Cardio Risk And Diseae Flashcards
CVD- a public health challenge
CVD is the 2nd most common cause of death in the UK, according for total of around 155,000 deaths in 2014
2014, there were almost 41,000 premature deaths (<75 Years if age) that were caused by CVD (25% in men and 17% in women)
Major ethnic and socioeconomic differences in incidences and outcomes
CVD and mortality- UK
2014 CVD caused 27% of all death while cancer caused 29%
CHD biggest cause of death in UK (15% male, 10% female) total 69,000
Around 39,000 deaths from stroke 2014 (6% in men, 8% in female)
25% of male, 17% of female premature mortality was attributed to CVD in 2014
Morbidity- key facts 1
In the UK m, there were more than 1.6 million episodes related to CVD, 10% of male, 6.3% of female inpatients
401,000 CHD episodes in NHS
AMI accounted for about 1.2% in men and 0.5% in female episodes
187,000 AMI in UK
Morbidity- key facts 2
Stroke accounts for about 1% of all hospital episodes in the UK, higher among male than females More than 7 million people in UK with some form of CVD, 500,000 with HF, 1.1 mil with AF and 1.2 mil have stroke
CHD and Health Inequality
ETHNIC DIFFERENCES IN INCIDENCES: south Asians living in UK- 50% high premature death in male and 51% in female; black Caribbean- 35% lower CHD deaths rates than rest of population
LARGE REGIONAL DIFFERENCES: premature death in Scotland 50% higher in SW (80% higher in females)
CHD and health inequality 2
LARGE SOCIOECONOMIC DIFFERENCES: incidence and outcome e.g. CHD death rate 54% higher in manual workers than non-manual
MAJOR FACTORS IN REDUCED LIFE EXPECTANCY: people living in areas of worst deprivation indicators- for males CVD accounts for 35% of the gap in life expectancy for female 30% of the gap
Reasons for ethnic differences
Multifactorial- not all genetic
Differences in incidences of a number of CVD risk factors e.g. hypertension, cholesterol, BMI, exercise
Diabetes is a major factor- again partly genetic but also other risk factors e.g. exercise and diet
CVD treatment
2013, more than 300 mil prescriptions were dispensed for- CVD, more than 6x as many issues in 1972
More than £6.8 Bol was spent in treating CVD within the NHS England. 63% of these costs came within 2ndary care and 21% within primary care
% of total health expenditure which is spent on CVD within regions in England ranged from 7.9% in south east to 6.3% in London
Changes in death rates in the UK
CVD death rate falling- by 44% in <75 yr, cancer now major mortality cause in males
CHD falling- by 49% in men (55-64) and 26% men (35-44). Women 55% and no change
60% due to reduce risk factors and the rest to secondary prevention- main factor smoking
Risk factors for CVD- non- modify-able
- The family history of premature CVD
- Older age
- Being male
- Ethnic background
- Co-morbidities that can increase the risk of developing CVD: hypertension; diabetes; CKD; dyslipidaemia; mental health problems
CVS risk factors modifiable
High BP Large amounts of non high density lipoprotein Smoking Obesity Insufficient physical activity Poor diet Psychosocial stress Excess alcohol consumption
Hypertension and CVD
Risk of CVD is directly related to higher levels of BP
Unhealthy diet is estimated to be responsible for half of hypertension with physical inactivity and obesity accounting for 20% each
Drug treatment and lifestyle changes, particularly weight loss, physical activity and dietary improvement, can effectively lower BP
Body weight and CVD
- Overweight and obesity increases the risk of multiple diseases including CVD, cancer and type 2 diabetes
- Adults with BMI of 25-30 are overweight and with a BMI of over 30 are obese. Both increase risk of morbidity and mortality
- Abdominal obesity is a predisposing factor for CVD
- WHO recommend cut off point (37 inch for men and 31 for women)
- Ratio cut off point 0.9 for men and 0.85 female
Blood cholesterol and CVD
- Blood cholesterol level is positively associated with CHD in both middle and old ages
- Blood cholesterol levels can be reduced by physical activity, dietary and by drugs
- HDL is an independent predictor of Cardiovascular risk, high level being protective and lower levels increasing the risk
- NICE state to use non-HDL cholesterol levels as opposed to total/HDL cholesterol, as optimal predictor of CVD risk
CVD risk assessment
FARMINGHAM method- US data. Modified for UK application
QRISK2- UK data derived from medical practises; both assess risk of CVD over a 10 year period, both are estimates
NICE: risk <10% offer lifestyle advice; <10% than lifestyle advice and consider treatment of co-morbidity and offer atorvastatin 20mg daily if there are no complications (primary prevention- try to stop MI before it happens)
