Chronic Diseases (CVD and Cancer)

Question 1

What is Chronic Disease?

Answer 1

Diseases of long duration & slow progression, cannot be transferred to other people.
Leading cause of mortality globally: 70% of deaths.
40 million deaths/year (31M in low/middle income countries), 15 million <70 years of age; >80% of premature deaths were in low/middle-income countries

Question 2

4 major chronic diseases

Answer 2

Cardiovascular diseases (17.7M), cancers (8.8M), chronic respiratory diseases (3.9M), diabetes (1.6M)

Question 3

Primary Risk Factors

Answer 3

Smoking, physical inactivity, obesity, unhealthy diet, high blood pressure, high cholesterol, high blood glucose

Question 4

Leading risk factors globally (% of deaths):
HTEPO

Answer 4

High blood pressure (19%), tobacco (10%), elevated blood glucose (6%), physical inactivity (6%), obesity (5%).

Question 5

9/10 Canadians have ≥1 risk factor:

Answer 5

Smoking, Physical inactivity, < recommended daily Vegetables/Fruit, Stress, Overweight/Obesity, High Blood Pressure, Diabetes.  2/5 have ≥3 risk factors.

Question 6

Cardiovascular Disease (CVD)

Answer 6

Collective term for diseases of heart & blood vessels
1.6 million Canadians have heart disease or are living with the effects of a stroke
Affects 120,000 Canadians annually; heart disease & stroke are the leading cause of death
>$22 billion in direct ($7.6B) & indirect ($14.6B) health costs
Hospital care ($4B), Drug costs ($2.1B), Physician care ($1.5B)
Premature death ($9.3B), Long-term disability ($4.2B), Short-term disability ($1.2B).

Question 7

Cardiovascular System

Answer 7

The system that circulates blood through the body: the heart + blood vessels

(O2)Arteries (O2)Heart 

(DeOx)Veins (DeOx) Heart

(both) Capillaries (both) Tissues 

Question 8

Parts of the Heart

Answer 8

Fist-sized, 4 chambers
Right side: Pulmonary circulation
the system of transportation that shunts de-oxygenated blood from the heart to the lungs to be re-saturated with oxygen before being dispersed into the systemic circulation.
Left side: Systemic circulation
carries oxygenated blood from the left ventricle, through the arteries, to the capillaries in the tissues of the body.

Question 9

How does the heart work

Answer 9

(1) Waste-carrying, 02-poor blood enters right atrium
(2) Flows into right ventricle, pumped through pulmonary arteries to lungs
(3) Picks up 02, discards CO2, flows through pulmonary veins into left atrium
(4) Flows into left ventricle, pumped through aorta into rest of body’s blood vessels

Question 10

Blood Pressure and how heart beat contract/relax

Answer 10

Force exerted by the blood on the walls of the blood vessels, created by the pumping heart
Systole  when the heart contracts (beats)
Diastole  when the heart relaxes between beats

Question 11

Major forms of CVD (x5) ASHPC

Answer 11

ASHPC
Atherosclerosis
Stroke (cerebrovascular disease)
Heart disease and attacks (CHD)
Peripheral Arterial Disease (PAD)
Congestive Heart Failure

Question 12

Atherosclerosis

Answer 12

Thickening & hardening of arteries, narrowed by deposits of fat, cholesterol, other substances
Endothelial cell damage by smoking, high BP, high insulin or glucose, LDL particle deposit
Fatty plaques accumulate/grow on artery walls, loss of elasticity, restricted blood flow
Vulnerable to blockage by blood clots
Coronary artery, cerebral arteries, limb arteries

Question 13

Heart Disease & Heart Attack (CHD)

Answer 13

CHD (=CAD) most common form, caused by atherosclerosis

Partial blockage of coronary artery  Angina (chest, neck pain)

Complete blockage of coronary artery  MI (heart attack) myocardial infarction

Damage or death of heart muscle (myocardium)
The end result of a long-term disease process
Canada: 70,000/year = 1 every 7 min!
Sudden cardiac death (cardiac arrest) resulting from arrhythmia often cause of death in fatal MI

Question 14

Heart Attack Symptoms

Answer 14

Chest pain or pressure 66%
Arm, neck, shoulder, back or jaw pain
Difficulty breathing, shortness of breath
Excessive sweating; cool, clammy skin
Nausea & vomiting
Loss of consciousness
Fear, anxiety, denial
death first two hours within the first sign of symptoms

Question 15

) Stroke (cerebrovascular disease)

Answer 15

“Brain attack”
2 million brain cells die per minute; brain ages 3.5 years each hour
Ischemic stroke (87%): Either blood clot forms in a cerebral artery, or blood clot carried in the blood stream that becomes wedged in cerebral artery
Hemorrhagic stroke: Blood vessel in brain bursts, spilling blood into surrounding tissue
Death rates in Canada have declined dramatically
Survivors usually have long lasting disability

Question 16

Stroke Symptoms

Answer 16

Sudden numbness/weakness of face, arm, leg usually 1 side of body
Sudden confusion, trouble speaking, understanding
Sudden trouble seeing in 1 or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache, no known cause

Question 17

(4) Peripheral Arterial Disease (PAD)

Answer 17

Atherosclerosis in leg or arm arteries
Significantly increased risk with smoking, diabetes
Risk of amputation
Claudication: aching or fatigue in leg with exertion
Rest Pain: more severe stage, artery significantly narrowed or completely blocked
About 800,000 Canadians have PAD

Question 18

(5) Congestive Heart Failure

Answer 18

Caused by hypertension, atherosclerosis, CHD, MI, diabetes
Damage to heart’s pumping mechanism, fluids back up, seep through capillary walls  Edema
Pulmonary edema
400,000 Canadians per year develop
Can be controlled & treated

Question 19

Major modifiable risk factors (x6) SHHPOD

Answer 19

SHHPOD
Smoking
Hypertension
High cholesterol
physical inactivity
Obesity
diabetes

Question 20

Smoking

Answer 20

15% of CVD deaths
30% of smoking related deaths are due to CVD
1 pack/d = 2x risk of MI; 2+ packs/d = 3x risk of MI
Smokers 2-3x more likely to die from MI vs. non-smokers
2x risk of stroke

Question 21

Hypertension

Answer 21

The “silent killer”
20% of Canadian adults (only 2/3 controlled)
Short-term HBP = normal; chronic HBP = health risk.
Cause: increased output of blood from heart, increased resistance to blood flow from arteries
HBP scars & hardens arteries   even higher BP
Heart works harder vs. normal, force blood through arteries
Primary vs. secondary hypertension
Age, OCP, obesity, First Nations/African/Asian, inactivity, stress, alcohol, high-fat/high-salt diet
Lifestyle modification, Sodium restriction, Medication

Question 22

High cholesterol

Answer 22

Important component of cell membranes, sex hormones, Vit D, fluid coating lungs, protective sheaths around nerves
Cholesterol not used by cells spills out & collects on artery walls
Does dietary cholesterol have big impact on blood cholesterol?
Chol carried in blood on lipoproteins
LDL: carries chol from liver to tissues; Too much = BAD
HDL: carries unused chol back to liver for recycling = GOOD
40% of Canadians have high blood cholesterol
Optimal Levels: LDL < 3.3 mmol/L; HDL men > 1.0 mmol/L, women > 1.3 mmol/L; Tg < 1.7 mmol/L; TC:HDL ratio <5.
Lowering TC  reduced risk of heart attack; raising HDL may even reverse plaque formation on artery walls
Lifestyle modification : Increasing fibre, reducing Sat + Trans fats, PA, weight loss, quit smoking

Question 23

physical inactivity

Answer 23

PA = the magic pill?
Reduces BP & HR, increases HDL, helps maintain healthy weight, improves condition of blood vessels, prevents/controls diabetes
Risk of heart attack cut by 50% with just 3 hrs of brisk walking per week

Question 24

Obesity

Answer 24

Risk of CVD death 2-3x higher
Weight maintenance also important
Excess body fat  hypertension, high chol, insulin resistance, diabetes, endothelial cell dysfunction
PA & Fitness  strong positive influence on CVD health in individuals who are overweight/obese
Recall: “Fit-Fat” paradox
Modest weight reduction 5-10% of body weight  reduced CVD risk

Question 25

diabetes

Answer 25

Elevated blood glucose, due to insufficient insulin or inadequate action of insulin
2x risk of CVD for men, 3x risk for women: Most common cause of death for diabetics
Diabetes  obesity, hypertension, high cholesterol
Type 2 diabetes = “adult-onset” diabetes?
Pre-diabetes: Healthy diet + PA vs. medication

Question 26

Modifiable contributing risk factors

Answer 26

High Triglycerides e.g. “hypertriglyceridemic waist”
Psychological & Social factors: Stress, chronic hostility/anger, emotional suppression, depression, chronic anxiety, social isolation, low SES
Alcohol & other drugs
Inflammation/C-Reactive Protein: High levels= substantially increased risk of MI & stroke

Question 27

Non-Modifiable risk factors

Answer 27

Heredity: for both CVD itself + risk factors
Age: 65+
Being Male: especially at younger age, greater risk of MI, hypertension, stroke. ** Estrogen=protective
Ethnicity: Aboriginal, South Asian, African: Higher rates of hypertension, heart dx, stroke

Question 28

Prevention

Answer 28

Diet: Decreased Sat + Trans fat, increased fibre + whole grains, reduced sodium/increased potassium, moderate alcohol, other diet factors
Exercise! Meeting the Canadian PA Guidelines
Avoid Tobacco
Know (& manage if necessary) your BP
Know (& manage if necessary) your Chol levels
Effective coping & stress management

Question 29

Cancer

Answer 29

> 225,000 new cancer diagnoses & >80,000 deaths / Year
665 Canadians per day (28/hr) diagnosed with cancer
238 Canadians per day (10/hr) die from cancer
* > 50% of new cases: Lung, Breast, Colorectal, Prostate
* 2 in 5 Canadians will develop cancer in lifetime; 1 in 4 will die from cancer.
* 60% of Canadians diagnosed with cancer survive ≥ 5 years after diagnosis.

Question 30

who gets cancer

Answer 30

Approx. 90% of new cancers are diagnosed over age 50
Approx. 44% diagnosed over age 70
<1% at age 0-19

Question 31

who dies from cancer

Answer 31

more males died from cancer than females

Question 32

Probalility of surviving cancer

Answer 32

five year relative survial

Question 33

10 most common cancers in men in order from most to least

Answer 33

Prostate
all other cancers
lung
colorectal
bladder
non-hodgkin lymphoma
kidney
leukemia
melanoma
pancreas
oral

Question 34

10 most common causes of cancer death in men in order from most to least

Answer 34

Lung
all other cancers
colorectal
prostate
pancreas
bladder, esophahus, leukemia
non-hodgkin lymphoma
stomach
brain

Question 35

10 most common cancers in women in order from most to least

Answer 35

Breast
all other cancers
lung
colorectal
body of uterus
thyroid
non-hodgkin lymphoma
melanoma
ovary
leukemia
pancreas

Question 36

10 most common causes of cancer death in women in order from most to least

Answer 36

all other cancers
lung
Breast
colorectal
pancreas
ovary
non-hodgkin lymphoma
body of uterus
leukemia
brain, stomach

Question 37

What is Cancer?

Answer 37

Abnormal, uncontrolled multiplication of cells that, if untreated, can ultimately cause death

Tumour (neoplasm) – a mass of tissue that serves no physiological purpose
Benign vs. Malignant
benign tumors generally don’t invade and spread, malignant cells are more likely to metastasize, or travel to other areas of the body
Metastasis via lymphatic system or bloodstream
Some cancers (e.g. Leukemia) do not produce a tumour

Question 38

Stages of Cancer

Answer 38

stage 0 – carcinoma in situ a precancerous change
stage 1 – the tumour is usually small and hasn’t grown outside of the organ it started in
stages 2 and 3 – the tumour is larger or has grown outside of the organ it started in to nearby tissue
stage 4 – the cancer has spread through the blood or lymphatic system to a distant site in the body (metastatic spread)

Question 39

Most common cancers

Answer 39

1. Lung
2. Breast and prostate
3. colorectal

Question 40

Lung cancer

Answer 40

Most common cause of cancer death in Canada
85% could be prevented by avoiding exposure to tobacco smoke
Difficult to detect early; difficult to cure
50% 5-yr survival if detected early; 15% 5-yr survival overall

Question 41

breast and prostate

Answer 41

Most common cancer in women: 1 in 8 women
1 in 34 women will die from it
Age (80% > age 50), strong genetic component, early menstruation, late menopause, no children, HRT, obesity, physical inactivity, diet, alcohol
Early detection: Screening every 2yrs > age 50
Most common cancer in men: 1 in 8 men
1 in 30 men will die from it
Age (80% > age 65), physical inactivity, obesity, diet
Early detection: Screening > age 50

Question 42

colorectal

Answer 42

1 in 16 men, 1 in 18 women
1 in 38 men, 1 in 43 women will die from it
Age (50% > age 70) & heredity
Alcohol, smoking, physical inactivity, obesity, diet
Screening is effective: Recommended > age 50, could reduce incidence by 80%… but only 50% of adults do it

Question 43

Major known cancer causes

Answer 43

DNA, genetics, heredity
Gene mutations can be inherited, but most are caused by environmental factors (carcinogens)

Tobacco
85% of lung cancers, 30% of all cancer deaths

Physical Inactivity & Obesity
Especially breast & colon cancers

Diet (other card)
Environmental Carcinogens (other card)

Question 44

Major cancer causes (diet)

Answer 44

Diet
High consumption of dietary fat, processed & red meats
Alcohol
Fried foods
Acrylamide = human carcinogen (also: tobacco smoke)

Help reduce risk
Fibre
Fruits & Vegetables
“anti-carcinogens”: Vit A, C, E, B9 (folate); selenium, Ca
Phytochemicals in plants

Question 45

Environmental Carcinogens

Answer 45

Microbes (viruses, bacteria, parasites): 15% global cancers
HPV, Helicobacter pylori, Epstein-Barr, Herpes, Hep B & C
Ingested chemicals
Preservatives & additives: Some are anti-oxidants (good);
Others not good e.g. nitrates/nitrites in processed meats prevent bacteria growth/food poisoning, but can combine with dietary substances in stomach to form nitrosamines
Environmental/Industrial pollution
Air/water: < 2% of cancer deaths
Occupational: 5% of cancer deaths (N. America, vs. Eastern Europe, Former USSR)
Radiation
Medical x-rays, radioisotopes, UV rays

Question 46

Major warning signs of cancer (x7) (caution)

Answer 46

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

Question 47

Cancer Treatment

Answer 47

Surgery: Primary & often most useful Tx

Radiation: Tumour cells killed by gamma rays or x-ray beams; radioactive ‘seeds’ for small tumours – Destroys normal cells also, but can be precisely directed

Chemotherapy: Use of cell-killing drugs to destroy rapidly dividing cancer cells – Normal slow-growing cells are not destroyed, but tissue damage = side effects

Targeted treatments: Immunotherapy, hormone therapy, etc.