A L1.1 Risk factors for coronary diseases

Question 1

ESTABLISHED CHD factors

*Reversing these factors will help with CHD*

Answer 1

• Age (most important factor)
  
  • 80% CHD occurs in people > 65yo
  • Exponential ↑ in risk with age (due to wear and tear of heart)
• Cholesterol
• BP
• BMI
• Smoking, Diabetes

Question 2

Percentage of people dying from CHD?

Answer 2

40%

Question 3

POSSIBLE CHD factors

*reversing these may not help with CHD*

Answer 3

• L. ventricular size (2nd most important factor)
  
  • Reflects BP, diabetes…
• Fibrinogen (clotting factor)
• Other lipids
• Homocysteine

Question 4

Weight gain

Answer 4

• Promotes major CHD traits

Question 5

Gender

Answer 5

• Males > Females risks
  
  • Females ‘protected’ before menopause, risk ↑ after menopause but men’s risks are still higher
  • Hormone therapy in menopause DOES NOT reduce CHD
    
    • Actually promotes risk of other things (i.e breast cancer…)

Question 6

Family history (genetics)

Answer 6

• CHD in 1st degree relative, ↑ risk 4x
• Env ≥ genes (in terms of importance)
  
  • e.g. IRS-1 gene
    
    • Insulin resistant gene → related to hypertension, high TAG

Question 7

Lipids

Answer 7

• vLDL, LDL, HDL (which is associated with exercise & a little alcohol → ↓CHD factors)

Question 8

Stress

Answer 8

• Unproven; Hard to measure

Question 9

Alcohol

Answer 9

• 2 Units of alcohol = ideal

Question 10

Graded risk effect

Answer 10

• There is a graded risk for CHD where every factor is additive to the risk
  
  • Relative risk: Relative to the general population: Graph is skewed to the right
  • Absolute risk: Multiplies by population: Normal distribution graph (bell curve)

Question 11

Socio-economic

Answer 11

• CHD is ↑ in developing countries;
• ↑ in central & eastern Europe
• ↓ in North America, Australasia, Japan
  
  • ↓ CHD is however opposed by ageing population

Question 12

Wealth

Answer 12

• Low wealth: ↑ disease → poor life expectancy
• High wealth: Different problems (CVD & Cancer) → usually better life expectancy (adequate nutrition)

Question 13

Japanese paradox

Answer 13

• Low medical consumers (not relying on medical tech), 2/3 men smoke → still lowest in CHD
• Have good nutrition diet, ↓25% fat content in food

Question 14

French paradox

Answer 14

• French smoke & have high fat diet but 2nd lowest CHD
• Red wine → may be beneficial for CHD