ening of the aortic wall by atherosclerosis can result in aortic aneurysm formation and rupture, which lead to cardiovascular collapse.

Sudden cardiac death:

Death may be due to a massive myocardial infarction but may also be attributable to myocardial ischemic attack, which allows the establishment of arrhythmias characterized by rapid rates and a collapse of cardiac output.

Diseases That May Be Due to Effects of Hypertension on the Cardiovascular System

Hemorrhagic stroke: Neurologic deficit caused by the bursting of an intracerebral artery. The disruption of brain tissue and increase in cranial pressure are often fatal and almost always disabling.

Hypertensive heart disease: Condition in which the heart muscle initially increases in mass due to increase in work against elevated arterial pressure in the aorta. Eventually, the heart may become stiff and unable to fill with blood, or it may dilate with loss of myocardial cells, leading to congestive heart failure.

CARIOVASCULAR RISK FACTORS

A variety of factors have been identified as possibly causative of atherosclerosis and its clinical sequelae. These risk factors can be classified as modifiable or not modifiable. Among modifiable risk factors, the evidence supporting their modification as a way to prevent cardiovascular disease (CVD) can be classified as established, likely, or unproven (Pasternak et al., 1996; Pearson and Fuster, 1996).

Risk factors for which modification has been shown in epidemiologic studies or clinical trials to reduce risk include cigarette smoking , increase in low-density lipoprotein (LDL) cholesterol level (the fraction that carries most of the cholesterol in the blood), a high-fat and high-cholesterol diet, hypertension (high blood pressure, usually defined as >140/90 mm Hg), hypertrophy of the left ventricle (thickening of the cardiac muscle, usually due to high blood pressure), and thrombogenic factors (as evidenced by reduced clinical cardiac events with treatment by aspirin or anticoagulants).

A number of other risk factors have good epidemiologic evidence for their association with CVD, but weaker evidence from clinical trials. These include diabetes mellitus (a metabolic syndrome that includes elevated blood sugar levels), physical inactivity, low levels of high-density lipoprotein (HDL) cholesterol (the lipoprotein fraction thought to be responsible for removing cholesterol from the arterial wall), triglycerides (another form of fat carried in the blood), obesity, and postmenopausal status in women. With the advent of additional



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