment added by 79.176.213.139 (talk) 19:32, 20 July 2012 (UTC)

2013 statistics update
May be useful: http://circ.ahajournals.org/content/127/1/e6.full Ocaasit &#124; c 17:24, 2 February 2013 (UTC)

VITAMIN C
As someone who doesn't often contribute to Wikipedia and struggles with the coding, protocols, etc involved in editing, it takes me quite some time to make even a small contribition to an article, with the citations taking the most time to complete as accurately and comprehensively as possible. I recently spent a lot of time with this aspect of adding some info on Vitamin C's involvment in heart disease without first "asking permission" on this talk page. To my amazement every last contributution was removed the very next day (today) and the only mistake I may have made was not including the page number and volume of the journal that published the study that I used for my citation, since it was taken from the website of the National Institute of Health and I do not have access to the journal in which it appeared and therefore cannot provide the exact page number, etc. I don't believe I violated any copyright law as only a small part of the article was quoted. My citation appeared in the edit screen as follows (I hope this comes out exactly as I typed it in the edit screen of the article) :

Here it is again without the ref parts: = >{{cite journal |author=Block G, Jensen CD, Dalvi TB, Norkus EP, et al. |title=Vitamin C treatment reduces elevated C-reactive protein: Randomized Controlled Trial |journal=Free Radical Biology and Medicine |year=2009 |pmid=18952164 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631578/

I used this citation for a reference to various sections of the article that I contributed to such as the section Risk Factors adding: high inflammation levels, after high serum cholesterol levels, etc. I added the same citation above to the section on Screening, specifically to the existing bullet point appearing second last on the list (inflammation as measured by C-reactive protein). I wrote the following under the section Diet and added it to the second paragraph of that section: ''Vitamin C is one of the nutrients found in a diet high in fruits and vegetables and has been shown in a study to have a statistically significant effect when analysis is restricted to those deemed by the CDC/AHA to be at elevated cardiovascular risk. Those at risk typically include those with elevated levels of the inflammation marker C-reactive protein (CRP) amongst other markers. This particular study concluded that "...Among persons with baseline CRP ≥ 1.0 mg/L, treatment with 1000 mg/day vitamin C for two months was associated with a 16.7% within-group change, p<0.05. Compared to subjects in Placebo, allocation to vitamin C was associated with a 25.27% reduction in median CRP concentrations, p=0.02. Significant differences between the vitamin C and Placebo group was also seen in parametric analysis, despite the very conservative approach of assuming that those with missing data had zero change. Treatment with 800 IU/day vitamin E was also associated with some reduction in CRP, but the treatment effect did not achieve statistical significance..."''

I would like to know who found this so offensive and why. If there were a few slight technicalities I missed, or even spelling mistakes, why not just correct them instead of removing EVERYTHING I contributed?!!! This is what I HATE about Wikipedia--197.65.11.16 (talk) 14:18, 29 March 2013 (UTC)


 * Per WP:MEDRS we strongly prefer secondary sources such as review articles. What you have provided is a primary source that looked at a surrogate marker and thus does not support the material added.


 * Per this 2011 review "Epidemiological and clinical trial evidence surrounding the benefit of B vitamins and antioxidants such as carotenoids, vitamin E, and vitamin C, have been contradictory. While pharmacological supplementation of these vitamins in populations with existing CHD has been ineffective and, in some cases, even detrimental, data repeatedly show that consumption of a healthy dietary pattern has considerable cardioprotective effects for primary prevention."  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:49, 29 March 2013 (UTC)


 * And here is a more recent review  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:09, 29 March 2013 (UTC)

I have posted the following on your page Doc James: I agree with Ryanspir and regarding this page (http://en.wikipedia.org/wiki/Cardiovascular_disease) - how are these NOT primary sources:

http://en.wikipedia.org/wiki/Cardiovascular_disease#cite_note-51 http://en.wikipedia.org/wiki/Cardiovascular_disease#cite_note-52

And despite this, my primary source gets deleted!!! (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631578/) This is a good primary source - even if only proving Vitamin C is good at PREVENTING heart disease by reducing levels of C-reactive protein (a known contributor to heart disease and a bigger contributor than even cholesterol). Additionaly if there are studies proving Vitamin C has no benefit, then this article should state that studies have been contradictory regarding Vitamin C, as my source clearly shows the opposite.--41.118.110.161 (talk) 09:55, 2 April 2013 (UTC)

Here is a link to the abstract only - on the same website - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631578/?report=abstract   Maybe you consider that to be more of a secondary source if only the abstact is used ???--41.118.110.161 (talk) 10:07, 2 April 2013 (UTC)


 * This page primary source explains what a PS is. This page explains what a review article is. Review articles are secondary sources. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:30, 2 April 2013 (UTC)

Why does this article say: "the effect of antioxidant supplementation (vitamin E, vitamin C, etc.) or vitamins generally has not been shown to improve protection against cardiovascular disease"? Another Wikipedia page on Niacin (Vitamin B3) contains a huge section on the cardiovascular protective effects and states, amongst other facts that : "Because niacin blocks the breakdown of fats, it causes a decrease in free fatty acids in the blood and, as a consequence, decreases the secretion of VLDL and cholesterol by the liver.[44] By lowering VLDL levels, niacin also increases the level of high-density lipoprotein (HDL) or "good" cholesterol in blood, and therefore it is sometimes prescribed for people with low HDL, who are also at high risk of a heart attack.[45][46]" - https://en.wikipedia.org/wiki/Niacin#Deficiency --197.79.0.9 (talk) 21:26, 2 May 2013 (UTC)


 * Thanks yes. Have added another newer meta analysis. Adjusted the wording slightly. The mechanism is not entirely clear. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:53, 3 May 2013 (UTC)

{{reflist}}

Diet
Not sure why much of the content was removed in this edit. Thus restored again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:09, 17 April 2013 (UTC)
 * It would be useful if the user in question would discuss here to get consensus for changes first. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:28, 19 April 2013 (UTC)

It's quite evident that there is no ref suggesting a controversy. Another ref indicates a problem with replacing saturated fat with refined sugars, which seems to be a no-brainer. That does not eliminate sat fat as problematic though. — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 19:39, 19 April 2013 (UTC)
 * We have meta analysises that state different things. This one states "that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:17, 20 April 2013 (UTC)
 * And than we have this just out " An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit.". Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:26, 20 April 2013 (UTC)
 * Well, the role of saturated fat in CHD is pretty well established (every major medical organization recognizes it as a risk factor for CHD); the more recent research has suggested those who substitute it with carbohydrates, however, do not get much (if any) benefits as compared to replacing it with mono or poly unsaturated fat (see for example these recent reviews  ). That saturated fat doesn't have any effect on CHD is a WP:FRINGE position, and suggesting there is a significant controversy here probably gives undue weight to that position. Yobol (talk) 01:33, 20 April 2013 (UTC)
 * Again, these studies suggest replacing saturated fat with refined carbohydrates (sugar) as problematic, I mean really? Is that a mystery to anyone? Replacing saturated fat dietary calories with whole-food carbs, like leafy vegetables (also a carb) does not carry the same problematic outcome. I think it's unscientific to throw all carbohydrates in the same bucket, which is what seems be going on here.
 * The above updated meta analysis from 2013 which was published in the BMJ and found no benefit from substituting poly unsaturated for saturated fat. The BMJ is not known for publishing fringe opinions. I agree that the Cochrane review from 2012 provides "suggestive" evidence of benefit and should be included. The review from BMC states "although major flaws have been reported in the analyses supporting this approach" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:18, 20 April 2013 (UTC)
 * The sentence reflecting the Cocharan meta isn't reflected of his conclusions. When conclusions are evaluated, whats the relevance? It seems to further prove saturated fat as problematic. It certainly doesn't back up the preceding sentence well.
 * And than we have this 2012 JAMA systematic review and meta analysis which concluded "omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association."  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:54, 20 April 2013 (UTC)
 * Of course, we aren't talking about supplementation of diet with omega 3, we are discussing replacing saturated fats with PUFA. In fact, other reviews have noted replacing SFA with PUFA may be independent of omega 6 . I think we have to be careful in how we phrase this section. The "controversy" in the medical community is the type of nutrient to replace SFA with to improve CV risk (and there does not appear to be much controversy here; most recommendations including the AND now suggest replacing with PUFA instead of a straight reduction in SFA).  There is also a "controversy" in the lay public where there is a suggestion that SFA plays absolutely no role in CV risk; this is clearly the fringe position we should be clear about not supporting. Yobol (talk) 13:57, 20 April 2013 (UTC)
 * Yes the majority of reviews recommend replacing SFA with PUFA and state that there is tentative evidence that it decreases CVD. We have this review from 2010 "A meta-analysis of prospective epidemiological studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD" Not sure how reputable the journal though.  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:34, 20 April 2013 (UTC)
 * Your first sentence is sound, but this 2010 meta study was conducted by members heavily funded by the meat and dairy industries, and the Atkins foundation. It was found to follow improper procedures, and has been largely discredited. J. Stamler is quite highly respected, and stated his full opposition to it. His findings are linked.
 * The paper in question states "No conflicts of interest were reported." Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:54, 23 April 2013 (UTC)

Keep in mind most of these clinical trials involve tests on the elderly and or, those with prior CVD events, usually both. Also, many of these researchers aren't debunking SFA as a leading risk factor for CVD, but determining what EFA to replace those dietary calories with. What about replacing those calories with complex carbohydrates, in the form of green leafy vegetables, whole fruits, and whole-grains? Also, are there any clinical trials with an ideal control population, perhaps patients with normal/acceptable/borderline blood panels, blood pressure, and weight, perhaps 20-40 years old and observe their findings? Where are the trials which get an otherwise normal patient from an LDL of 150 (acceptable), down to below 75 (outstanding)? This would be the ultimate in preventive medicine, finding a 30 year old male, and getting his numbers down to exceptional levels at 30 years old, instead of waiting for his second heart attack at 65, and trying a litany of measures based on these clinical trials. There are numerous trials and epidemiological research indicating the benefits of lifetime low cholesterol panels vs a lifetime of high panels. A patient with a sudden drop after a CVD event scares the patient into eliminating risk factors seems to be the focus in many of these trials. Even still, some CVD patients have greatly benefited from an aggressive dietary treatment, through elimination of SFA. While anecdotal, an example being President Bill Clinton, adopting a mostly strict vegetarian diet, which eliminates all SFA. I believe this section would benefit from a rewrite. I suggest breaking this into multiple paragraphs, the first being the reduction of saturated fat, and it's benefits. Para number 2 should show popular diets that achieve desired outcomes through the reduction of SFA. Again, I see no hard reason to suggest referencing the supposed "saturated fat controversy" in any case.
 * I do not know why you
 * Added this primary research paper from 2003 looking at 46 people
 * I see what you're saying here. I wanted to grab something showing dietary benefit in preventing heart disease. I'll remove this one, and substitute another.
 * Removed this 2012 review article from the Journal of Internal Medicine
 * Was unaware that I did. I can put it back.
 * Also IMO we should discuss overall diets before we discuss specific dietary components.
 * For example? The diet section about med diet et al seems a bit 'thrown together' is that what you mean?
 * So have reverted your changes Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:38, 23 April 2013 (UTC)
 * Why not just add back the old stuff, and remove the new stuff? I also corrected some flow and structure issues.
 * Which flow and structure issues exactly did you correct? Unsure why you are trying to change the order of the sections? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:51, 23 April 2013 (UTC)

Refs are needed to support the additions you made including "Often overlooked are the patient's results based off what nutrient replaces dietary saturated fat." "However, little or no benefit is likely if saturated fat is replaced by carbohydrate, but this will in part depend on the form of carbohydrate. Because both N-6 and N-3 polyunsaturated fatty acids are essential and reduce risk of heart disease, the ratio of N-6 to N-3 is not useful and can be misleading. In practice, reducing red meat and dairy products in a food supply and increasing intakes of nuts, fish, soy products and non-hydrogenated vegetable oils will improve the mix of fatty acids and have a markedly beneficial effect on rates of CVD." Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:08, 23 April 2013 (UTC)
 * Okay found it. You copied and pasted from . You cannot do this as it is plagiarism. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:09, 23 April 2013 (UTC)
 * I copied and pasted the text so I could read it on one screen. I just simply forgot to remove it, but I have now. I never intended to leave it. I am aware that C and P isn't allowed. — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 14:13, 23 April 2013 (UTC)
 * Your changes do not make sense. Have reported you for edit warring here Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:34, 23 April 2013 (UTC)
 * I have reviewed your criticisms, yet you still do not like my edits, because, well apparently, you just don't. That's not good enough, I engaged your criticisms (3 questions) in good faith, and made changes. If my changes don't make sense, and I've corrected the issues you had, yet you still have problems, do you have additional issues, if so what are they? I welcome Wikipedia's recommendation. I've also asked you a litany of questions, to which you might have answered one or two. It sounds like you are having control issues because you aren't getting your way, I'm sorry about that. To put this more simply, you're not the gate keeper to this page. — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 14:42, 23 April 2013 (UTC)

I have reverted the latest change that removed well-sourced content and changed existing content to move away from what sources say. In particular, important content about the unsettled question over the effects of saturated fat was made less clear, some unnecessary editorializing was added ("Often overlooked..."), changes against WP:MEDMOS were made (references to "patient"), the JAMA meta-analysis was described as focusing on elderly women but it appears the study base was wider than that, and the mention "Total fat intake does not appear to be an important risk factor" was removed. Suggest we break up and discuss this large number of significant changes to get consensus so the content can be stable. 15:07, 23 April 2013 (UTC)


 * unsettled question over the effects of saturated fat was made less clear
 * In what respect? The is no question on the effects of replacing saturated fat with sugary junk food, and that is well sited. Any notion that suggests that saturated fat is not a leading cause of CVD is WP:FRINGE opinion at best. Not to mention that it contradicts several statements on this page which repeatedly state that it is.
 * JAMA meta-analysis was described as focusing on elderly women but it appears the study base was wider than that
 * Admitted this, and changed
 * "Total fat intake does not appear to be an important risk factor"
 * This statement vastly understates the ref. It's misleading and suggests that dietary fat is not potentially problematic.
 * "total fat intake" means "total fat intake". Our readers are intelligent and can figure this out. Especially when the next few sentences adds details. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:05, 23 April 2013 (UTC)
 * ("Often overlooked...")
 * How does this violate wiki standards? — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 15:25, 23 April 2013 (UTC)
 * Were is the evidence that it is "often overlooked"? If there is not any it is original research. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:06, 23 April 2013 (UTC)
 * "There however is some questions around the effect of saturated fat on cardiovascular disease in the medical literature."
 * This emphasizes WP:FRINGE opinions on saturated fat, directing to saturated fat controversy. The word 'some questions' leads to believe it's substantial enough to be noticed in medical literature. It's absolutely miniscule at best. Nutritional science has moved on from this debate.
 * Your edits are a little hard to follow because you not only change a bunch of text but move it around in a single edit. IMO we should discuss overall diets first and than specific components second. You keep switching it around and have not provided any justification or developed consensus. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:05, 23 April 2013 (UTC)
 * can you not address my statement? — Preceding unsigned comment added by Fgmoon353 (talk • contribs) 03:35, 28 April 2013 (UTC)

Suggestion
Hello, I'm not English, but I think it might be interesting to synthesize this information in this article. If anyone is interested, do it with not hesitate. Sanchez-Gonzalez MA, May RW, Koutnik AP, Kabbaj M, Fincham FD, Sympathetic vasomotor tone is associated with depressive symptoms in young females: a potential link between depression and cardiovascular disease ; Am J Hypertens. 2013 Dec;26(12):1389-97. doi: 10.1093/ajh/hpt131. Epub 2013 Aug 9 (abstract). Sorry if my english is not good and thank you to evrybody for your collaborative work on wikipedia. --Lamiot (talk) 13:22, 30 November 2013 (UTC)
 * We typically use secondary sources rather than primary ones per WP:MEDRS Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:57, 30 November 2013 (UTC)

hi, i think you should add the SCORE risk chart. this is the link : http://www.escardio.org/communities/EACPR/Documents/score-charts.pdf it is made by a big organization, so it shouldn't be a problem with the copyrights. — Preceding unsigned comment added by 160.114.158.13 (talk) 09:56, 11 January 2014 (UTC)

ICD10 Codes
It seems to me that ICD10 Codes in Wikipedia are often very narrow. For cardiovascular disease, for example, the article includes a lot more than the code does. (The code does only point to the first finding of the ICD search engine it seems.) Either the article discription is to brought or the code is not sufficient. I have the feeling this is true for other medical article as well. I am not a specialist of ICD, so please check and improve if possible. All the best! — Preceding unsigned comment added by 195.37.118.145 (talk) 17:23, 15 February 2014 (UTC)

BMI
Why is BMI linked next to "body fat percentage" in the Prevention section? BMI and body fat percentage have nothing to do with one another. BMI only measures overall weight and height, not body fat percentage. I suggest removing the link to BMI. — Preceding unsigned comment added by 99.17.8.187 (talk) 00:51, 29 April 2014 (UTC)
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:10, 6 October 2014 (UTC)

Pathophysiology
I'm not sure it makes sense to have a pathophysiology section for such a wide class of diseases - I accept that atherosclerosis is a relatively common cause, but I think the pathophysiology would be better dealt with on other dedicated pages. I would like to suggest this section be deleted.Adh (talk) 23:07, 27 December 2014 (UTC)

The quoted paper

Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA (Oct 2006). "Awareness, knowledge, and perception of heart disease among adolescents". Eur J Cardiovasc Prev Rehabil. 13 (5): 718–23. doi:10.1097/01.hjr.0000214611.91490.5e. PMID

does not say anything about youths aged 7-9, but rather 15-19.

Here's the quote: The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 15–19 years [2]. Caranhyas (talk) 11:34, 21 January 2016 (UTC)

Role of stress
The latest edition of Braunwalds Heart Disease indicates that stress is a factor in cardiovascular disease. The statement in the article that stress isn't a factor cites a review of qualitative research, which doesn't seem appropriate. TimidGuy (talk) 12:05, 9 January 2015 (UTC)
 * We state "Stress however plays a relatively minor role in hypertension (if it even plays any role in the development of hypertension at all is often disputed)." supported by a systematic review in the BMJ  Doc James  (talk · contribs · email) 16:22, 9 January 2015 (UTC)
 * As far as I can see, that review is of qualitative research -- questionnaires. Those questionnaires were asking patients why they stopped taking their meds. Am I wrong? Can you point to a specific statement in the review? Here's what Braunwalds says:
 * "A clear association has been observed between emotional state and heart health (see Chapter 86). Identification of an increased tendency toward hostility was associated with a doubling of risk for ischemic heart disease over a 10-year period. A moderate or high level of perceived stress before myocardial infarction was associated with a 42% increase in 2-year mortality risk. Stress can induce ischemia by triggering both epicardial and microvascular vasoconstriction. In addition, stress leads to autonomic dysregulation and an outpouring of circulating catecholamines with potentially serious consequences, including takotsubo cardiomyopathy, or stress-related heart failure. The range of reported antecedent stressors to this potentially fatal condition is broad, including the death of a parent, a surprise birthday party, fear of a medical procedure, and public speaking."
 * This is from the 2014 edition of the leading medical textbook on heart disease. I don't see how it could be more clearly stated that stress is a factor in cardiovascular disease. TimidGuy (talk) 11:59, 10 January 2015 (UTC)
 * The review in the BMJ states
 * "The nature of the connection between hypertension and stress has been researched extensively. Acute stress has been shown to temporarily increase blood pressure levels.81 Evidence from observational studies has also shown that chronic stress can be associated with a sustained rise in high blood pressure.82 In the medical literature, however, stress is considered in the context of other important risk factors for hypertension, both modifiable and non-modifiable: age, ethnicity, family history, obesity, a sedentary lifestyle, and alcohol and salt intake.1 While participants in our review widely reported avoiding stressful situations, a meta-analysis of randomised controlled trials of relaxation interventions for people with hypertension found that they did not substantially improve blood pressure levels, nor did the trials find good evidence of an effect on cardiovascular disease or mortality.83From the medical perspective, stress plays a small part in hypertension, whereas a recurring theme in the studies presented here was that stress was by far the most important cause." "Stress should be placed in the context of other modifiable and non-modifiable risk factors for hypertension and cardiovascular disease; it should be noted that relieving stress alone is not likely to normalise blood pressure and that treatment is recommended at times of high and low stress."
 * While the association is clear the size of that association is the question. Doc James  (talk · contribs · email) 17:48, 10 January 2015 (UTC)

This was recently published and I have added the conclusions  Doc James  (talk · contribs · email) 17:51, 10 January 2015 (UTC)
 * Thanks. That quote from BMJ is helpful. However, I don't see how it supports the parenthetic statement in the article "if it even plays any role in the development of hypertension at all is often disputed." Thanks for finding the recent meta-analysis and adding that to the article. TimidGuy (talk) 12:15, 16 January 2015 (UTC)
 * Agree and trimmed. Doc James  (talk · contribs · email) 00:09, 18 January 2015 (UTC)
 * Thanks. I wonder if we should change it further. I don't see how that statement supports the point that stress plays a relatively minor role. TimidGuy (talk) 12:06, 18 January 2015 (UTC)
 * It does say "From the medical perspective, stress plays a small part in hypertension, whereas a recurring theme in the studies presented here was that stress was by far the most important cause." Doc James  (talk · contribs · email) 12:44, 18 January 2015 (UTC)

Semi-protected edit request on 16 January 2015
Please change the bad link on this Cardiovascular disease https://en.wikipedia.org/wiki/Cardiovascular_disease page. The link in the caption under the first picture, a micrograph, is wrong for "heart". Either a mistake or a hack. "heart" now links to https://www.dreams-image.com/ Maybe it should link here https://en.wikipedia.org/wiki/Heart ? Good luck. Thanks

Jess (talk) 18:07, 16 January 2015 (UTC)
 * Yes check.svg Done, Thank you very much for the correction suggested. Anupmehra  - Let's talk!  18:30, 16 January 2015 (UTC)

Proposed merge with Vascular disease
There is a lot of overlap of content needlessly separated - would be much better included on cardiovascular disease page Iztwoz (talk) 08:12, 26 June 2015 (UTC) Think Doc James ' idea would be a better move - there is quite a list which would suit its own page.--Iztwoz (talk) 18:19, 26 June 2015 (UTC)
 * semi-oppose it could be merged but it could also stay as is, it has enough unique information for an article--Ozzie10aaaa (talk) 11:09, 26 June 2015 (UTC)
 * No opinion yet The vascular disease article could be moved to "list of vascular diseases" with one section for each and the main term redirected to cardiovascular disease Doc James  (talk · contribs · email) 13:33, 26 June 2015 (UTC)

I also agree with Doc James 's idea Adh (talk) 08:30, 19 July 2015 (UTC)

Semi-protected edit request on 26 September 2015
Please add in 'However, a study by Jeff Volek, published in 2009 in the American Journal of Clinical Nutrition found that swapping saturated fats with carbohydrates had no benefit in reducing people's risk of heart disease, as people then tended to replace saturated fats with excessive amounts of carbohydrates; this can still lead to excesses of palmitoleic acid in the blood and adipose tissue, a factor consistently linked to cardiac disease and heart failiure' after the sentence 'There is evidence that higher consumption of sugar is associated with higher blood pressure and unfavorable blood lipids,[31] and sugar intake also increases the risk of diabetes mellitus.[32]'. Thank you

JTurner751 (talk) 18:41, 26 September 2015 (UTC)
 * What ref does 31 and 32 stand for? Doc James  (talk · contribs · email) 18:00, 28 September 2015 (UTC)


 * Red information icon with gradient background.svg Not done:
 * Please give a link to the article you are talking about or the complete reference information including title, volume, issue, pages, ect. When you do please reactive this request.  Thank you. --Stabila711 (talk) 03:51, 2 October 2015 (UTC)

Semi-protected edit request on 14 October 2015
Please add "Monoclonal antibody treatment (against the secreted endogenous protein PCSK9) has been shown to inhibit the action of a protein that interacts with the LDL cholesterol receptor in order to exacerbates CVD symptoms. ", to the medication section.

Blncnnr (talk) 11:47, 14 October 2015 (UTC)


 * That is a primary source. We need secondary sources like review articles. Doc James  (talk · contribs · email) 12:12, 14 October 2015 (UTC)
 * I am also a little confused as this primary source does not once mention the words "cardiovascular" or "symptoms". None of the authors is named Betteridge either. Cannolis (talk) 12:15, 14 October 2015 (UTC)

Why can people no longer edit Cardiovascular disease
Why can people no longer edit Cardiovascular disease — Preceding unsigned comment added by 173.79.226.184 (talk) 15:33, 25 December 2015 (UTC)

Timeline of cardiovascular disease
I recently created the timeline. Please, anyone with power to edit here, if you can wikilink https://en.wikipedia.org/wiki/Timeline_of_cardiovascular_disease it will be much appreciated.Wikisanchez (talk) 20:06, 1 August 2016 (UTC)

Risk assessment
... guidelines reviewed and found to contradict each other 10.7326/M16-1110 JFW &#124; T@lk  14:40, 14 September 2016 (UTC)

What is this disorder?
I knew someone who had almost no blood circulation in half of his body, laterally. What is this disorder called? David Spector (talk) 15:36, 5 August 2017 (UTC)
 * Not sure. Doc James  (talk · contribs · email) 23:28, 5 August 2017 (UTC)

Celiac disease
Well a risk factor it is on the minor side of things. Thus per DUE discussing it in the body is sufficient IMO. Doc James (talk · contribs · email) 19:45, 17 March 2018 (UTC)

Omega-3 FA reduces CVD risk in some patients?
and others - FWIW - re "Fish Oil Drug May Reduce Heart Attack and Stroke Risks for Some - Large doses of an omega-3 fatty acid in fish oil sharply reduced the rate of cardiovascular events in people with a history of heart disease or Type 2 diabetes" - is this study, recently described in The New York Times, worth adding/integrating to the "Omega-3 fatty acid" and/or "Cardiovascular disease" articles - or not? - in any case - Enjoy! :) Drbogdan (talk) 13:11, 26 September 2018 (UTC)


 * Will be interesting to see if this alters the position of reviews on the subject or not. Doc James  (talk · contribs · email) 22:44, 26 September 2018 (UTC)

The full text of REDUCE-IT, the study mentioned above, came out in the NEJM in January 2019. The big finding was that "the risk of the primary composite end point of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina, assessed in a time-to-event analysis, was significantly lower, by 25%, among the patients who received 2 g of icosapent ethyl twice daily than among those who received placebo, corresponding to an absolute between-group difference of 4.8 percentage points in the rate of the end point and a number needed to treat of 21." ( https://www.nejm.org/doi/full/10.1056/NEJMoa1812792).

It's important to note that the drug used in REDUCE-IT, Vascepa (EPA only, 4 grams/day), is prescription only, ie FDA oversight. A popular fish oil supplement, Nature Made Burpless Fish Oil 1200 mg, when taken as directed, gives patients 720mg/day of EPA ( https://www.amazon.com/Nature-Made-Burpless-Omega-3-Softgels/dp/B004GJVD2K/ref=zg_bs_10728501_8?_encoding=UTF8&psc=1&refRID=F4TF4ASHRX59XEA26NRY). If the fish oil supplement contains the stated amounts of Omega-3 Fatty acids, the dose of EPA is substantially smaller than in Vascepa. Further, a 2015 paper that looked at 47 fish, krill, and algal oil supplements (no FDA oversight) found that "Over 70% of the supplements tested did not contain the stated label amount of EPA or DHA." ( https://www.ncbi.nlm.nih.gov/pubmed/25044306). The big differences between Vascepa and supplements seem to be which Omega-3 is present (EPA vs DHA) as well as the dose of that Omega-3. This helps to explain why REDUCE-IT had significant findings while earlier trials of Omega-3 Supplements were inconclusive ( https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003177.pub3/full). Do you think this a worthwhile update to the page? Mikel NH (talk) 16:56, 25 June 2019 (UTC)Mikel NH

A new Cochrane review (below) that will update citation #129 on current article will change the statement about diet and the role of LCn3. Any comments or other thoughts on this prior to making the citation update? BDD user (talk) 16:13, 8 July 2020 (UTC)

Semi-protected edit request on 27 September 2018
Risk factors> occupational exposure: switch headings "Chemical risk factors" and "Non-chemical risk factors" S Troake (talk) 12:30, 27 September 2018 (UTC)
 * Yes check.svg Done Gulumeemee (talk) 07:15, 28 September 2018 (UTC)

Semi-protected edit request on 21 January 2019
7b1VSC (talk) 03:29, 21 January 2019 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. DannyS712 (talk) 03:34, 21 January 2019 (UTC)

Wrong quoting of citation "90% of CVD is preventable"
The article says in the introduction that "It is estimated that 90% of CVD is preventable", citing (ref 5 in the current version of the article). However, the reference talks about coronary heart disease (CHD) and atherosclerosis in particular and not all of CVD.

Dajuno (talk) 17:47, 31 January 2019 (UTC)


 * This is strictly correct, although one of the key references cited in the article by McGill Jr et al. (Lloyd-Jones et al https://doi.org/10.1161/CIRCULATIONAHA.105.548206) actually refers to CVD (myocardial infarction, coronary insufficiency, angina, stroke, claudication) not just CHD. I've not cited the Lloyd-Jones paper since secondary sources are preferred in Wikipedia. It should be recognized that any estimates of attributable risk are approximate at best but I have added another source (DOI:https://doi.org/10.1016/S0140-6736(16)30506-2) relating to stroke that is consistent with this estimate. I've also reworded the text slightly. — Preceding unsigned comment added by Adh30 (talk • contribs) 11:40, 1 February 2019 (UTC)

Semi-protected edit request on 24 January 2020
Please change

Cardiovascular diseases are the leading cause of death globally. This is true in all areas of the world except Africa

to

Cardiovascular diseases are the leading cause of death globally and in all areas of the world except Africa.

The meaning is the same, and little sentences look choppy and less formal. 208.95.49.53 (talk) 21:09, 24 January 2020 (UTC)


 * ✅. –Deacon Vorbis (carbon &bull; videos) 21:42, 24 January 2020 (UTC)

Semi-protected edit request on 2 January 2021
Add to External links: CVDS - Cardiovascular Diagnostics Society PaulTConley (talk) 15:50, 2 January 2021 (UTC)
 * . No reason to add. Alexbrn (talk) 16:25, 2 January 2021 (UTC)