Epidemiology Flashcards
Coronary Heart Disease
Pathology
image
Section through a coronary artery
CHD Pathology: Coronary Artery Sections
images
Normal: muscle wall, endothelium + open lumen
=
Atheroma Plaque (mainly lipids) added to the artery
=
plaque ruptures + triggers clotting (angina, chest pains etc.)
= THROMBUS = Sudden hear attack or cardiac death
Typical pattern of disease
progression
graph
= progressive, degenerative disease over lifetime
middle age and old age: inflammation + thrombosis start to dev.
happens through whole life, unaware when young because of minimal/no symptoms (below arbitrary line)
CHD Clinical Presentations (5 marks)
- SUDDEN CARDIAC DEATH
- HEART ATTACK /myocardial infarction/MI
- ANGINA (chest pain on exertion or stress)
- progressive HEART FAILURE (shortness of breath, ankle oedema & fatigue)
Many patients chronically disabled with POOR QUALITY OF LIFEPOOR QUALITY OF LIFE (graphs and surveys - images)
Survival following Acute Myocardial Infarction or CHD
poor survival of patients following them - die v rapidly (within 1-10 yrs often)
(stats start at 50% because of sudden cardiac death (before hospitalisation-so not even recorded as tehy die rapidly))
Heart failure has poor survival rates compared to prevalent cancers
UK pre-covid CVD data
image
-account for 26% of all UK deaths;
168,000 per year (2019 data)
-Estimated 7+ million people in the UK living with CVD
-Estimated 42,245 die under the age of 75 every year
- 70,00070,000 deaths UK annually, deaths UK annually, 23,000 )premature (<75 years)
- 16% of all male and 10% female deaths
- 2.3 million living with CHD
- relatively high mortality rates
internationally - 2.5 million years of life annually
- £6.8 billion costs NHS costs
CHD big problem for NHS
- 200,000 Myocardial Infarctions (MIs) per year
- 30,000 out of hospital cardiac arrests (survival <1in 10)
- Almost 1 million have survived a heart attack
- CHD PREVALENCE ~ affects 2.3 million people in UK middle aged & elderly people)
NHS ACTIVITY ANNUALLY (approx):
* GPs see 1million1million individuals
* Hospitals admit half a million CHD patients
* 3.5% NHS admissions UK men, 1.5% UK women
* 97,00097,000 get angioplasty, &16,000 CABG
CHD Descriptive Epidemiology factors (3 marks)
*Time
*Place
*Person
Time
-decreased in CHD mortality over past 20/30yrs
-data (images)
-increase following pandemic
(think about why)
Place
Not really changed over time - fairly consistent
Eastern Europe, Ukraine, Russia = highest death rates ( high smoking, alcohol + diet)
Southern Europe, Greece, Japan = lowest death rates (Mediterranean diet)
Person
men > women
increase in age + susceptibility is v steep (= log scale)
men and women even out nearer old age (65+) because women lose oestrogen advantages (decreased levels)
increased in Deprived areas, esp. younger ppl (under 65yrs)
understanding so far
1) CHD is caused by atheroma &CHD is caused by atheroma &thrombosis
2) Coronary atheroma
- develops silently from childhood-
- manifests as adult disease or
death
3)CHD epidemiology is well understood
Risk Factor
ANY characteristic which IDENTIFIES a group at increased (decreased) risk of disease
They need NOT be:-
-independent
-causal
-modifiable
Cause
A CAUSE is a factor which itself
increases risk of disease (prevalence, incidence, mortality)
Cause = a biological, not a sociocultural phenomenon
R + C studies:
increased death rates in smoker +/ high cholesterol men +/ high BP
‘9 potentially modifiable risk factors could for over 90% of the risk of an initial acute myocardial
infarction’ : Smoking, Hypertension, Lipids, Abdom obesity, Diabetes, Fruit+Veg, alcohol, exercise, psychosocial, other = DIET explains 50% of death
