Unraveling the complex web: Heart disease and stroke

Abstract

INTRODUCTION As we delve into the complexities of the human body, we often find ourselves facing formidable adversaries, many of which remain unknown. Heart disease and stroke are two such adversaries, claiming millions of lives each year.[1] According to the World Health Organization,[2] ischemic heart disease was the leading cause of death worldwide in 2019, responsible for 8.9 million fatalities, while stroke was the second leading cause, accounting for 6.1 million deaths. The inextricable links between heart disease and stroke are obvious, as 30% of strokes are complicated by heart attacks and the mortality rate soars as high as 54%. Furthermore, symptoms of cardiovascular disease, such as atrial fibrillation and heart failure, can exacerbate the inflammatory response after a stroke, leading to worsened functional outcomes. These facts emphasize the need to address both diseases concomitantly and highlight the importance of a multi-pronged approach in our battle against them. This Special Issue of Heart and Mind aimed to shine a light on these entwined conditions and their ongoing battle against humanity. THE CHALLENGE OF PREVENTION The magnitude of the challenge at hand cannot be overstated, and as such, we must focus on reducing the global impact of heart disease and stroke. A key part of this battle is the prevention of common risk factors,[3,4] which include: (1) High blood pressure: A leading cause of both heart disease and stroke, hypertension damages blood vessels and increases the risk of plaque buildup in arteries, which can lead to heart attacks and strokes. (2) High cholesterol: Elevated levels of low-density lipoprotein cholesterol contribute to the formation of plaque in blood vessels, increasing the risk of heart disease and stroke. (3) Diabetes: High blood sugar levels can damage blood vessels and nerves, increasing the risk of heart disease and stroke. (4) Smoking and secondhand smoke exposure: Tobacco use and exposure to secondhand smoke can damage blood vessels and increase the risk of heart disease and stroke. (4) Obesity: Excess weight puts a strain on the heart and can lead to high blood pressure, high cholesterol, and diabetes, all of which increase the risk of heart disease and stroke. (4) Unhealthy diets: Diets high in saturated fats, trans fats, cholesterol, and sodium can contribute to heart disease and stroke. (5) Physical inactivity: Sedentary lifestyles increase the risk of heart disease and stroke by contributing to obesity, high blood pressure, and high cholesterol. (6) Mental stress: Chronic stress has been linked to an increased risk of heart disease and stroke due to its effects on blood pressure and inflammation. Addressing these risk factors may help reduce health disparities and improve outcomes for individuals across geographic, racial, ethnic, and socioeconomic divides. COMPREHENSIVE EXPLORATION Currently, we encompass a comprehensive exploration of heart disease and stroke prevention, diagnosis, treatment, outcomes, and the intricate interactions between these two diseases. Our efforts include the following strategies: (1) prevention: innovative approaches to reducing risk factors for heart disease and stroke, as well as community-based interventions and public health policies aimed at promoting heart-healthy lifestyles; (2) early detection and diagnosis: advances in diagnostic techniques, biomarkers, and imaging modalities that enable early identification of individuals at risk for heart disease and stroke; (3) treatment options: cutting-edge therapies, including pharmacological treatments, surgical interventions, and lifestyle modifications, aimed at improving outcomes for patients with heart disease and stroke; and (4) rehabilitation and recovery: strategies for optimizing functional recovery, quality of life, and long-term outcomes in patients who have experienced a heart attack or stroke. This includes physical, occupational, and speech therapy, as well as psychological support and caregiver education. In the prevention strategies, innovative approaches to reducing risk factors for heart disease and stroke have been increasingly explored, with a focus on personalized interventions.[5] This includes community-based initiatives like education campaigns, worksite wellness programs, and public health policies promoting heart-healthy lifestyles.[6] Advances in digital health technologies, such as mobile apps and wearable devices, have also shown promise in supporting lifestyle modifications and risk factor management.[7] For the early detection and diagnosis, technological advancements in diagnostic techniques have played a pivotal role in the early identification of individuals at risk for heart disease and stroke. The development of novel biomarkers and high-resolution imaging modalities, such as advanced magnetic resonance imaging[8] and computed tomography techniques, has allowed for more accurate detection and assessment of cardiovascular risk factors and disease progression.[9,10] Regarding treatment options, the landscape of treatment options for heart disease and stroke has evolved rapidly in recent years, with the emergence of cutting-edge therapies. These include new pharmacological treatments, such as proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors for lowering cholesterol levels,[11] and novel anticoagulant agents for stroke prevention in atrial fibrillation.[12] Ischemic preconditioning, especially the remote ischemic preconditioning (RIPC), has been proved to provide long-term protection against ischemic injury both in heart and brain.[13] RIPC, characterized as a transient sudden of ischemia/reperfusion in distant organs, helps brain against a subsequent prolonged ischemic insult. Clinical studies have demonstrated the beneficial outcomes of RIPC in the ischemic conditions, such as reducing myocardial infarction,[14] delaying imaging lesions progress and cognitive damage in patients with cerebral small vessel disease,[15] accelerating cerebral ischemic injury recovery after cardiac arrest,[16] and decreasing subsequent brain infarct in patients with severe carotid stenosis undergoing carotid artery stenting. Advances in surgical interventions, like minimally invasive procedures for valve replacement and repair, as well as endovascular therapy for acute ischemic stroke, have also improved patient outcomes.[17,18] Furthermore, the importance of lifestyle modifications, such as dietary changes, physical activity, and stress management, in the management of heart disease and stroke cannot be overstated.[19] In addition, optimizing rehabilitation strategies and functional recovery, quality of life, and long-term outcomes for patients who have experienced a heart attack or stroke is crucial. Multidisciplinary rehabilitation programs, encompassing physical, occupational, and speech therapy, play a key role in this process.[20] Psychological support for patients and their caregivers, as well as ongoing education, are vital components of comprehensive rehabilitation efforts.[21] CONCLUSION AND FUTURE DIRECTIONS Our attempts aimed to provide a comprehensive understanding of the prevention, diagnosis, treatment, outcomes, and intricate interactions between these two leading causes of death. Furthermore, we provide a platform for innovative research and emerging ideas, bridging the gap between scientific knowledge and clinical practice. Our goal is to inspire physicians, basic scientists alike, and policymakers in their search for strategies to better the lives of their patients and reduce the global burden of heart disease and stroke. As we look toward the future, it is essential to continue expanding our understanding of the complex mechanisms underlying heart disease and stroke, as well as exploring innovative approaches to prevention, diagnosis, and treatment. The integration of emerging technologies, such as artificial intelligence and machine learning, in the realms of diagnostics, treatment planning, and personalized medicine, holds significant promise for improving patient outcomes.[22,23] Furthermore, addressing health disparities by ensuring equal access to quality health care and promoting heart-healthy lifestyles across all demographics will be crucial in reducing the overall impact of heart disease and stroke worldwide.[24] Ultimately, through multidisciplinary collaboration, the sharing of knowledge, and the relentless pursuit of innovation, we will be better able to make significant strides in combating heart disease and stroke, as we strive to build a healthier and more equitable world. We hope that the publications in this special issue will serve as a catalyst for change and a beacon of hope for those affected by these devastating conditions.