2013-08-30 Coronary Prevention Flashcards
- Characterize the incidence and mortality patterns of coronary heart disease.
all dzs of the heart = 24% of all deaths in 2012; largest killer
—and CAD only = 15%
—only cancer is higher than CAD at 23%
women < men until menopause then becomes more equalized
incidence in black women ~= white women
incidence in black men = white men until ~age 75, then black < white
death rate from CVD has been falling significantly. decr 50% 1950 to 1990
- Consider atherosclerosis as a lifelong illness beginning in childhood.
fatty streaks are seen in 15-20% by the time you are in your 20s “Korean War Casualties: Coronary artery atherosclerosis seen in 77.3%. JAMA 1971;216:1185”
–can be seen as early as 3 y/o; obstructive plaques can be seen as early as 20-30 y/o
- Know the coronary risk factors and how to modify them.
- *Risk factors are correlations (does not imply causality)
- *risk factors demonstrate synergism
INHERENT
- -age
- -sex
- -familial hypercholesterolemia
MODIFIABLE
- -Diabetes
- -sedentary lifestyle
- -obesity
- -Type A personality
- -Gout
“EMERGING” RISK FACTORS
- -Homocysteinuria
- -CRP (inflammation)
- -Metabolic Syndrome
- -Depression
- -PTSD
- Appreciate the likely extent to which different interventions may reduce coronary mortality.
~50% of decreased CVD deaths from ‘80-2000 are from 1° prevention intervention
- Med diet w/ EVOO or nuts: 30% reduction
- Simvastatin: 30% reduction
- Wt loss in women w/ BMI >27: 20% reduction
BP, smoking and cholesterol modification seem to have the biggest bang-for-buck
- Be able to estimate coronary risk in persons with and without known disease.
Framingham Risk Score Calculator–gives 10 yr risk of CVD mortality
Risks included:
- -smoking
- -SBP
- -age
- -sex
- -cholesterol
What are the steps of atherosclerosis pathogenesis?
PHOTO (slide 25)
Key Findings for Framingham Study
Cigarette smoking
Cholesterol level
BP
EKG abnormalities
Physical activity found to reduce the risk
Obesity
Menopause
Psychosocial factors found to affect heart disease
High levels of HDL cholesterol found to reduce risk of death
New risk prediction formulas to calculate risk of CAD over the next 10 yrs published
Dr. Bell’s steps in coronary prevention
- Determine CHD risk category
a. Framingham risk calculation
>20% - high risk
10-20% - intermediate risk
20% risk)
-Diabetes - Smoking cessation counseling for smokers
- Anti-hypertensive therapy for hypertensives
- Therapeutic lifestyle changes (TLC)
- Cholesterol-lowering drug therapy if LDL still >goal
- -LDL goals:
a. High risk: LDL < 100
b. Intermediate risk: LDL < 130
c. Low risk: LDL < 160
Dean Ornish Diet
10% saturated fat vegetarian diet
exercise
smoking cessation
yoga for stress mgmt
3% reversal of stenosis in tx group
27% WORSENING of stenosis in ctrl group
–over 5 years
Best drugs for increasing HDL
nicotinic acid incr 15-35%
gemfibrozil incr 10-20%
Best drugs for decreasing TGs
nicotinic acid decr 20-50%
gemfibrozil decr 20-50%
statins decr 7-30%
Rough estimate of years saved by quitting smoking by sex by age
MEN stop at ~35y/o —> 5 yrs stop at ~45y/o —> 4 yrs stop at ~55y/o —> 3 yrs stop at ~65y/o —> 2 yrs
WOMEN stop at ~35y/o —> 3 yrs stop at ~45y/o —> 2 yrs stop at ~55y/o —> 1 yrs stop at ~65y/o —> 1 yrs