B P1 C2 Global Burden of Cardiovascular Disease

Question 1

____ disease now causes most deaths in all low- and middle-income regions, with the exception of sub-Saharan Africa, where it is the second leading cause of death overall, and the leading cause in those 50 years and older

Answer 1

Cardiovascular disease

Question 2

Enumerate the 5 typical stages of epidemiologic transition in CV mortality

Answer 2

(1) Pestilence and famine
(2) Receding pandemics
(3) Degenerative and man-made diseases
(4) Delayed degenerative diseases
(5) Inactivity and obesity

Question 3

_____ cause most CVD.

Answer 3

Rheumatic valvular disease
Hypertension
Cerebrovascular accident (stroke)

Coronary heart disease (CHD) often occurs at a lower prevalence rate than stroke, and CVD accounts for 10% to 35% of deaths.

Question 4

Typical Stages of Epidemiologic Transition in Cardiovascular Disease Mortality

Predominance of malnutrition and infectious diseases as causes of death; high rates of infant and child mortality; low mean life expectancy.

Answer 4

Pestilence and famine

Rheumatic heart disease, cardiomyopathies caused by infection and malnutrition

Question 5

Typical Stages of Epidemiologic Transition in Cardiovascular Disease Mortality

Improvements in nutrition and public health lead to decrease in rates of deaths caused by malnutrition and infection; precipitous decline in infant and child mortality rates.

Answer 5

Receding pandemics

Rheumatic valvular disease, hypertension, CHD, stroke

Question 6

Typical Stages of Epidemiologic Transition in Cardiovascular Disease Mortality

Increased fat and caloric intake and decreased physical activity lead to emergency of hypertension and atherosclerosis; with increased life expectancy, mortality from chronic, noncommunicable diseases exceeds mortality from malnutrition and infectious diseases.

Answer 6

Degenerative and man-made diseases

CHD, stroke

Question 7

Typical Stages of Epidemiologic Transition in Cardiovascular Disease Mortality

CVDs and cancer are the major causes of morbidity and mortality; better treatment and prevention efforts help avoid deaths among those with disease and delay primary events.
Age-adjusted CVD mortality declines; CVD affects older and older individuals.

Answer 7

Delayed degenerative diseases

CHD, stroke, congestive heart failure

Question 8

Typical Stages of Epidemiologic Transition in Cardiovascular Disease Mortality

Increasing prevalence of obesity and diabetes; some slowing of CVD mortality rates in women.

Answer 8

Inactivity and obesity

Question 9

Stage of epidemiologic transition with highest proportions of death caused by CVD

Answer 9

Degenerative and man-made diseases (35-65%)

Followed by:
Delayed degenerative diseases (40-50%)

Question 10

_____ was the leading cause of death in 2017, accounting for 16% of all deaths worldwide.

The second-ranking cause of death was _____, at 11%.

Answer 10

CHD

Stroke

Question 11

_____ remain the leading causes of CHD; tobacco, obesity, and physical inactivity remain important contributors as well

Answer 11

Elevated levels of BP and cholesterol

Question 12

By many accounts, _____ is the most preventable cause of death in the world. More than 1.4 billion people use tobacco worldwide, with 5.8 trillion cigarettes smoked globally in 2014.

Answer 12

Tobacco use

Question 13

_____ is an early indicator of an epidemiologic transition.

Answer 13

Elevated BP

Rising mean population BP occurs as populations industrialize and move from rural to urban settings.

Question 14

Four incremental strategies were evaluated for the treatment of MI and compared with a strategy of “no treatment” as a control for the six World Bank low- and middle-income regions. The four strategies compared were:

Answer 14

(1) Aspirin
(2) Aspirin and atenolol (beta blocker)
(3) Aspirin, atenolol, and streptokinase
(4) Aspirin, atenolol, and tissue plasminogen activator (t- PA)

Question 15

A combination of _____ for secondary prevention can lead to acceptable cost-effectiveness ratios in all low- and middle-income regions.

Answer 15

Aspirin
ACE inhibitor
Beta blocker
Statin

Question 16

_____ scoring may add the most in terms of changes in C-statistic (discrimination) or the net reclassification improvement (NRI) in intermediate-risk populations, and is found to be cost-effective at least in high-income settings

Answer 16

Coronary artery calcium

Question 17

Five “Best buys” for tobacco control include _____.

Answer 17

(1) Increased excise taxes on tobacco
(2) Standardized large graphic warnings on tobacco packaging
(3) Enforce bans on advertising and promotion
(4) Reduce exposure to secondhand smoke in work and public settings
(5) Implement mass media campaigns about harms of tobacco.

Question 18

Quitting smoking in the _____ trial was associated with a 40% relative risk reduction for MI.

Answer 18

Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5

Further studies suggest that varenicline leads to increased smoking cessation rates although it is unclear whether it is better than traditional NRTs

Question 19

The analyses on salt reduction achieved as a result of mass interventions are also quite favorable. Four WHO “Best buys” are:

Answer 19

(1) Reduce salt intake through the reformulation of food products with target levels

(2) Increase options of lower sodium food options in institutions

(3) Mass media campaigns for behavioral change

(4) Front of package labeling of sodium content

Question 20

Elimination of trans-fat through legislation is also proven cost- effective and recommended by the WHO.

Four other dietary recommendations that are either cost-saving or cost-effective include:

Answer 20

(1) Financial incentives to those purchasing food through government food provision programs

(2) Taxation of sugar sweetened beverages

(3) Incentives to purchase healthy food items administered through government health insurance schemes

(4) Menu calorie labeling regulations

Simple measures such as changing prescription length for medications such as statins or training community health workers to do screening for CVD can be cost-effective