3.1 Risk Factors Flashcards
What are the modifiable risk factors for CVD?
*Smoking
*Dyslipidemia
*Hypertension
*Diabetes (type 2 and pre-diabetes)
*Sedentary lifestyle
*Obesity
*Stress/Depression/Anger/Hostility
How does exercise affect cholesterol?
800-1000 kcal/week has effects but requires months, augmented by weight loss
TC moderately decreases
LDL-no change to moderate decrease
HDL increases on avg 10%, may increase linearly with exercise up to 4500 kcal/wk
Trig decrease on avg 20%
When would a person be considered to have metabolic syndrome?
3 or more of the following:
Waist circumference ≥ 102 cm in men, ≥ 88 cm in women
Trig ≥ 1.69 mmol/L
HDL-C ≤ 1.04 mmol/L in men, ≤ 1.29 in women
BP ≥ 130/85
BG ≥ 6.1 mmol/L or Glucose intolerance
What are the non-modifiable risk factors for CVD?
Family history
Age
Gender
A fasting blood glucose within what range is considered pre-diabetic? A fasting blood glucose above what is considered diabetic?
Pre-diabetic: 6.1-6.9
Diabetic: 7.0+
An A1C within what range is considered pre-diabetic?
An A1C above what is considered diabetic?
6.1-6.4 = prediabetic
6.5+ = diabetic
Diabetics want their A1C to be below what?
7.0
Why are waist circumference and waist to hip ratio a better indicator of increased health risk than BMI?
Central obesity (increased visceral body fat) is strongly linked with adverse health outcomes
BMI does not factor body composition (ratio of fat mass to fat free mass)
What is the relative risk for CVD associated with 1,2,3 and 4 risk factors?
- 1 risk factor = 2-3x risk
- 2 risk factors = 8x risk
- 3 risk factors = 15x risk
- 4 risk factors = 30-40x risk
Describe what would classify as a family history of heart disease.
1st degree relative
(immediate family - parent or sibling) with a history of CVD, men <55, women before age of 65
At what age does CVD risk increase?
Male > 55yrs
Females >65yrs (or premature menopause without hormone-replacement therapy)
What is the biggest modifiable risk factor to change first?
Smoking
When is smoking considered a risk factor?
At what point has previous smoking maximized possible risk reduction?
current, or quit within 6 months (still considered active)
maximized risk reduction after 3yrs
What are the levels for dyslipidemia as criteria for CVD risk factors?
TC > 5.2
LDL > 3.4
HDL <0.9
Triglycerides > 2.3
Risk ratio (tot chol/HDL) >5.8
On medication
At what point is HDL considered a negative risk factor? (takes away a risk factor)
HDL >1.6 mmol/L
What is the BP range we want people with diabetes to have?
<130mmHg systolic
<80mmHg diastolic
What is the criteria for diagnosis of hypertension risk factor?
systolic >140mmHg
diastolic >90mmHg
on medication
When is diabetes considered a risk factor for CVD?
type 1 diabetes and >30 yrs old, or for more than 15 yrs
type 2 diabetes and >35 yrs old
if they have impaired fasting glucose
What is considered an impaired fasting glucose affecting insulin resistance?
≥5.6 mmol/L
What is the criteria for overweight vs. obesity?
Overweight: ≥25 kg/m2
Obese: ≥30 kg/m2
WC ≥88cm female; ≥102 cm male
What is the criteria for sedentary lifestyle to be considered a risk factor for CVD?
no regular exercise program
< minimal recommendation from US Surgeon General
What are the psychosocial CVD risk factors?
Stress
Depression
Anger
Hostility
What 3 types of factors impact an individual’s risk for CVD?
Risk factors
Susceptibility
Exposure
What is the difference between absolute risk, accrued risk, and relative risk?
absolute risk: individual’s risk of developing CVD over a set period of time, 5-10yrs.
accrued risk: how long? how high?
relative risk: individual’s personal increase in risk - often 2x the risk compared to someone not diagnosed with CVD
What are the 4 points of an aggressive risk factor management?
role of exercise
role of diet
no smoking
role of medication
What does the Framingham Risk Score do?
Estimates risk of heart attack in 10 years
What is considered optimal BP?
110/70
What is considered normal BP?
130/85
What is a high normal BP?
130-139/85-89
130/85 to 139/89
What is considered mild hypertension?
140-159/90-99
140/90 to 159/99
What is considered moderate hypertension?
160-179/100-109
160/100 to 179/109
What important aspects of lifestyle impact blood pressure?
Sodium intake
Smoking
Physical activity
Body weight
Alcohol
What levels would you want someone with diabetes to have for:
impaired fasting glucose
pre-meal
1-2hrs post meal
A1c level?
impaired fasting glucose: 6.1-6.9
pre-meal: 7.0
1-2hrs post meal: 5-10
A1c level: <7
What is the risk for CVD for males vs. females with diabetes?
Males - increase 2-4 fold
Females - up to 7 fold
What are the common complications for diabetics in terms of microvascular and macrovascular disease?
Microvascular: retinopathy, neuropathy, nephropathy
Macrovascular: CV disease, cerebrovascular disease, peripheral vascular disease
What effect does exercise have on diabetes?
improved blood glucose control (esp. type 2)
improved glucose uptake
increases insulin sensitivity
decreased insulin resistance
decreased hyperinsulinemia
reduced risk of diabetic complications due to improved glycemic control
Low HDL is a strong predictor of what?
CVD
Cessation of smoking impacts cholesterol how?
increases HDL
How does improved diet impact cholesterol?
lower LDL, total cholesterol, and triglycerides
How does weight loss impact cholesterol?
lower LDL, total cholesterol, and triglycerides
How does lower alcohol consumption impact cholesterol levels?
increases HDL and lowers triglycerides
How do you calculate BMI?
kg/m2
What is an overweight BMI for an asian population?
BMI > 23
What is the mild, moderate, and severe obesity BMI ranges?
mild: BMI>30-34.9
mod: BMI>35-39.9
severe: BMI>40
Central obesity results in an increased risk for what?
increased risk for hypertension, type 2 diabetes, hyperlipidemia, CAD, premature death
What is the range for increased risk for waist to hip ratio?
> 0.8 female
0.9 male
What are the ranges for increased risk vs obese for waist circumference?
increased risk:
>80cm female
>94cm male
obese:
>88cm female
>102cm male
Metabolic condition is characterized by what 4 factors?
insulin resistance / diabetes
hypertension
dyslipidemia
central obesity
What is the key component for reduction of the development of diabetes?
exercise
What are the 5 treatment goals?
reduce body weight by 5% or more
exercise for 30+min/day
reduce fat intake to <30% of tot cal/day
reduce sat. fat to <7-10% of tot cal/day
increase fiber to 15g/1000kcal
In the Finnish Diabetes Prevention Study, those who achieved 4+ of the treatment goals had what % prevention of CVD?
100% prevention
those who follow lifestyle suggestions prevent the development of type 2 diabetes for at least _ years.
it was 6, now 10
What % of population has 1 or more major modifiable risk factors?
ages 45-74
81-94%
What % of population has 2 or more major modifiable risk factors?
ages 45-74
40-64%
What % of people with type 2 diabetes have hypertension?
60%
How does insulin affect hypertension?
increased levels of insulin may cause hypertrophy of the media layer of the artery
insulin is involved in the renal tubular absorption of sodium
