You have probably heard that kidney disease is an important risk factor for cardiovascular disease (CVD). You may have even heard that cardiovascular disease is the number one cause of death in patients with chronic kidney disease on dialysis or have received a kidney transplant. Still, you may not know what cardiovascular disease refers to exactly. If so, this is understandable because it is a term that covers a variety of diseases and disorders involving the heart, brain, and blood vessels.
Cardiac Disease
Cardiac disease refers to a number of diseases involving the heart. Although it is most commonly used in the context of heart attacks (acute coronary events), it actually refers to a number of other diseases as well. For example, it covers all types of diseases leading to too little oxygen reaching the heart tissues (ischemic heart disease or IHD) as well as diseases involving the valves (valvular heart disease), the heart muscle (cardiomyopathies), the electrical system (arrhythmias) and the sac surrounding the heart (pericardial diseases).
- Although patients with kidney disease suffer the same types of heart disease as those in the general population, they tend to occur more frequently and at a younger age. Heart disease also tends to be more aggressive and have worse prognoses in kidney patients.
Cerebrovascular Disease
Cerebrovascular disease refers to diseases involving the blood vessels going to or are in the brain. The most dramatic type of cerebrovascular disease is a stroke -- death of brain tissue from lack of blood or oxygen (also called a cerebral vascular accident or CVA). There are several different types of strokes, which have varying causes. A stroke from a blocked blood vessel is called ishemic or white stroke whereas one from a ruptured and bleeding blood vessel is called a red stroke. If the brain tissue is temporarily starved of oxygen but not yet dead, it is referred to a transient ischemic attack (or TIA).
- White or ischemic strokes typically involve narrowing or blocking of large blood vessel by atherosclerosis (thrombosis) or traveling blood clots (emboli). The carotid arteries are commonly involved.
- Red strokes typically involve rupture of a weakened and dilated blood vessel (aneurysm). Blood thinners and other clot-busting drugs can cause a red stroke to complicate a white stroke.
- Cerebravascular disease can also referred to diseases involving the small vessels in the brain. Although less dramatic than strokes involving large blood vessels, these multiple “mini-strokes” can lead to dementia and the loss of other brain functions.
Peripheral Vascular Disease (PVD)
Peripheral vascular disease typically refers to diseases involving blood vessels outside of the heart and brain. Similar to coronary artery disease and cerebrovascular disease, it is most commonly caused by atherosclerosis (fatty plaques build up and clogging of blood vessels). Less commonly, it is caused by inflammation (vasculitis), blood clots (thrombosis or emboli), infections, injury and congenital defects.
- When people talk about PVD, they are usually referring to the narrowing, weakening or blocking of the main blood vessel coming from the heart (aorta) or the large arteries leading to the legs (e.g. femoral or iliac arteries), kidneys (e.g. renal arteries), intestines, and arms. However, it can also refer to disease involving smaller vessels (particular in diabetics) and large veins.
Sources:
National Kidney Foundation. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005 Apr;45(4 Suppl 3):S1-153.
Weiner, Daniel and Sarnak, Mark. “Cardiovascular Disease in Patients with Chronic Kidney Disease.” Chronic Kidney Disease, Dialysis, & Transplantation 2nd Edition: A Companion to Brenner and Rector’s The Kidney. Eds. Pereira, Sayheh & Blalke. Philadelphia: Elsevier Saunders, 2005. 158-173.