lifestyle factors and CVD Flashcards
What are the leading causes of death in the UK
24% CVD
21% Cancer
20% respiratory distress
4% external causes
How is rate of CHD distributed across the UK
Mortality not evenly distributed across country Onset and progression of CVD is strongly influenced by lifestyle (behaviour, not all genetic factors or non-modifiable differences)
How do lifestyle factors affect CVD
Elimination of modifiable risk factors – inc unhealthy lifestyle- would prevent 80% of cases
Behaviour affects CVD in 3 ways
1 health related behaviours such as diet, smoking, exercise
2 causing acute or chronic physiological changes that lead to CHD
3 access to and use of medical care
What are physical CVD risk factors
Physical (immutable- cant change)
Age, sex, family history (genes or diet, behaviour, learning and env)
Other demographics – education, SES etc
What are psychosocial CVD risk factors
Health behaviour Stress Depression Social support Come together to inc risk of metabolic syndrome
what did the EPIC-Norfolk study reveal about diets influence on CVD
Compared to those eating 5+ a day, others were:
- 7x more likely to die early from CVD
- 4x more likely to have a stroke
What did the US nurses study reveal about diets affect on CVD
Compared to lowest 20% for total fat intake
Top 20% total fat 1.3x more likely to get CVD
Top sat fat 1.5x
What did secondary prevention reveal about diets affect on CVD
improve diet can lower CVD death rate and risk of further cardiac events
what did the EPIC-Norfolk study reveal about smoking influence on CVD
Compared to non smokers, smokers were
1.9x likely to die early from CVD and 1.7x more likely to have stroke
what did the EPIC-Norfolk study reveal about exercises influence on CVD
Compared to active people, those below the threshold
- 3x more likely to die prematurely from CHD
- 3x more likely to have a stroke
What did secondary prevention reveal about smokings affect on CVD
Compared to CHD patients who keep smoking, quitters had 36% lower risk of premature death and 32% lower risk of another MI
What did secondary prevention reveal about exercises affect on CVD
Meta analytic evidence that intervention can increase exerciser and interventions can reduce all cause mortality, reduced CVD mortality and non fatal cardiac events
what are demographic and psychosocial factors that affect CHD risk
Hierarchy of occupations
managers to unskilled
do lower or high social classes have a higher CVD risk
Compared with top 20% income, lowest 20% income have 2.7x greater risk of CVD death and 4.3x greater risk of acute MI
do lower or high social classes have a higher CVD risk after adjustment for behavioural factors
lowest 20% income have
No greater risk of CVD and 2.8x greater risk of acute MI
Lower SES have more behavioural risk factors
Biological markers, behavioural and psychosocial factors
how do health beliefs affect risk of CVD
Biased risk perception (health optimism, general vs personal risk)
General public people acknowledge influence of various CVD risk factors but underestimate impact of diet and exercise
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(stress)
35 vs 40 %
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(smoking)
27 vs 32 %
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(don’t know)
25 vs 10%
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(hereditary)
16 vs 33 %
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(overweight)
10 vs 12 %
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(hyperlipidemia)
8 vs 30 %
what do you think contributed to this heart attack study - in hospital vs 2/2.5 yr post discharge
(inactivity)
6 vs 24 %
what do you think contributed to this heart attack study - men vs women answer
men more likely to cite poor diet or hard work and women chance or bad luck
how does getting to hospital in time affect CVD
Outcome of MI strongly associated with speed of treatment
what factors are linked to shorter time to get to hospital
Being male
Being married
Believing MI has more serious consequences
Active coping style/Using problem focused coping
More pain symptoms (breathlessness, dizziness etc)
what are the different responses to acute and chronic stress
Physical fight or flight for acute
Behavioural poor diet, smoking, alcohol, drugs chronic
Emotional anxiety anger depression chronic
Cognitive Poor concentration acute/chronic
what are coping responses to stress
Approach problem solving
Avoidance distraction – psych or behavioural
what evidence do epidemiological studies provide about stress and its effect on CHD
Acute stress associated with MI and cardiac death, MI and CD after disasters eg 9/11 terrorist attacks or football world cup
what evidence do animal studies provide about stress and its effect on CHD
Chronic stress induced atherosclerosis, lowers threshold for arrythmia
what evidence do experimental studies provide about stress and its effect on CHD
Acute stress increases ischaemia with patients with CHD, associated with cardiovascular changes (HR, BP)
how does stress link to ischaemia
Acute stress triggers ischaemia in patients with CHD
Intense physical activity
Stressful mental activity
Feeling tense, frustrated, angry sad
how does job strain lead to chronic stress
Occurs when demands are high but control and support is low
Greater CVD risk
Individual vulnerability factors – cardiac reactivity
can lifestyle risk accumulate across a lifetime
Yes, increases risk of cardiac event over time.
CE can be triggered by acute stress (the two interact to make this more likely)
what is a type A personality
Type A personality Identified in 1950s Hard driving competitive behaviour Vigorous speech characteristics Impatience Potential for hostility
how does personality link to CVD risk
Equivocal evidence
May be a risk factor for CHD in healthy people, not a risk for further issues for those with CHD
Hostility is most important component
what is the emotional impact of CHD
Higher than average prevalence of psychological symptoms post MI
Depression (up to 30%)
Anxiety (approx. 40%)
PTSD (up to 15%)
How does depression link to MI
2-3x more common after MI compared to other times in life
More severe following earlier or more severe cardiac events
An independent predictor of premature death in CHD patients
is it important to screen for depression in cardiac patients
yes
Associated with poorer adherence to medication or lifestyle mod post MI
Goal to target those most in need of treatment or support
Effective treatment of depression via meds or psychotherapy can reduce depression and improve survival
