CVD tutorial

Question 1

Describe the epidemiology of cardiovascular disease

Answer 1

-prevalence: 1.2 mil Aus
double in indigenous populations
- mortality: 25% of all deaths

• most common: CHD, Afib, heart failure and stroke
• CHD includes AMI and angina
• higher in men and with age
• note: almost all (hospitalisations, deaths) worse among Indigenous people, remote areas, SES (Exc remote and deaths)

why remote? geographic isolation, histocultseco arrangemtns leading to inequalities in healthcare, cult attitudes delay seeking care, as well as inequities eg racism and discrimination, skills and resources of avaialbel health care, broken health system and organisation (hierarchy aka GP ->spec)

SES?

Question 2

Identify important modifiable and non-modifiable risk factors for CVD.

Answer 2

Non mod: age, sex, FHx, and ethnicity

Mod: obesity, smoking, diabetes or hyperglycaemia, hypertension, hypercholesterolaemia, sedentary life cycle (Also diet, stress and depression under reserch, largely from crossectional studies so no causal relationships can be derived, SES complicates the mod RFs)

Question 3

Recognise the comorbidity of CVD with diabetes and chronic kidney disease.

Answer 3

Comorbidity is defined as the presence of two or more conditions at once. In CVD it exacerbates risk and prognosis because factors are interrelated

Question 4

Define absolute risk assessment of CVD and describe its role in the prevention of CVD

Answer 4

Likelihood or probability event within in 5 years
Expressed as a percentage

Role is to prevent onsent or progression

Question 5

List the four steps to assessing absolute CVD risk in clinical practice

Answer 5

Five steps:
- identify people for assessment
- calculate risk
- identify the risk
- communicate risj
- manage risk

Question 6

Explore the multifactorial relationships between social, biomedical and behavioural determinants of CVD

Answer 6

(i) Psychological: socioeconomic disadvantage, poor built environments, racism and limited social support is associated with poorer mental health. Depression and anxiety has been linked with an increased risk of cardiovascular morbidity and mortality, and elevated levels of atherosclerosis biomarkers.

ii) Behavioural: socioeconomic gradient exists for many health behaviours over the life-course. Behavioural risk factors also vary by race/ethnicity. Social support and cohesion are associated with behavioural risk factors and also vary across the socioeconomic spectrum. Characteristics of the residential and built environment influence behavioural risk factors such as physical activity and eating behaviours, and poorer communities have fewer resources such as parks/recreational facilities and healthy food outlets.

(iii) Biological: the article discusses three biological process linking social factors to CVD
* Clustering of risk factors – socioeconomically disadvantaged populations experience a greater burden of the Framingham risk factors (i.e. those to measure absolute risk).
* Chronic stress response and systemic inflammation – social and economic stresses results in biological wear and tear, known as the allostatic stress response, involving inflammatory, stress hormone and metabolic disturbances.
* Prenatal/early childhood deprivation – socioeconomic disadvantage in utero and in early childhood have long term anatomical and physiological effects that lead to CVD in adulthood.

Approachability: identify existence of healthcare services
Acceptability: individual perception of the appropriateness of services.
Availability: location, hours of opening, appointment availability.
Affordability: free healthcare vs. insurance-based systems.