Lecture 6 - Cardiovascular Risk Factors

Question 1

Two broad types of cardiovascular disease

Answer 1

1) Heart attack (death of heart muscle)

2) Stroke (issue with blood supply to the brain)

Question 2

Broad types of strokes

Answer 2

1) Issue with blood supply to the brain

2) Haemorrhage in the brain

Question 3

Why is the heart particularly prone to death?

Answer 3

Cardiac muscle cells can’t divide

No collateral blood supply to the heart

Question 4

Established CVD risk factors
1)
2)
3)
4)
5)
6)

Answer 4

1) Age
2) Cholesterol
3) Blood pressure
4) Body mass index
5) Smoking
6) Diabetes

Question 5

Other, more poorly-characterised CVD risk factors 
1)
2)
3)
4)

Answer 5

1) Left ventricular size
2) Fibrinogen levels (elevated->CVD)
3) Other lipids
4) Homocysteine levels

Question 6

CVD risk factor that tends to precede others

Answer 6

Obesity

Question 7

Single most important CVD risk factor

Answer 7

Age.

Over 80% of CVD occurs in people over 65

Question 8

Why is high fibrinogen a CVD risk factor?

Answer 8

Atherosclerosis leading to narrower blood vessels and turbulent flow.
Endothelium over plaque can bind clotting factors.
High fibrinogen increases risk of clot forming over plaque, occluding blood vessel

Question 9

Gender-specific risks

Answer 9

Men more likely to die from CVD
Women before menopause have reduced CVD risk (though have lower risk even after menopause)
Hormone therapy in menopause doesn’t reduce CVD risk

Question 10

How strong is family history in CVD?

Answer 10

First-degree relative with CVD increases your risk fourfold

Question 11

Amount that genetics contributes to CVD risk

Answer 11

Probably polygenic.

Individual genes explain small amount of risk

Question 12

Lipids implicated in CVD

Answer 12

LDL, VLDL, triacyl glycerides associated with increased risk

HDL associated with decreased risk

Question 13

Type of obesity particularly associated with CVD risk

Answer 13

Central obesity (particularly prevalent in men)

Question 14

Effect of alcohol on CVD risk

Answer 14

Below or above two standard units of alcohol increases risk

Question 15

HDL role

Answer 15

Transports cholesterol from peripheral tissues to liver

Question 16

LDL role

Answer 16

Transports cholesterol from liver to peripheral tissues

Question 17

Relative risk vs absolute risk of CVD, by blood pressure

Answer 17

Relative (personal) risk is highest at higher blood pressures.

Absolute (population) risk is highest at the average blood pressure (systolic=140mmHg), as more people have this blood pressure, therefore more people with 140mmHg die of CVD.

Question 18

What is defined as a high cardiovascular risk?

Answer 18

Over 15% event risk over 5 years (according to the national heart foundation)

Question 19

Blood pressure thresholds for treatment
1)
2)
3)

Answer 19

1) Systolic over 180mmHg
2) Diastolic over 110mmHg
3) Systolic over 160mmHg and diastolic under 70mmHg
4) Systolic over 140mmHg or diastolic over 90mmHg with associated heart conditions

Question 20

Conditions that increase CVD risk

Answer 20

Diabetes, renal disease, preexisting cardiovascular disease

Question 21

End organ damage of CVD
1)
2)
3)
4)
5)

Answer 21

1) Left ventricular hypertrophy
2) Microalbuminuria (indicates renal damage)
3) Low eGFR (estimated glomerular filtration rate)
4) Intima-media thickness (measuring arterial wall thickness)
5) Pulse wave velocity (speed at which blood travels through a vessel