lifestyle factors & cardiovascular disease

Question 1

what are the 3 pathways affecting cardiovascular disease?

Answer 1

1) health related behaviours such as diet, smoking, exercise
2) causing acute or chronic physiology changes that lead to CHD
3) access to and use medical care

Question 2

what are physical CVD risk factors?

Answer 2

• age
• sex
• family history
• genes

Question 3

what are psychological (modifiable) CVD risk factors?

Answer 3

• health behaviours
• stress
• depression
• social support

Question 4

what does metabolic syndrome lead to?

Answer 4

overweight and abdominal fat distribution, hypertension, insulin, resistance, hyperglycemia

Question 5

what does the EPIC-Norfolk study on diet show?

Answer 5

compared to those eating 5+ a day, other people were:

• 1.7x more likely to die early from CVD
• 1.4x more likely to have a stroke

Question 6

what does the US nurses healthy study on diet show?

Answer 6

compared to people in the lowest 20% for total fat intake:

• top 20% total fat = 1.3x more likely to develop CVD
• top 20% saturated fat = 1.5x more likely to develop CVD

Question 7

what is the secondary prevention for diet?

Answer 7

interventions can improve diet and
= lower death rates (CVD and total)
= lower risk of further cardiac events

Question 8

what does the EPIC-Norfolk study on smoking show?

Answer 8

compared to non-smokers, smokers were

• 1.9x more likely to die early form CVD
• 1.7x more likely to have a stroke

Question 9

what is the secondary prevention of smoking?

Answer 9

compared to CHD patients who keep smoking quitters had:

• 36% lower risk of premature death
• 32% lower risk of another MI

Question 10

what does the EPIC-Norfolk study on exercise show?

Answer 10

compared to active people, those below activity threshold were:

• 1.3x more likely to die early from CVD
• 1.3x more likely to have a stroke

Question 11

what is the secondary prevention of exercise?

Answer 11

meta-analytic evidence that interventions can increase exercise and that interventions can:

• reduce all-cause mortality
• reduce cardiovascular mortality
• reduce non-fatal cardiac events

Question 12

compared to the top 20% income, the lowest 20% income have…?

Answer 12

• 2.7x greater risk of CVD death

- 4.3x greater risk of MI

Question 13

after adjustment of behavioural risk factors the top 20% income to the lowest 20% income have…?

Answer 13

• no greater risk of CVD death

- 2.8x greater risk of acute MI

Question 14

what are the percentages of factors contributing to a heart attack in hospital?

Answer 14

• stress = 35%
• smoking = 27%
• dont know = 25%
• hereditary = 16%
• overweight = 10%
• hyperlipidemia = 8%
• lack of activity = 6%

Question 15

what are the percentages of factors contributing to a heart attack 2-2.5 years after discharge?

Answer 15

• stress = 40%
• smoking = 32%
• dont know = 10%
• hereditary = 33%
• overweight = 12%
• hyperlipidemia = 30%
• lack of activity = 24%

Question 16

what factors shortern the time to get to hospital when having an MI?

Answer 16

• being male
• being married
• believing that MI has more serious consequences
• active coping style
• using problem-focused coping
• more non-pain symptoms

Question 17

what are the different responses to stress?

Answer 17

• physical = fight or flight response
• behavioural = poor diet, smoking, alcohol, drugs
• emotional = anxiety, anger, depression
• cognitive = poor concentration

Question 18

what are the coping responses to stress?

Answer 18

• approach = problem-solving

- avoidance = distraction - physiological or behavioural

Question 19

what things triggers ischaemia in patients with CHD?

Answer 19

• intense physical activity
• stressful mental activity
• feeling tense
• frustrated
• angry
• sad

Question 20

what type of stress does job strain cause?

Answer 20

chronic stress

Question 21

what is ‘type A personality’?

Answer 21

• hard-driving competitive behaviour
• vigorous speech characteristics
• impatience
• potential for hostility

Question 22

what are the links between type A personality and heart disease?

Answer 22

• equivocal evidence
• may be a risk factor for CHD in healthy people
• not a risk for further problems in people with CHD
• hostility appears to be most important complement

Question 23

what disorders raise the prevalence of physiological symptoms post MI?

Answer 23

• depression (up to 30%)
• anxiety symptoms (approx 40%)
• PTSD (up to 15%)

Question 24

how much more likely is depression after an MI than other times in life?

Answer 24

2-3 times more likely

Question 25

how does depression link to CHD?

Answer 25

• more severe following earlier or more severe cardiac events
• an independent predictor of premature death in CHD patients
• associated with poorer adherence to medication or lifestyle modification post MI

Question 26

what is the goal for health care in patients with CHD and depression?

Answer 26

target those most in need of treatment and support

Question 27

what is the effective treatment of depression?

Answer 27

via medication of psychotherapy can reduce depression and improve survival in MI patients with depression