Evolutionary Imprints on Cardiovascular Physiology and Pathophysiology

Abstract

Today, cardiovascular diseases (CD) are the overall leading cause of mortality worldwide. The most prevalent cardiovascular forms of diseases can be linked to adaptive selective forces acting during the evolution of cardiovascular systems from invertebrate animals to mammals, i.e., for 4 billion years, that have become maladaptive during the post-agricultural period, in humans following the changes in civilization, environment, and habits. Key among these is the association of arterial hypertension with increased dietary salt intake. Atherosclerotic disease has also been linked to meat and fat consumption. Policies to treat CD must be twofold: (1) to remove the maladaptive changes, e.g., high dietary salt, obesity, and high cholesterol and (2) to use our understanding of the molecular aspects of CD to develop targeted therapeutics, e.g., diuretics to increase salt excretion and to reduce lipids.

Glossary

Atherosclerosis

Atherosclerotic plaques are aggregates of plasma lipids (especially cholesterol) cells (smooth muscle cells and monocytes/macrophages), and connective tissue matrix (collagen fibers and proteoglycans). Inflammation is the “dominant process” with atherosclerotic plaques characterized by increased cellular proliferation, lipids accumulation, calcification, ulceration, hemorrhage, and thrombosis. Typically, a major acute coronary syndrome occurs when an atherosclerotic plaque in a coronary artery ruptures with subsequent thrombosis. Chronic ischemia caused by reduced blood flow in the coronary artery due to narrowing of the vessels by atherosclerosis triggers chronic stable angina and may cause heart failure. The most common form of stroke arises when blood clots form on atherosclerotic plaques in carotid and cerebral arteries and blocks flow (reviewed in [30]).

Hypertension

Over 500 million people experience hypertension worldwide and its prevalence increases with age especially in Western civilization. There is overwhelming evidence that reducing hypertension reduces cardiovascular morbidity and mortality. Antihypertensive therapy has been associated with reductions in stroke incidence averaging 35–40 %, myocardial infarction 20–25 %, and heart failure >50 %. It is estimated that in patients with stage 1 hypertension and additional cardiovascular risk factors, achieving a sustained 12 mmHg reduction in systolic blood pressure over 10 years will prevent 1 death for every 11 patients treated [51]. The origins of current standard and effective treatment of hypertension can be derived from evolutionary insights.