Exam #2: Risk Factors for Heart Disease

Question 1

What is a risk factor?

Answer 1

Characteristic or feature of an individual or population demonstrated to increase the chance of future disease

Question 2

What is primary prevention?

Answer 2

Strategy to reduce the risk of an initial adverse event

Question 3

What is secondary prevention?

Answer 3

Strategy to reduce risk of a new adverse event in a patient with a known disease or condition

E.g. a patient with known CAD that are trying to prevent a MI in.

Question 4

What are the major risk factors in CAD?

Answer 4

1) Dyslipidemia
2) HTN
3) Tobacco use
4) DM
5) Chronic renal disease

Note that these are synergistic; account for most of the risk of MI; one risk factor is associated with 90% of adverse cardiac events

Question 5

What is the major difference between primary and secondary prevention?

Answer 5

Primary prevention is less cost effective

Question 6

Describe the multifactorial nature of CHD.

Answer 6

1) Predisposing factors and behavior lead to metabolic abnormalities
2) Metabolic abnormalities lead to quiescent disease markers/ evidence of disease
3) Markers transition to overt disease

Question 7

What are the non-modifiable risk factors for CHD?

Answer 7

Age
Gender
Family history

Question 8

What are the diagnostic and screening tests that help us predict CHD risk?

Answer 8

• EET (exercise tolerance test)
• EBT (electron beam tomography)
• ECHO
• CRP

Question 9

What are the modifiable risk factors of CHD?

Answer 9

Smoking 
Lipids 
BP 
DM 
Obesity 
Alcohol 
Diet 
Physical Acitivity

Question 10

What are the preventative medications for CHD?

Answer 10

ASA
Beta Blockers
ACE inhibitors

Question 11

What are the interventions for CHD?

Answer 11

PCI

CABG

Question 12

What is the lipid hypothesis?

Answer 12

Elevated serum cholesterol is linked to atherosclerosis

Question 13

What is the best term for elevated cholesterol? Why?

Answer 13

Dyslipdiemia b/c we are concerned with the ratios of lipids and lipoproteins

Question 14

What is the “number” for dyslipidemia?

Answer 14

Total cholesterol greater than 240 mg/L

Question 15

What classification system is used for dyslipidemia today?

Answer 15

Biochemical

Question 16

What is “optimal” cholesterol?

Answer 16

• LDL less than 100
• Total less than 200
• HDL greater than 40

Increased HDL decreased incidence of CHD

Question 17

How should dyslipidemia be managed?

Answer 17

1) Screening= over 20
2) Primary prevention= behavior modification
3) Secondary prevention= behavior AND pharmacologic intervention

Question 18

What is the basis for the intensity of ASCVD?

Answer 18

Individual risk assessment of lipid levels

Question 19

What are the highest risk groups for ASCVD?

Answer 19

• DM
• Noncoronacy atherosclerotic arterial disease
• Aortic aneurysm

Confer a high 10-year risk of CHD.

Question 20

How much does smoking increase the risk of an acute MI?

Answer 20

3x

Question 21

How much does smoking cessation reduce the risk of a cardiac event?

Answer 21

50% in the FIRST YEAR

Question 22

What should you do with patients in regards to smoking?

Answer 22

1) Always ask
2) Education and counseling by the PHYSICIAN–makes it important
3) Pharmacologic intervention

Question 23

How much does an increase in 7mmHg diastolic BP increase risk of CHD?

Answer 23

27%

Question 24

How much does HTN contribute to CVA and CAD?

Answer 24

CVA= 54% 
CAD= 47%

Question 25

How should you treat HTN?

Answer 25

Lifestyle

• Exercise
• Optimize weight
• Na+ reduction
• Smoking cessation
• Limit alcohol
• Adequate K+ and Ca++
• Lipid lowering

Drug therapy

Question 26

What accounts for 77% of the hospitalization for Diabetics?

Answer 26

CVD

Question 27

How did DM effect the annual CHD mortality in the Framingham study?

Answer 27

Men= doubled mortality 
Women= quadrupled

Question 28

What is synergistic risk?

Answer 28

Additional risk factors amplifies risk to a degree greater than the additive risk