Lifestyle factors and CVD

Question 1

3 pathways in which lifestyle factors affect CVD

Answer 1

1. Via health-related behaviours
2. By causing acute or chronic physiological changes that lead to CHD.
3. Via access to and use of medical care.

Question 2

Physical, immutable CVD risk factors.

Answer 2

Age

Sex

Family history

Genes

Question 3

Psychosocial, modifiable CVD risk factors

Answer 3

Health behaviours

Stress

Depression

Social support

Personality

Question 4

Metabolic syndrome

Answer 4

Factor than increases CVD risk, described as:

Being overweight and have great abdominal fat distribution.

Having hypertension

Insulin resistance

Hyperglycaemia.

Question 5

5+ fruit and veg a day and risk of CVD

Answer 5

Those who were not having 5+ a day:

1. 7 x likely to die early from CVD
2. 4 x more likely to have a stroke.

Question 6

Fat intake and risk of CVD

Answer 6

Those in top 20% of total fat intake:
1.3 x more likely to develop CVD

Top 20% saturated fat:
1.5 x more likely to develop CVD.

Question 7

Smoking and CVD risk

Answer 7

Compared to non-smokers:

1. 9x more likely to die early from CVD
2. 7 x more likely to have a stroke.

Compared to CHD patients who keep smoking, those quitted had:
36% lower risk of premature death
32 % lower risk of re-infarct.

Question 8

Exercise and CVD health risk

Answer 8

Those below activity threshold:
1.3 x more likely to die early from CVD.

1.3 x more likely to have a stroke.

Question 9

Demographic and psychosocial factors on CVD risk

Answer 9

Lower classes have greater CVD risk:
Compared to top 20% income, bottom 20% have
2.7 x risk of CVD death

4.3 x greater risk of AML.

However, adjustment for behavioural risk factors:
lower 20% have no greater risk of CVD compared to top 20%

Have A 2.8 X greater risk of AMI.

Question 10

Association between socioeconomic status and CVD

Answer 10

Those in a lower SES more likely to develop CVD

Large part of this is attributed to differences in:

Biological markers: more likely to have hypertension and cholesterol

Behavioural factors:
More likely to smoke, have a worse diet, exercise less.

Psychosocial factors:
More likely to be depressed and have social support.

Question 11

Why do people risk their health?

Answer 11

Biased risk perception:
Health optimism, don’t think it would happen to them

General risk vs Personal risk; even though there are stats for risk in the general population, it is difficult to personalise that risk.

People underestimate the impact of diet and exercise, whilst acknowledge other risk factors for MI and other CVD.

Question 12

Patients and their underestimation of what they think caused MI

Answer 12

Those in hospital and 2-2.5yrs after discharge mainly attributed the cause to stress and smoking.

25% in hospital didn’t know.

Men more likely to cite poor diet and hard work.

Women more likely to cite chance/ bad luck.

Question 13

Factors that affect getting to hospital on time- speed of treatment

Answer 13

Shorter time:

Being male

Being married

Believing MI has more serious consequences

Active coping style

More non-pain symptoms

Question 14

Physical responses to stress

Answer 14

Physical: fight/flight, acute situations.

Question 15

Behavioural response to stress

Answer 15

Poor diet

Smoking

Alcohol

Drugs

Causes chronic stress- increase CVD risk

Question 16

Emotional response to stress

Answer 16

Anxiety

Anger

Depression

Chronic stress- Increase risk of CVD

Question 17

Cognitive response to stress

Answer 17

Lack of concentration- acute/ chronic

Question 18

Coping responses to stress

Answer 18

Problem solving: managing the stress in short and long term.

Psychological/ Behavioural distraction: avoidance.
Not thinking about it or eatin/smoking to cope with stress.

Question 19

Epidemiological studies on stress

Answer 19

Acute stress associated with MI and cardiac death

MI and CD increase after disasters- 9/11, world cup.

Question 20

Animal studies on stress

Answer 20

Showed that chronic stress induces atherosclerosis

Lowere threshold for arrhythmia

Question 21

Experimental studies on stress

Answer 21

Shows that acute stress triggers ischaemia in patients with CHD

Acute stress is also associated with CV changes; BP, HR.

Question 22

Stress and ischaemia

Answer 22

Acute stress triggers iscahemia in CHD patients.

examples:
Intense physical activity
Stressful mental activity
feeling tense, frustrated, angry or sad.

Job strain- chronic stress
Associated with increased CVD risk
- demand in workplace is high
- Control of stress is low
- Lack of support in workplace

Question 23

Personality and CVD risk

Answer 23

Type A personality:
Hard driving competitive behaviour
Vigorous speech characteristics 
Impatience
Potential for hostility

May be a risk factor for CHD in health people but not for those who already have CHD.

Hostility is the most important component.

Question 24

Hostility and CHD

Answer 24

Independent predictor of CHD incidence.

Significant interaction with waist-to-hip ratio

Question 25

Emotional impact of CHD

Answer 25

Post MI:

Up to 30% are depressed

Around 40% have anxiety

Up to 15% have PTSD

Question 26

Depression and MI

Answer 26

2-3x more common after MI compared to other times in life.

Independant predictor of premature death in CHD patients

Associated with poor adherence to medication or lifestyle modification post MI.

Effective treatment of depression may improve survival in MI patients.

Question 27

Cardiac rehab

Answer 27

Involves:
Health education and promotion

Behavioural change

Stress management

Psychotherapy for depression and anxiety

Support groups.

SMART goals and Dual-process model is used to tailor needs and preference of patient.

Question 28

Effects of cardiac rehab

Answer 28

20% reduction in overall mortality + 36% reduction in cardiac mortality.

Reduces smoking BUT NOT:
Re-infarction rates
Quality of life significantly

Half of patients drop out

Patients who do not attend perceive medication as being more important for promoting health.