Cardiovascular disease: epidemiology and risk

Question 1

Definition of CV diseases

Answer 1

Diseases of the circulation: heart and vessels
Excludes diseases relating to formation of blood
Includes diseases of blood coagulation
Includes diseases of other organs resulting abnormal blood supply

Question 2

Cardiovascular mortality in the UK

Answer 2

In 2012, CV disease was the second main cause of death in the UK after cancer
46% of CV deaths are due to coronary heart disease
CHD most common cause of premature death (<75years)

Question 3

The cost of CV disease in the UK

Answer 3

CHD mortality has fallen steadily since the 1970s, due mainly to better treatments and more of them
490000 inpatient cases for CHD
175000 admissions for MI
17000 coronary bypass operations
92000 percutaneous coronary interventions
360000000 prescriptions for CV disease

Question 4

The scale of CV disease in the UK

Answer 4

CHD mortality is falling but morbidity is rising

In over 65s, morbidity (including disability) due to CHD had increased by 20% since late 1980s

Question 5

The global scale of CV disease

Answer 5

CV disease is the leading cause of death worldwide- 17.5 million deaths in 2012 (31% of total)
In 2012, CHD was second greatest cause of death after cancer
Mortality is rising in low income countries and restructuring countries of Eastern and Central Europe
By 2030, WHo predicts that CV mortality will increase too 23.3 million death per annum; CHD will remain leading cause of death

Question 6

Cardiovascular risk and risk factors

Answer 6

Most CV disease is acquired, not congenital, develops gradually e.g. ischaemic heart disease, cerebrovascular disease
Most CV disease develops as a result of life-style factors i.e. it is largely preventable
Modification of risk factors to prevent development of CV disease&raquo_space; primary prevention

Question 7

Fixed vs modifiable risk

Answer 7

Acquired CV disease is often multi-factorial, mix of modifiable factors and fixed (genetic) factors

Question 8

Major established risk factors for CHD include:

Answer 8

Age, male gender, family history, serum LDL cholesterol, smoking, low physical activity, diabetes, hypertension

Question 9

Approaches to primary prevention

Answer 9

Preventative measure in individuals with a high risk of developing CV disease
Screening programmes- identify populations at risk, investigate risk to individuals
Intervention to reduce modifiable risk- educate about risk, lifestyle/ behavioural alterations, pharmacological intervention to reduce risk

Question 10

Secondary prevention

Answer 10

Comprehensive risk factor reducing interventions (including pharmacotherapies) and rehabilitation for patients who have had a heart attack or stroke
Early disease detection increases opportunities for interventions to prevent progression and mortality
Aims of secondary prevention: extend survival improve quality of life, decrease need for major interventions e.g. PCI, CABG, reduce risk of subsequent major adverse CV event