CVD epidemiology Flashcards
Angina
temporary blockage and pain in chest
Are we getting healthier?
Yes, we are getting much healthier DESPITE the fact we are getting fatter. We are living a lot longer, even though there is a widespread idea we are getting sicker.
Heart disease journey
Heart disease peaked in 1970, but now is declining in EVERY age group.
Men (higher prevalence) and women rates get closer together as they get older.
Why do people say older women get heart disease more then men?
Because there’s more older women then there are men! Women get heart disease ~10years later
M/F comparison for stroke, what does this mean?
Men and women have around the same mortality and incidence of stroke. Stroke is caused primarily by high BP. It is thought the early decline in strokes in the early 50’s is due to the domestic refrigerator.
Importance of the domestic refrigerator?
Before the refrigerator we used to preserve our food with salt. > high BP
Total mortality CVD blip
Total mortality was going up in the 60’s due to the increase in coronary heart disease. This was a ‘blip’ as overall mortality has been decreasing for centuries around the world.
Currently 1/3 CVD 1/3total cancer
How we diagnose heart disease has changed. We are getting better and better at diagnosing smaller heart attacks. How does this affect our hospital rates?
if there was no decline in heart disease, you would expect the rate of hospitalisations to go UP, as we are diagnosing more and more smaller Heart attacks. BUT the IHD first admission are actually declining, so we are actually having less heart attacks.
Once you have a heart attack, you are ___x more likely to have another one
10x
Therefore if someone has a heart attack we really have to treat them well.
What is the one thing thats getting worse??
BMI. We are getting fatter (slowly but surely).
Those who are getting fatter faster are ‘english speakers’ perhaps because they don’t have many healthy food traditions
The 1st vs 2nd 20-25 years decline in mortality trends for heart disease
1960’s-1990
Very little medical innovation in this area. SO we believe most of the initial decline was due to lifestyle change, and not medically related.
Post 1990’s
more due to medical innovation
The research for medical care, smoking or blood pressure causing the decline in coronary heart disease (the FIRST part) is unsupported by evidence. Therefore what is the main contributing factor?
Saturated fats! A diet low in saturated fats seems to be the main contributor.
Butter contributes almost a quarter of the saturated fat in our diet. (Butter is no nutrients, it’s just fat!)
Butter consumption peaked in the early 50’s and then began to decline corrosponding with the CVD decline. around this time we started eating less red meat and more chicken(low in sat.fat)
Margarine was introduced in 1972 (it used to be illegal to protect our dairy industry)
How have our cholesterol levels changed?
Our total cholesterol levels have gone down.
2nd part of decline, medical innovations…
Statin usage have hugely increased (control lipids)
CVD medications : 1/2 NZ are taking meds by 60
Obesity stats.
Large proportion of obesity increasing, BUT mean BMI only slowly increasing
