Epidemiology of Coronary Heart Disease

Question 1

Why has the age standardisation death rates for CVD / CHD / stroke have been falling in the UK?

Answer 1

• Improved risk factors, i.e. fewer smokers, better cholesterol control, better hypertension control
• Better treatments

Question 2

Why might CVD death rates decrease with higher social class?

Answer 2

Better health behaviours as you move up the social ladder

Question 3

What ethnic groups are more at risk of CVD deaths?

Answer 3

South Asian

African-American

Question 4

What ethnic groups are more protective against CVD deaths?

Answer 4

Afro-Caribbean

Question 5

State 4 non-modifiable risk factors for CHD

Answer 5

• Increased age
• Gender (male)
• Family history
• Race

Question 6

State 9 modifiable risk factors for CHD

Answer 6

• Hypertension
• Hyperlipidaemia
• High LDL / Low HDL ratio
• Diabetes
• Smoking
• Obesity
• Inactivity
• Alcohol
• Stress

Question 7

Define “Risk”

Answer 7

Probability of an event occurring in a given time period

Question 8

What are two ways in which we can measure Risk? State both equations

Answer 8

Risk ratio: Risk of disease (exposed) / Risk of disease (unexposed)

Risk difference: Risk of disease (exposed) - Risk of disease (unexposed)

Question 9

What is Odds ratio?

Answer 9

Probability of disease occurring in an exposed group / Probability of disease occurring in an unexposed group

Question 10

What is Population Attributable Risk?

Answer 10

The proportion of disease in a population which is attributable to a certain risk factor

Question 11

What is the Prevention Paradox?

Answer 11

A preventative measure that brings large benefits to the community but offers little to each participating individual

Question 12

State the two approaches to Health Promotion

Answer 12

High Risk Strategy - Targeting only high risk patients

Population Strategy - Targeting general population

Question 13

What are the advantages to the High Risk Strategy of Health Promotion? 5 points

Answer 13

• Appropriate to individual
• Motivated subject
• Motivated clinician
• Cost-effective resource use
• Benefit to patient is high

Question 14

What are the disadvantages to the High Risk Strategy for Health Promotion? 4 points

Answer 14

• Screening is difficult
• Palliative and temporary
• Limited potential
• Labelling occurs

Question 15

What are the advantages of the Population Strategy for Health Promotion? 1 point

Answer 15

• Has a large potential

Question 16

What are the disadvantages of the Population Strategy for Health Promotion? 3 points

Answer 16

• Population paradox (small individual benefit)
• Poor motivation can cause compliance issues
• Benefit to patient is low