CVD Epidemiology 2 Flashcards
Local Policy effect
Eg) cigarettes or sugar used to be sold at the hospital. Now it is not.
Legislation effect
eg) allowing margarine to be sold in NZ
The ‘modern’ clinical approach
Is Type 2 diabetes a disease? Hypertension doesn’t exist.
Hypertension doesn’t exist. How?
It is said HT is when you are over 140BP, and that this makes you ‘worse off’. This ‘140’ has been extremely variable, and actually has an extremely low risk from 40onward, and means something very different for each individual age group. This does not mean that High BP isn’t dangerous, it’s just that we shouldn’t look at it by itself!
The clinical impact of a risk factor such a BP depends on the presence of other risk factors.
Each individual RF makes the BP worse. So even if you have a higher BP, if there are no other RF’s present, then they are still at a very low risk!
This has an impact around giving/prescribing drugs.
Benefits of Treatment are greatest in patients at high total CVD risk
It is easy today to HALVE someones risk. eg) 20% to 10% is higher then 5% to 2.5%
Therefore the priority for treatment are the people with the high risk. So low risk people treat with pharmacological methods.
How does this new understanding of hypertension relate to hyperlipidemia
It is the same thing! It doesn’t exist. It is only one risk factor though!
It seems like the lower the total cholesterol level the better, but the risk still depends on level of risk
The greatest benefit of lipid/bp lowering are in those with the highest risk bracket because they have the ____
Most risk factors
Type 2 diabetes doesn’t exist
It’s main cause is obesity. These people have a condition that’s largely attributed to weight, and you can treat this by losing weight. For example gastric bypass is used to treat diabetes.
Blood glucose >50 = diabetes
Obesity doesn’t exist
Because we currently define obesity at 30 BMI. BUT the ideal BMI (~24) gives a much lower risk for non-smokers over smokers
Smoking +40-50kg overweight
So the current definition of obesity is based on clinically meaningless threshold.
What does this all mean??
DOn’t just say “yes” or “no”, count all the risk-factors to assess risk of disease in each individual patient
The alternative to diagnosis is?
Risk prediction.
PREDICT in primary care: electronic decision support for CVD risk management.
Every time data is put in for a patient, it is recorded, so whenever they are hospitalised we get that data
