Epidemiology of cardiovascular diseases Flashcards
how does atherosclerosis form and progress?
- Atherosclerosis with plaque formation - composed mainly of lipids.
- Plaque will grow and obstruct a larger proportion of the vessel lumen, decreasing blood flow.
- Critical limit is reached (around 75% of the lumen), symptoms begin: oppressive chest pain – angina.
- More dramatic events may occur: the plaque may rupture and trigger the formation of a clot, that occludes the artery. The portion of myocardium supplied by that artery will die, causing an infarct.
- Patient may die suddenly or suffer a heart attack, we call it an acute myocardial infarction.
What is the typical disease progression of coronary heart disease
- Process starts early in adulthood
- progress is mainly asymptomatic until the critical stage is reached or the development of inflammatory process and thrombosis cause a total occlusion of the vessel.
- These dramatic events may present as sudden death or by excruciating chest pain signalling a myocardial infarction.
- If you survive the heart attack, the loss of muscle in the heart decreases its ability to work as a pump, leading to heart failure
Clinical presentations of coronary heart disease?
- Sudden cardiac death
- Heart attack /myocardial infarction (mi) – this causes some heart muscles to die
- Angina (chest pain on exertion or stress)
- Progressive heart failure (shortness of breath, ankle oedema & fatigue)
- These increase your chances of dying
- Many CHD patients are chronically disabled with poor quality of life
How does acute myocardial infarction affect someone’s life?
It increases risk of mortality
What can affect the risk of developing CHD?
Time: are there certain trends regarding the disease over time?
• CHD death rates have reduced in the UK – due to lifestyles changes and discovery of better treatments
Place: is it more common in certain places?
• Life style and culture (diet) can affect the risk of getting CHD – some countries have low salt and low fat diets, some cultures consume more alcohol
Person: are certain people more likely to get the disease?
• CHD mortality is higher in males, but women catch up around their fifties, generally after menopause.
• Age is a powerful determinant – the older you get the more likely you are to develop CHD.
• Mortality increases as deprivation increases – especially in young people
What is CHD caused by?
Atheroma and thrombosis
2 features of coronary atheroma?
- develops silently from childhood
* manifests as adult disease or death
Risk factors and causes for CHD
- Smoking increases risk.
- Lipids, diet and smoking have a particularly large affect on the risk of developing CHD
- Cholesterol and blood pressure are important as well
- They interact, and having more risk factors increases your risk correspondingly
What are the 3 types of prevention
- Primary prevention (before disease presents)
- secondary prevention (reduce complications)
- tertiary prevention (rehabilitation)
What does secondary prevention do for CHD patients?
postpone death and control symptoms
What does primary prevention do for CHD patients?
radically change the trajectory of the disease, by early intervention in the determinants of progressive atherosclerosis – postpone the appearance of symptoms
What are the 2 groups for CHD prevention?
- Prevention in people who already have CHD (secondary prevention)
- Prevention in people who are free from CHD (primary prevention)
How should we prevent CHD in people who do not yet have it?
- Identify high risk subjects
2. Reduce risk in population
What are risk charts for?
- Categorising patient by key risk factors e.g. sex, age, diabetes status, smoker, BP and cholesterol
- Calculating risk of major CV event within 10 years
What is used to identify subjects with 10 year CVD risk of 10% or more?
QRISK2 score
