Acute Coronary Syndrome (ACS)—Acute cardiac pain and ECG changes due to a developing myocardial infarction. Also called unstable angina.
American Cancer Society (ACS)—National volunteer organization promoting cancer research and education. Instrumental in campaign to reduce cigarette smoking.
American College of Cardiology (ACC)—National professional society of cardiologists. Co-sponsors national treatment guidelines in heart disease.
American Heart Association (AHA)—National volunteer organization promoting heart disease research and education. Co-sponsors national treatment guidelines in heart disease.
American Lung Association (ALA)—National volunteer organization promoting pulmonary disease research and education. Instrumental in campaign to reduce cigarette smoking.
Amiodarone—A drug used to treat arrhythmia. Its use has declined due to significant pulmonary toxicity
Angina Pectoris—Exertional chest pain due to coronary atherosclerosis, limiting the blood supply to the heart muscle.
Angiography—A radiologic (x-ray) procedure in which dye is injected to visualize the contours of blood vessels and their target organs. Coronary angiography is the primary diagnostic procedure for assessing potential targets for revascularization procedures.
Angioplasty—A procedure in which a balloon catheter with an inflatable cuff is threaded into an artery that is partially obstructed by atherosclerotic plaque and the cuff is inflated to compress the plaque and restore blood flow.
Angiotensin Converting Enzyme (ACE) Inhibitors—A class of drugs that block the conversion of the inactive to the active form of angiotensin, used to treat hypertension, myocardial infarction, and heart failure
Angiotensin Receptor Blockers (ARB)—A class of drugs that block the action of angiotensin and have fewer side effects than ACE inhibitors. They are used as an alternative to ACE inhibitors to treat hypertension, myocardial infarction, and heart failure.
Antiplatelet Drugs—A class of drugs that includes aspirin, clopidogrel, and others, that inhibits clotting by blocking the action of platelets.
Antithrombotic Drugs—A class of drugs that includes warfarin, heparin, and others, that inhibits clot formation by interrupting the cascade protein reactions that result in the conversion of fibrinogen to fibrin.
Arrhythmia—Disruptions of the regular heartbeat, ranging from benign premature atrial contractions to life-threatening ventricular fibrillation.
Aspirin—A salicylate, initially derived from willow bark and used to treat pain and fever, which is now a staple of secondary prevention because of its inhibition of clot-forming platelets.
Asystole—Absence of any electrical activity in the heart. Usually irreversible.
Atherosclerosis—The pathological chronic inflammatory process in which cholesterol, calcium, and cell debris are deposited in arterial walls, eventually obstructing blood flow. Their sudden rupture and resulting clot formation is the immediate cause of most heart attacks and many strokes.
Atherothrombotic Stroke —The acute deprivation of blood flow and oxygen to a portion of the brain following a rupture of an atherosclerotic plaque in one of the cerebral arteries.
Atrial Fibrillation—Total disruption of electrical conduction in the heart’s atrial chambers leading to inability to actively pump blood into the ventricles. Not immediately fatal, but stagnation of blood in the left atrium may lead to the formation of blood clots that may travel to the brain and cause strokes.
Beta Adrenergic Blockers—Drugs that block the action of epinephrine (adrenaline) and are useful in treating hypertension, arrhythmia, and myocardial infarction.
Biguanides—Antidiabetic drugs that reduce insulin resistance
Bile Acid Sequestrant Resins—Pre-statin cholesterol-lowering drugs that block the reabsorption of bile acids in the large intestine.
Blinded Clinical Trial—A clinical trial in which the patients (single-blind) and sometimes the treating medical practitioners (double-blind) are kept unaware of which treatment each participant receives. Also called “masked.”
Blood Pressure (BP)—The pressure within the arteries when the left ventricle is contracted (systole) or between contractions (diastole), as measured by the height (in millimeters) of a column of mercury (Hg) will be supported when a cuff around the arm is inflated to impede blood flow in the arm.
Body Mass Index (BMI)—Weight in kilograms divided by height in meters. In general, a BMI < 30 kg/m2 is considered healthy.
Calcium Channel Blockers—A class of drugs used to treat high blood pressure by impeding the flow of calcium across membranes.
Carbohydrates—Sugars and sugar polymers.
Cardiac Enzymes—Protein catalysts of muscle energy metabolism in the heart that leak into the bloodstream in a myocardial infarction and the measurement of which are useful in diagnosis.
Cardiopulmonary Bypass—A machine which takes over the function of the heart by oxygenating blood and returning it to the circulation while the heart is stopped for a surgical procedure.
Cardiopulmonary Resuscitation (CPR)—A method of buying time for a patient who has suffered a cardiac arrest by rhythmically compressing the chest and inflating the lungs until the heartbeat can be restored by defibrillation.
Cardiovascular Disease—All diseases of the heart and blood vessels supplying the heart, brain, limbs, kidneys, and other organs.
Cardiovascular Risk Factors—Attributes and behaviors (age, male sex, BP, LDL cholesterol, smoking, diabetes, etc.) that predict the risk of future adverse cardiovascular events.
Centers for Disease Control and Prevention (CDC)—The branch of the U.S. Department of Health and Human Services responsible for tracking and fighting infectious diseases and for maintaining national health statistics.
Cholesterol—A fat-soluble organic animal sterol that is a structural component of cell membranes, the precursor of steroid hormones, and is also a major component of atherosclerotic plaques.
Cholesteryl Ester Transfer Protein (CETP)—A protein that assists the transfer of cholesterol from HDL to LDL and was therefore once thought to be a promising target for intervention to raise circulating HDL cholesterol levels.
Confounding Variables—Variables than are correlated both with the treatment and outcomes of interest and which may confuse the results of clinical trials if they are imbalanced among treatment groups.
Congenital Heart Disease—A group of structural heart malformations of varying severity caused by in utero disruption of cardiac development.
Coordinating Center—An organization that provides essential statistical and logistic support for the conduct of large blinded randomized clinical trials.
Coronary Artery Bypass Graft (CABG) Surgery—A surgical procedure in which obstructed segments of coronary arteries are bypassed by grafting segments of the superficial saphenous (leg) veins or joining an internal thoracic artery to the coronary artery distal to the obstruction.
Coronary Heart Disease (CHD)—The disease caused by obstruction of the coronary arteries by atherosclerotic plaques potentially leading to angina, myocardial infarction, and death. I have used the terms CHD death, IHD death, and heart attack death interchangeably.
Cytokines—A broad category of small proteins important in cell signaling
DASH Diet—A diet based on low intake of fat and high intake of grains and vegetables, which is proven to reduce BP and LDL cholesterol.
Diabetes Mellitus (or Diabetes)—A metabolic disease caused either by insulin deficiency (type 1) or insulin resistance (type 2), which disrupts glucose metabolism and is associated with life-threatening ketoacidosis (in type 1), disease of the small blood vessels of the eyes, kidneys and other organs, and with a threefold increased risk of CHD.
Diastole—The period between heartbeats when BP is at its lowest.
Digitalis—A drug derived from the foxglove plant that was once a mainstay for treating myocardial infarction and heart failure but is now used mainly to treat atrial fibrillation.
Door-to-Balloon Time—The time between the arrival of an acute MI patient in the emergency room and revascularization by PCI.
DPP4 Inhibitors—Antidiabetic drugs that inhibit dipeptidyl Peptidase-4 (DPP4) and stimulate insulin secretion
Electrocardiogram (ECG)—An external recording of voltages associated with the electrical depolarization and repolarization of the heart in the course of a heartbeat. Sometimes abbreviated EKG from the German.
Endpoints—The pre-defined patient outcomes (heart attack, death, etc.) upon which the success of a treatment will be judged in a clinical trial.
Estrogen—The primary female hormone secreted by the ovaries, which is responsible (with progesterone) for the menstrual cycle and the development of female secondary sexual characteristics, and whose abrupt decline after menopause is responsible for the adverse vasomotor symptoms of menopause.
External Defibrillator—A device that is applied externally to the chest of a person in ventricular fibrillation to deliver a high-voltage shock to try to restore a normal heart rhythm.
Ezetimibe—A second-line LDL cholesterol-lowering drug often used in conjunction with a statin or instead of a statin in statin-intolerant patients.
Factorial Trial—A trial in which patients are simultaneously randomized with regard to two or more independent treatments (see Figures 3.1–2 in Chapter 3).
Familial Hypercholesterolemia—An autosomal dominant genetic condition characterized by defective or absent LDL receptors. Patients who inherit a defective gene from both parents (homozygotes) suffer severe coronary atherosclerosis and often die before adulthood. Patients who inherit a defective gene from one parent and a normal gene from the other survive to adulthood but are at elevated risk for heart attacks in middle age.
Fibrates—Second-line cholesterol-lowering drugs that modestly raise HDL cholesterol and lower LDL cholesterol and triglyceride levels.
Food and Drug Administration (FDA)—The federal agency in the Department of Health and Human Services that responsible for approving (or disapproving) new drugs and for monitoring their safety after they are approved.
Framingham Heart Study (FHS)—The first large cardiovascular epidemiologic study, founded by the NHLBI in 1948 in Framingham, Massachusetts.
Global Health Index—A composite endpoint used in the Women’s Health Initiative to assess the overall harm or benefit of menopausal hormone therapy.
Glucagon-like Peptide-1 (GLP-1) Receptor Antagonists—Antidiabetic drugs that reduce glucose reabsorption by the kidneys.
Glucose—The simplest sugar, which is the fundamental substrate of energy metabolism in humans and other animals.
Glycemic Index—A metric for rating of carbohydrates by their tendency to raise blood glucose levels.
Heart Attack—A popular term for the symptoms produced by acute blockage of a coronary artery (myocardial infarction) and the resulting deprivation of oxygen (ischemia) of the heart muscle downstream. I have used the term “heart attack deaths” interchangeably with CHD or IHD deaths, to signify deaths due to coronary atherosclerosis.
Heart Disease (HD)—All diseases of the heart including those from non-atherosclerotic causes (congenital, rheumatic, cardiomyopathy, etc.) as well as atherosclerotic CHD.
Heart Failure—Decreased ability of the heart—most often the left ventricle—to pump blood to the body. Related terms include left ventricular dysfunction, congestive heart failure, and reduced ejection fraction.
Hemoglobin A1c (HbA1c)—A circulating glycated hemoglobin molecule whose concentration in the blood is superior to the level of glucose itself as a stable measure of the state of glucose metabolism.
Hemorrhagic Stroke—A sudden often lethal bleed into the substance of the brain often associated with hypertension. Less commonly the source of bleeding may be the rupture of a small congenital aneurysm (a bulging and weakened arterial wall) in a small artery at the base of the brain.
High-Density Lipoprotein (HDL)—A protein-rich cholesterol-carrying particle, associated with reduced cardiovascular risk.
HMG CoA Reductase—3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, the key rate-controlling enzyme in the synthetic pathway for cholesterol
Hypertension—Elevated blood pressure, defined until recently as > 140/90 mmHg, but now defined as > 130/80.
Hysterectomy—Surgical removal of the uterus (and sometimes the Fallopian tubes and ovaries).
Implantable Cardioverter Defibrillator (ICD)—A device inserted in the chest of patients who have survived a sudden cardiac arrest (SCA) or are at high risk for an SCA to detect life-threatening ventricular arrhythmias and to deliver a corrective electrical shock to the heart when such an arrhythmia is detected.
Insulin—A peptide (short protein) hormone, made in the pancreas, which is essential for the utilization of glucose by fat and muscle cells. Absence of or resistance to insulin is the underlying metabolic defect in diabetes.
Ischemia—Deprivation of oxygen-carrying blood to an organ due to obstruction of the blood vessels supplying that organ.
Ischemic Heart Disease (IHD)—Used interchangeably with coronary heart disease (CHD)
Isolated Systolic Hypertension—Elevation of systolic BP without elevation of diastolic BP. Most often seen in older patients, as a manifestation of arterial stiffening.
Left Main Coronary Artery Disease—Significant atherosclerotic obstruction of blood flow in the proximal section of the left coronary artery before it bifurcates into the anterior descending and circumflex branches. Associated with the highest risk of a fatal MI.
Low-Density Lipoprotein (LDL)—The particle typically containing 60–70% of circulating cholesterol, associated with elevated cardiovascular risk.
Malignant Hypertension—An increasingly uncommon condition, featuring systolic BP levels exceeding 200 mmHg, retinal hemorrhage, and heart and kidney failure.
Mediterranean Diet—A diet based on dietary patterns in Italy, Greece, and other Mediterranean countries, which is characterized by high intake of olive oil and other unsaturated fats and relatively low intake of carbohydrates and has recently been shown to lower cardiovascular risk.
Meglitinides—Antidiabetic drugs that stimulate insulin secretion
Meta-Analysis—A statistical method to combine the results of clinical trials to produce more reliable estimates of overall benefit and more robust subgroup results.
Myocardial Infarction (MI)—An acute blockage of an atherosclerotic coronary plaque and subsequent clot formation, which causes measurable ischemic damage to the segment of heart muscle downstream.
National Center for Health Statistics (NCHS)—The CDC Center that is responsible for tracking national vital statistics and conducting national health surveys.
National Health and Nutrition Survey (NHANES)—A biennial survey conducted by the NCHS to track national trends in BP, cholesterol, diet, smoking, and other attributes and behaviors related to cardiovascular risk.
National Heart Lung and Blood Institute (NHLBI)—The NIH institute responsible for reviewing and supporting grants and contracts for basic and applied research in non-cancer diseases of the heart, lungs, and blood.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)—The NIH institute responsible for reviewing and supporting grants and contracts for basic and applied research in diabetes and in digestive and kidney diseases.
National Institutes of Health (NIH)—The agency within the Department of Health and Human Services that is responsible for reviewing and supporting grants and contracts for basic and applied biomedical research.
Niacin—A B vitamin (B-3), which when given in in high doses (150–400 times the 14–16 mg recommended daily intake), modestly raises HDL cholesterol and lowers LDL cholesterol and triglyceride levels.
Obesity—Defined here as having a BMI > 30 kg/m2. Overweight is defined as BMI between 25 and 30 kg/m2, and severe obesity is defined as BMI > 35 kg/m2.
P-Value—The probability that a treatment effect at least as large as the one observed in a clinical trial could have occurred by chance. P < 0.05 (i.e., one in 20) is generally accepted as the threshold for statistical “significance.”
Pandemic—A worldwide outbreak of a disease. An epidemic refers to an outbreak in one country or geographic region.
PCSK9 Blockers—Injectable monoclonal antibodies that block proprotein convertase subtilisin kexin 9 (PCSK9), a natural membrane protein that interferes with LDL receptors
Percutaneous Intervention (PCI)—The combination of angioplasty and stent placement via arterial catheter to produce a lasting re-establishment of blood flow in a partially obstructed coronary (or other) artery.
Placebo—An inactive drug provided to the control group of a clinical trial to achieve “blinding.”
Plaques—Gruel-like deposits of cholesterol, calcium, and cellular debris within artery walls that may partially obstruct blood flow and may cause an acute occlusion and ischemia of the tissue downstream—i.e., a heart attack, a stroke, etc.—when they rupture and a blood clot forms See Figure 5.2.
Primary Prevention—Treatments designed to prevent an initial heart attack or other cardiovascular event, in persons who have not already had a prior event.
Progesterone—The female hormone secreted by the ovaries, which is responsible (with estrogen) for the menstrual cycle. Progesterone mitigates the stimulatory (and pro-carcinogenic) effect of estrogen on the uterus.
Proteins—Large amino acid polymers, which comprise many of the cell’s structural elements, hormones, and enzymes.
Randomized Clinical Trial—An experiment conducted in human volunteers in which the allocation of participants among treatment and control groups is random. Randomization ensures that the treatment groups are similar at the start of the trial.
Renin-Angiotensin-Aldosterone System (RAAS)—An interconnected group of vasoactive proteins and hormones involved in regulating sodium excretion and reabsorption in the kidneys and affect BP (see Chapter 11).
Revascularization—A procedure in which circulation is re-established to an ischemic area of the heart (or other organs) either by reopening or bypassing the obstructed arterial segment(s).
Rheumatic Heart Disease—A form of heart disease, manifested mainly in damage to the heart valves, caused by a hyperimmune response to an infection by certain strains of streptococcus bacteria.
Saturated Fat—Hard fats found mostly in animals and tropical plants, which are defined chemically by the absence of carbon-carbon double bonds.
Secondary Prevention—Treatments designed to prevent a recurrent heart attack or other adverse cardiovascular event, in persons who have already had a prior event.
Statins—Drugs that inhibit HMG CoA reductase, the rate-limiting enzyme for cholesterol synthesis, and thereby stimulate the productions of LDL receptors and lower circulating LDL cholesterol levels. Statins are first-line drugs for treating patients with high LDL cholesterol, diabetes, and prior heart attacks.
Statistical Power—The probability that a trial will obtain a positive result if the treatment does in fact have the hypothesized beneficial effect. Power depends on the size of the hypothesized effect, the number of patients enrolled, and the incidence rate of the primary endpoint.
Stent—A thin wire-mesh tube—often impregnated with a drug that inhibits scarring—that is inserted to keep an arterial channel open after an angioplasty.
Streptokinase—An enzyme produced by streptococcal bacteria than digests fibrin, the structural protein of blood clots. Can re-establish coronary circulation when administered intravenously to patients with acute MI.
Stroke—A sudden blockage of circulation to a portion of the brain either by rupture of an atherosclerotic plaque in a cerebral artery or a sudden bleed into the brain, resulting in a loss of neurologic function or death.
Sudden Cardiac Arrest (SCA)—A stoppage of the heart due to an acute MI, arrhythmia, or non-cardiovascular cause, which results in an immediate loss of consciousness and brain death within 10 minutes if the heartbeat is not restored.
Sulfonylureas—Antidiabetic drugs that stimulate insulin secretion
Systole—The portion of the cardiac cycle when the heart is maximally contracted and BP is at its highest.
Thiazide Diuretics—A class of diuretics—including chlorothiazide and hydrochlorothiazide and closely related to chlorthalidone—used as first-line drugs to treat hypertension.
Thiazolidinediones—Antidiabetic drugs that reduce insulin resistance. Associated with increased risk of heart failure.
Thrombolytic Therapy—Treatment of acute MI with drugs that dissolve fibrin (the structural protein of blood clots) and re-establish circulation after an arterial thrombosis. Thrombolysis has been largely been replaced by PCI but is still of value in hospitals that lack facilities to perform angiography and PCI.
Tissue Plasminogen Activator (tPA)—A synthetic intravenously administered thrombolytic drug, which replaced streptokinase as a first-line treatment.
Trans Fats—Harmful fats containing trans carbon-carbon double bonds produced by processing polyunsaturated oils to produce margarine that is sold at refrigerator temperatures.
Unsaturated Fats—Fats, found largely in plants and seafood, containing one (mono) or more (poly) carbon-carbon double bonds, which are liquid at room temperature. Examples are olive and canola oil (mono) and corn, safflower, and sunflower oil (poly). Oils derived from fish and certain plants contain double-bonds at a specific location (omega-3) in the carbon chain.
Ventricular Fibrillation (VF)—A ventricular arrhythmia in which the heart muscle cells are bombarded with uncoordinated electrical impulses, and the ventricles cannot pump blood. VF is lethal if not reversed rapidly by a high-voltage shock (defibrillation).
Ventricular Tachycardia—A potentially life-threatening ventricular arrhythmia in which the heart beats too fast to pump blood efficiently. A high-voltage electric shock (defibrillation) is often needed to prevent VF and death.