Lecture 6 - CVD Risk Factors

Question 1

What are the two end stage events in CV disease?

Answer 1

• Myocardial infarction

* Cerebrovascular accident (stroke)

Question 2

What are the established CVD risk factors?

Answer 2

• Age
• BP
• Cholesterol
• BMI
• Smoking
• Diabetes

(6 risk factors)

Question 3

What are the non-established CVD risk factors?

Answer 3

• Left ventricular size
- Bigger heart correlates to greater risk of CVD

• Fibrinogen (clotting factors)

etc.

Question 4

Risk factors tend to …

Answer 4

Aggregate

Weight gain promotes the other major CVD traits (diabetes, high BP etc.)

Question 5

What is the most important risk factors for CVD?

Answer 5

Age

80% of CVD occur in people > 65 years

Question 6

Describe gender as a CVD risk factor

Answer 6

More prevalent in males

Females protected up until menopause

Women have increased risk after menopause, but still not as great as males

Hormone therapy in menopause does not reduce CVD however

Question 7

Describe the role of family history in CVD

Answer 7

CVD in a first degree relative increases risk 4-fold

This is not just genetics, but also environment
i.e. we have similar habits, dietary, exercise etc. to our family

Question 8

Describe the role of genetics in CVD risk

Answer 8

Individual genetic variants explain small amounts of risk
Must be polygenic

(e.g. BP is polygenic)

Question 9

What is the role of lipids in CVD risk?

Answer 9

Cholesterol:
• LDL : correlates to CVD
• HDL: correlates with healthy status

TAG:
• Increased levels correlate to increased CVD risk

Question 10

Describe the risk factor of obesity

Answer 10

Obesity correlates with increased risk

Especially central adiposity
• “apple shaped” men

Obesity ‘triggers’ many other of the risk factors:
• Insulin resistance
• High BP
• High lipids

Question 11

Describe the risk factor of alcohol

Answer 11

J curve:

High risk: high consumption of alcohol

Lowest risk:
• Moderate consumption
• 2 units per day

Less than two units per day:
• Greater risk that 2 units per day
• Lesser risk than high consumption

Question 12

Describe the role of stress in CVD

Answer 12

Popular but unproven explanation

Question 13

Describe the risk factor of BP

Answer 13

Increasing BP correlates to increase risk of CVD

However, greatest absolute risk of CVD is in those with intermediate BP, as there are the most individuals in this group

→ CVD population paradox

Question 14

Describe the CVD population paradox

Answer 14

More deaths occur in the large number at modest risk than in the small number at high risk

Question 15

What are the approaches for reducing CVD?

Answer 15

1. Public health prevention
   • Health promotion
   • Better diet
   • More exercise
2. Treatment
   a. Pharmacological

b. Non-pharmacological

Question 16

What is the important thing to consider when deciding whether or not to treat?

Answer 16

Risk of treatment must be less than the benefit of the treatment

This will be dictated by the risk calculated by a complex algorithm

Question 17

What is the definition of high CV risk?

Answer 17

> 15% event risk over 5 years

Question 18

What are the guidelines for treatment?

Answer 18

1. • Systolic > 180 mmHg
   • Diastolic > 110 mmHg
2. With associated conditions:
   • Systolic BP > 140 mmHg, or
   • Diastolic > 90 mmHg

Question 19

What are the four standard risk factors of CVD?

Answer 19

• Age
• Systolic pressure
• Total:HDL cholesterol ratio
• Smoking

Question 20

Give examples of parameters that looked at to assess organ damage in CVD

Answer 20

• LV hypertrophy
• Low eGFR
• Microalbuminuria
• Pulse wave velocity
• Intima-media thickness

Question 21

Compare obesity rates in various countries around the world

Answer 21

Eastern Europe:
• Rising rates

Developing countries:
• Rising

North America & Australasia
• Declining rates

Japan:
• Declining form already low rates

Question 22

Describe the situation in Japan

Answer 22

Japan previously had relatively low rates of CVD

There has been a decline in rates in the past 50 years

This is despite high rates of smoking

Diet:
• Low fat diets

Question 23

What is the French paradox?

Answer 23

Low rates of CVD despite high fat, high carbohydrate diet