Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, accounting for approximately 17.9 million deaths annually, which represents about one-third of all global deaths [1]. Once considered diseases of affluence, CVDs are now rising rapidly in low- and middle-income countries due to urbanization, sedentary lifestyles, unhealthy dietary habits, and the increasing prevalence of risk factors such as hypertension, diabetes mellitus, and dyslipidemia [2,3]. The epidemiological transition has resulted in a steady increase in non-communicable diseases, with CVDs being a major contributor to premature mortality [4].

Understanding the clinicopathological spectrum of cardiovascular diseases is crucial, as it bridges the gap between clinical findings and structural or morphological changes observed in the heart and blood vessels. Such correlation enables accurate diagnosis, guides management, and helps in prognostication [5]. Autopsy and biopsy studies have shown that significant cardiovascular pathology, such as coronary atherosclerosis, myocardial fibrosis, and hypertrophy, may exist even in clinically silent individuals [6].

Hospital-based studies from tertiary care centers have documented varying patterns of CVDs. A study from Nepal reported ischemic heart disease, hypertension, and arrhythmias as the most frequent diagnoses among admitted patients [7]. Similarly, an echocardiography-based study from Ethiopia revealed a high prevalence of diastolic dysfunction, valvular heart disease, and left ventricular hypertrophy among patients referred for structural cardiac assessment [8]. However, comprehensive clinicopathological studies combining clinical data, risk-factor profiles, and histopathological correlation remain limited in Indian settings [9].

Hence, the present study was undertaken to evaluate the clinicopathological profile of cardiovascular diseases in adult patients at a tertiary care teaching hospital. The study aims to analyze the pattern and prevalence of various cardiovascular pathologies and to correlate these findings with clinical risk factors such as age, sex, hypertension, diabetes mellitus, smoking, and dyslipidemia. Such integrative research is expected to provide valuable insights into the underlying pathology of CVDs, assist in preventive strategies, and strengthen the hospital’s diagnostic and epidemiological database [10].

This was a hospital-based cross-sectional study carried out in the Department of Pathology in a tertiary care teaching institute catering to both urban and rural populations. The study was conducted over a period of one year, from January 2024 to September 2024. All patients aged 18 years and above who were clinically diagnosed with cardiovascular diseases (CVDs), admitted for evaluation or treatment during the study period, and whose adequate clinical records and laboratory data were available, were included. In addition, post-mortem specimens of the heart and major vessels showing gross or microscopic evidence of cardiovascular pathology were examined. Cases with incomplete clinical or pathological data and severely autolyzed specimens were excluded from analysis.

Relevant demographic details, clinical history, and risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol intake, obesity, and family history of CVD were recorded from case files and hospital records. Histopathological evaluation of biopsy or autopsy specimens was performed using standard techniques; tissues were fixed in 10% neutral buffered formalin, processed routinely, and stained with hematoxylin and eosin (H&E). Special stains such as Masson’s trichrome, Verhoeff–Van Gieson, and Von Kossa were used wherever required to demonstrate fibrosis, elastic fibers, and calcification. Data were entered in Microsoft Excel and analyzed using descriptive and inferential statistics. Frequencies and percentages were used for categorical variables, while mean ± SD was calculated for continuous data. Association between clinical risk factors and pathological findings was assessed using the Chi-square test, with p < 0.05 considered statistically significant [11,12].

Table 1. Demographic Profile of Study Population (n = 180)

Table 1 presents the demographic characteristics of the 180 patients included in the study. The mean age of the study population was 56.8 ± 12.4 years, indicating that cardiovascular diseases were predominantly seen in middle-aged and elderly individuals. The 46–60 years age group comprised the largest proportion of cases (38.9%), followed by those above 60 years (30.5%).

Males constituted a higher proportion (65.6%) compared to females (34.4%), reflecting the known male preponderance in cardiovascular morbidity. A majority of patients (62.2%) resided in urban areas, suggesting greater exposure to lifestyle-related risk factors such as sedentary habits, dietary changes, and stress associated with urban living. Overall, these findings highlight that cardiovascular diseases are more common among middle-aged and elderly men, with a higher burden in urban populations.

Table 2. Distribution of Cardiovascular Diseases by Clinical Diagnosis

Table 2 illustrates the clinical distribution of cardiovascular diseases among the 180 patients studied. The most frequent diagnosis was ischemic heart disease (IHD), accounting for nearly half of the cases (48.9%), followed by hypertensive heart disease (23.3%). Valvular heart diseases constituted 12.2%, mainly due to rheumatic and degenerative etiologies. Less common entities included cardiomyopathies (6.1%), myocarditis or pericarditis (5%), and congenital heart diseases (1.7%). A small proportion (2.8%) comprised other cardiovascular conditions such as pulmonary hypertension and aortic aneurysm.

Graph 2 depicts the proportion of major histopathological lesions observed among 180 cardiovascular disease cases studied at the tertiary care hospital during 2024. The most frequent lesion was coronary atherosclerosis (56.7%), followed by myocardial fibrosis (41.7%), indicating chronic ischemic injury as the predominant underlying pathology. Myocardial infarction accounted for 21.7%, while hypertensive vascular changes (18.9%) and valvular pathology (12.2%) were also significant contributors. Less common findings included myocarditis and other miscellaneous lesions (5%). This distribution reflects the continuing dominance of ischemic and hypertensive heart diseases in the adult population, emphasizing the strong interplay between vascular pathology, myocardial remodeling, and chronic cardiovascular morbidity.

Table 3. Distribution of Major Risk Factors among Patients with CVD (n = 180)

Table 3 presents the distribution of major risk factors among 180 patients with cardiovascular diseases. The most common risk factor identified was hypertension, affecting 62.2% of the study population, followed by diabetes mellitus (47.8%) and dyslipidemia (40.6%). Lifestyle-related risk factors such as smoking or tobacco use (38.3%) and alcohol consumption (28.9%) were also prevalent. Obesity, defined by a BMI ≥ 25 kg/m², was observed in 32.2% of patients, while a positive family history of cardiovascular disease was present in 15%. These findings highlight that the majority of patients had one or more modifiable risk factors, underscoring the significant role of hypertension, diabetes, and lifestyle habits in the pathogenesis of cardiovascular diseases and emphasizing the importance of preventive interventions and risk factor management.

Table 4. Histopathological Spectrum of Cardiovascular Lesions

Table 5. Correlation between Clinical Diagnosis and Dominant Histopathological Findings

Table 3 summarizes the distribution of major risk factors among the 180 patients with cardiovascular diseases. Hypertension emerged as the most prevalent risk factor, present in 62.2% of cases, followed by diabetes mellitus (47.8%) and dyslipidemia (40.6%). Lifestyle-related contributors such as smoking or tobacco use (38.3%) and alcohol consumption (28.9%) were also frequently observed. Obesity, defined as a BMI ≥ 25 kg/m², was noted in 32.2% of patients, while a positive family history of cardiovascular disease was documented in 15%. These findings emphasize the multifactorial etiology of CVD, with modifiable risk factors—particularly hypertension, diabetes, and dyslipidemia—playing a dominant role in disease development and progression, highlighting the need for effective preventive strategies and lifestyle modification programs.

In the present study, ischemic heart disease (IHD) emerged as the most common cardiovascular condition, accounting for 48.9% of cases, followed by hypertensive heart disease (23.3%) and valvular heart disease (12.2%). These findings are consistent with several Indian and international studies, which have reported IHD as the leading cause of cardiovascular morbidity and mortality worldwide [11,12]. The observed male predominance (65.6%) and higher incidence in the 46–60-year age group align with the established epidemiological trend that cardiovascular diseases manifest more commonly and at an earlier age among men due to greater exposure to risk factors such as smoking, alcohol consumption, and occupational stress [13].

Hypertension (62.2%) and diabetes mellitus (47.8%) were the most prevalent risk factors identified, corroborating previous studies that demonstrate the strong association of these comorbidities with cardiovascular pathology [14]. A similar pattern was reported by Prabhakaran et al. and Rajasekhar et al., where hypertension and diabetes significantly increased the risk of coronary atherosclerosis and myocardial fibrosis [15,16]. The high prevalence of dyslipidemia (40.6%) and obesity (32.2%) in the current study underscores the role of metabolic syndrome in the pathogenesis of ischemic and hypertensive cardiac diseases, emphasizing the growing burden of lifestyle-related risk factors in urban populations [17].

Histopathological examination revealed coronary atherosclerosis (56.7%) and myocardial fibrosis (41.7%) as the predominant lesions, which were most often observed in cases of IHD and hypertensive heart disease, respectively. These findings correspond with the results of Maheshwari et al., who also noted coronary atherosclerosis as the most frequent lesion in autopsy hearts, highlighting the impact of chronic vascular injury and ischemia on myocardial remodeling [18]. The presence of myocardial fibrosis in nearly half the cases reflects long-standing ischemic or pressure-overload injury, which may contribute to arrhythmogenesis and heart failure [19]. Valvular and inflammatory lesions were relatively less common, suggesting a declining trend of rheumatic pathology in comparison to degenerative and atherosclerotic heart diseases, consistent with the national epidemiological transition [20].

Overall, this study reinforces that cardiovascular diseases in the tertiary care setting are predominantly ischemic and hypertensive in nature, closely linked with modifiable risk factors such as hypertension, diabetes, dyslipidemia, and smoking. Strengthening community-based screening programs, promoting lifestyle modification, and early control of these risk factors are essential to reduce disease burden and improve outcomes. The clinicopathological correlation observed in this study underscores the value of integrating pathology findings with clinical data for a comprehensive understanding of cardiovascular disease progression

The present cross-sectional study highlights that ischemic heart disease remains the most prevalent cardiovascular disorder in tertiary care settings, followed by hypertensive and valvular heart diseases. The majority of patients were middle-aged to elderly males, reflecting the demographic most vulnerable to cardiovascular morbidity. Hypertension, diabetes mellitus, dyslipidemia, and smoking emerged as the dominant modifiable risk factors, indicating the major contribution of lifestyle and metabolic derangements to disease causation. Histopathological findings such as coronary atherosclerosis and myocardial fibrosis were consistent with chronic ischemic and pressure-overload injury, confirming a strong clinicopathological correlation. These results underscore the urgent need for early detection, effective risk-factor control, and health education to prevent progression to advanced cardiovascular disease. Strengthening preventive cardiology, community-based screening programs, and lifestyle interventions can significantly reduce the burden of cardiovascular morbidity and mortality in the population.

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