The human body is made up of eleven main systems, all of which work together with remarkable intricacy to perform every function we are capable of. However, the complexity of their relationship means that when there is a problem in one part of the body, it can have unexpected consequences elsewhere. The cardiovascular system is perhaps the best example of this. Gum disease, diabetes, liver disease, and psoriasis – all of these have been linked with heart problems and cardiovascular diseases. How? Keeping reading to find out.
What Are Comorbidities?
The word ‘morbid’ has far from pleasant connotations. It actually derives from the Latin word morbus, which simply means disease.
Comorbidity, therefore, means the presence of more than one disease in an individual, either physical or mental. There are certain diseases that are commonly comorbid with others, be it because they share risk factors, the pathogenesis of one disease can lead to the other, or a variety of other reasons.
While some of these links are well known and well understood, others may come as more of a surprise. In many cases, the roots of the links are still being researched.
A better understanding of these connections helps people living with diseases mitigate risks of developing other conditions, and guides healthcare professionals in their treatment plan.
What Are Cardiovascular Diseases?
Before we look at common comorbidities with cardiovascular diseases, it is worth taking a moment to define exactly what those diseases are. The cardiovascular system consists of the heart, arteries, veins, and capillaries, all of which combine to send blood around the body. A disease to any of these parts is considered a cardiovascular disease, and there are many.
A few of the most common are:
- Coronary Heart Disease (CHD) – Coronary heart disease develops over time as a substance called atheroma builds up on the inside walls of the coronary arteries. The narrowing of the arteries restricts blood flow, limiting the amount of oxygen and nutrients reaching the heart, which can result in pain called angina. A heart attack occurs when blood supply is cut off completely. You may also see CHD referred to as ischaemic heart disease (IHD) and coronary artery disease (CAD).
- Congestive Heart Failure (CHF) – If CHD is confusing because it has three names, heart failure is confusing because it does not mean complete failure of the heart. It actually means the heart – or at least a part of it – is too weak to fully perform its job of pumping blood around the body, which can often leave one feeling fatigued and breathless.
- Cardiac Arrest – Often confused with a heart attack, cardiac arrest is when the heart suddenly malfunctions. However, heart attacks tend to be more gradual as the heart is slowly starved of oxygen. Cardiac arrests, on the other hand, are much more sudden and caused by a disturbance to the electrical signals that act as the heart’s pacemaker. This is a much more dramatic event, which causes the heart to completely stop beating and prevents blood being pumped to the body’s vital organs. Cardiac arrest can result in death in a matter of minutes.
- Heart Arrhythmia – Heart arrhythmia is an umbrella term for any condition that causes an abnormal or irregular heartbeat. Atrial Fibrillation, for example, causes the heart to ‘flutter’ rather than fully beat, restricting blood flow – and can lead to complications such as a stroke. A similar phenomenon, ventricular fibrillation, occurs in the lower chamber of the heart. Ventricular fibrillation is fatal if a normal rhythm is not restored within minutes.
There are many more cardiovascular diseases, but for the sake of this post they are the most relevant – and the ones that can be caused by seemingly unrelated health conditions.
Diabetes: A Primary Risk Factor for Cardiovascular Diseases
Admittedly, this one will not come as a great surprise to many people, but diabetes is heavily related to cardiovascular diseases. Type 2 diabetes and cardiovascular diseases have many common risk factors, such as:
- High blood pressure (hypertension)
- Poor lipid counts
- Obesity
- Lack of physical exercise
In this respect, it is not so much that type 2 diabetes causes cardiovascular diseases, or vice versa, but that when one is at high risk of developing one, they are similarly at risk of developing the other.
The shared risk factors for cardiovascular diseases and type 2 diabetes do not apply when it comes to type 1 diabetes, which is normally diagnosed at a young age. However, both forms of diabetes share a common hallmark: hyperglycemia (high blood sugar levels). According to Diabetes.co.uk, ‘high blood glucose levels over long periods of time are known to lead to the blood vessels becoming damaged,’ although it is not fully understood why. This can subsequently lead to serious damage of the major organs, particularly the heart, leading to coronary heart disease and an increased risk of heart attacks.
For those living with type 2 diabetes, the risk factors it shares with cardiovascular disease, combined with the damage to blood vessels, makes heart complications a very real threat. In fact, cardiovascular diseases are responsible for over 70% of deaths in people with type 2 diabetes.
Type 1 diabetes does not share risk factors with cardiovascular diseases, but those living with it do so for a greater length of time because it tends to occur in childhood. Because damage to blood vessels is a gradual process that happens over time, those living with type 1 are more prone to the complications caused by it.
Whether type 1 or type 2, diabetes and cardiovascular diseases are intrinsically linked. Fortunately, the link is well established and understood, so people living with diabetes can take steps to keep their heart healthy, while treatment can also help mitigate the risks posed.
Psoriasis, Heart Disease & Heart Attacks
The link between psoriasis and cardiovascular diseases has been subject to a great deal of research in the last decade, and there is a growing body of evidence to suggest that those living with psoriasis are at an increased risk of heart complications. A study performed in 2006 demonstrated an increased risk of heart attacks in people living with psoriasis, a risk that increased in tandem with the severity of the condition.
So, what is it linking psoriasis to cardiovascular diseases? Inflammation. While many still consider psoriasis to be just a skin condition, it is actually far more complicated and runs much deeper. While the exact cause and mechanisms of psoriasis are not fully understood, it is widely believed that the immune system going into overdrive is a key factor. Skin cells usually take a month or so to cycle through the body, but when an individual has psoriasis this process can take but days. This creates an excess of cells that get pushed to the surface of the skin and create legions. However, it is believed this inflammation also impacts the inside of the body and the vital organs.
When the inflammation affects arteries, blood flow is restricted and the amount of oxygen and nutrients reaching the heart is reduced. It is this process that may cause an increased risk of heart disease and heart attacks in people living with psoriasis.
The exact nature of the link between psoriasis and cardiovascular diseases is still being explored. Studies performed around the globe have had varying results; some studies show a defined link between the two, some show a link only in those with severe psoriasis, and some show no link at all. However, the latter result is in the minority, with most showing at least some correlation. One study in the UK found that the life expectancy of people living with severe psoriasis was reduced by six years, with cardiovascular diseases the primary reason.
There are still plenty of unknown factors regarding the relationship between psoriasis and cardiovascular diseases. The good news is that as the body of evidence linking the two grows stronger, physicians are able to take it into account when treating psoriasis – thus allowing them to take steps to protect the heart.
Read personal posts by guest authors living with psoriasis on the MyTherapy blog:
Back from the Brink: The Emotional Anguish of Psoriasis – by Howard Chang
A Teenager’s Sporting Dream: Broken by Psoriasis – by John Redfern
The Link Between Multiple Sclerosis & CHD
Multiple Sclerosis is a disease we are yet to fully understand. It is widely accepted that the immune system attacks a fatty substance called myelin that coats some nerve cells, disrupting electrical signals being sent through the central nervous system. It is this disruption that causes a wide array of symptoms, common ones including walking difficulties, impaired cognitive abilities, and fatigue.
It has also been linked to a range of cardiovascular diseases, including heart attacks, heart failure, and atrial fibrillation (AFib). A Swedish study from 2013 suggested an increased risk of all the aforementioned cardiovascular diseases, as well as stroke, and noted that the increased risk was particularly prominent in women.
Understanding why MS increases the risk of cardiovascular diseases is tricky business considering there are plenty of unanswered questions about the underlying mechanisms of the disease. Nonetheless, research has been performed to try and answer some key questions. One of which is whether MS directly increases one’s chances of developing a cardiovascular disease, or whether the correlation is a result of impaired mobility and a subsequent reduction in physical exercise. It has also been noted that smoking is more common amongst people living with MS, which could contribute to the increased prevalence of cardiovascular diseases.
However, there is evidence to suggest the pathogenesis of MS directly impacts the heart in a similar way psoriasis does. Inflammation is today believed to play a primary role in the development of atherosclerosis – the build of atheroma on the inside walls of the arteries that eventually leads to coronary heart disease. “Inflammation and autoimmunity are central to the pathogenesis of MS,” says an Italian study from 2016, “which is a precursor of atherosclerosis and arterial vascular diseases.”
As is often the case, the link between MS and cardiovascular diseases is not black and white. It seems likely that both reduced mobility and lifestyle traits, and the inherent pathogenesis of MS, each increase the risk of cardiovascular diseases. To what degree each factor plays a role is still a matter of contention. Thankfully, research into MS is continuing to answer questions about this mysterious disease and will likely paint a clearer picture of its link to heart complications in the coming years – helping medical professionals treating people with MS also mitigate the risk of cardiovascular diseases.
Fatty Liver Disease & Cirrhosis Can Lead to Heart Complications
Nonalcoholic fatty liver disease (NAFLD) is as descriptive a name as they come; it quite simply means fat in your liver that is not caused by alcohol. The primary risk factor for NAFLD is obesity, so it is understandable why it goes hand-in-hand with cardiovascular diseases.
NAFLD shares common risk factors with a number of cardiovascular diseases, such as poor diet and lack of physical exercise, while the effects of NAFLD are also believed to increase one’s risk of heart complications. Much like psoriasis and MS, inflammation is the connection. The substances that are pumped into the blood stream by the liver of a person living with NAFLD is believed to contribute to inflammation, thus accelerating atherosclerosis and increasing the possibility of coronary heart disease and heart attacks.
Further down the line, cirrhosis presents another threat to the heart. Cirrhosis is a serious complication of liver disease that results in the loss of liver cells and leads to scarring. This can lead to a number of complications, one of which is cirrhotic cardiomyopathy – which is characterized by an adverse cardiac response to stress (from exercise, for example) in people living with cirrhosis but not necessarily a cardiovascular disease.
It was previously believed that cirrhotic cardiomyopathy was a direct toxic result of alcohol, but more recent studies have identified it in nonalcohol cirrhotic cases. Cirrhotic cardiomyopathy often remains silent until the heart is put under stress, meaning it can go undetected. This is particularly problematic when liver disease progresses to the point of requiring a transplant, a procedure that places a great deal of stress on the body. In such cases, serious cardiovascular complications after surgery are not uncommon.
Cirrhotic cardiomyopathy has only recently been realized as a complication of liver disease and people living with cirrhosis. Efforts are now focussed on better diagnostics and treatment, in order to protect the heart in stressful events such as transplants.
Guest authors on the MyTherapy blog share their experiences of living with MS:
- Life with Multiple Sclerosis and a Chronic Headache: Robert’s Story by Robert Joyce
- Traveling with MS: My Journey from America to Bali - Part One of Two by Richard Boughton
True or False? Gum Disease and Heart Disease
The supposed link between gum disease and heart disease is not a new one, nor is it one that is entirely understood. In fact, a group of experts said in 2012 that it does not exist at all. Their theory is that a person who is careful about oral care is more likely to maintain a healthy lifestyle than a person who does not. Thus, the figures that show a correlation between gum disease and heart disease are likely caused by lifestyle choices, rather than a direct connection.
However, other experts believe the two conditions are linked. Once again, inflammation plays a key role in this theory. Periodontitis is one of the major gum diseases, whereby the gum becomes inflamed because of periodontal bacteria. The inflammation can damage the gum and blood vessels, thus allowing bacteria to enter the blood stream. These bacteria, so the theory goes, is then able to spread throughout the body, and in particular the heart, thus causing further inflammations and increasing the risk of serious complications such as heart disease and heart attacks.
The big question is: who is correct? For the time being, there is no definitive answer.
However, what is certain is that good oral care certainly doesn’t do any harm to your ticker, so keep brushing, flossing and swilling that mouth wash – your heart may thank you for it.
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