Major Studies

Question 1

Which of the following statements most accurately describes the findings of the INTERHEART study?
A. The two strongest risk factors for an acute myocardial infarction are diabetes and hypertension.
B. Blood pressure readings recorded at the time of examination were used in the analysis.
C. The two most important risk factors identified are smoking and abnormal lipids.
D. Smoking accounts for about 25% of the PAR of acute myocardial infarction worldwide.

Answer 1

Correct answer = C

Smoking accounts for 36% of the PAR of AMI worldwide

Question 2

The INTERSTROKE study assessed the potentially modifiable risk factors associated with acute stroke in 32 countries. This study demonstrated that:
A. Smoking, diabetes, hypertension and apolipoproteins were more significantly associated with ischaemic stroke than intracranial haemorrhage.
B. There is no consistent association between self-reported hypertension or BP of 149/90mmHg or higher and all strokes.
C. Their primary estimate of PAR association with hypertension is not consistent with estimates derived from previous studies.
D. Ten potentially modifiable risk factors were associated with about 90% of the PAR for stroke in all regions.

Answer 2

Correct answer = D
A - cardiac causes, not hypertension (p8)
B - there is consistent association (p9)
C - there is consistent association (p13)

Question 3

In the Chicago Heart Association Detection Project in Industry study, which of the following statements about this study is incorrect?
A. The presence of a single elevated risk factor in middle age is associated with substantially increased lifetime risk for CVD death and shorter survival.
B. CVD risk factors are not associated with increased risk for non-CVD death.
C. The risk factors used in the study are elevated levels of BP, serum cholesterol, BMI, current smoking, use of antihypertensive medications.
D. Men and women with favourable risk factor profiles in middle age had low remaining lifetime risk for CVD death and prolonged survival.

Answer 3

Correct answer = B

Question 4

Which of the following statements about the Framingham Heart Study is correct?
A. The presence of elevated total cholesterol at 50 years of age conferred the highest lifetime risk for CVD of single risk factor.
B. It is a case-control study.
C. Smokers had a higher lifetime risk for CVD compared to non-smokers.
D. The absence of established risk factors at 50 years of age is associated with very low lifetime risk of CVD and markedly longer survival.

Answer 4

Correct answer = D
A - Diabetes not cholesterol
B - Cohort study
C - Lifetime risk for CVD was similar for smokers and non-smokers

Question 5

Which of the following statements about the MRFIT Study (1982) is correct?
A. The risk factors measured were hypertension, cigarette smoking and diabetes.
B. No beneficial effect on CHD was seen despite improvements in risk factors.
C. Smoking cessation was much more successful than had been expected.
D. B & C are correct.

Answer 5

Correct answer = D

A - elevated serum cholesterol, cigarette smoking and hypertension

Question 6

Which of the following statements about MRFIT (2000) is incorrect?
A. It is a long term prospective epidemiologic study.
B. It studied three large cohorts of men aged <50 years.
C. There is a continuous, graded, strong, independent relationship of serum cholesterol level to long term risk of CHD and CVD death.
D. Longer estimate life expectancy is observed for younger adult men with favourable serum cholesterol (<200mg/dL or <5.17mmol/L) vs those with unfavourable levels (≥240mg/dL or ≥6.21mmol/L).

Answer 6

Correct answer = B
Three large cohorts of younger men (≤ 39yo) from the Chicago Heart Association Detection Project in Industry, Chicago Peoples Gas Company and Multiple Risk Factor Intervention Trial studies

Question 7

Which of the following statements about the Nurses’ Health Study is correct?
A. 74% of the coronary events in this cohort might have been prevented if all women had been in the low-risk group.
B. Among the non-smokers, 82% of the coronary disease events might have been prevented by compliance with the remaining components of the low-risk index.
C. Women were considered low risk if they consumed an average of 11g or more alcohol per day.
D. The most important single factor was cigarette smoking, with a relative risk of 5.48 for those smoking 15 or more cigarettes per day, as compared with non-smokers

Answer 7

Correct answer = D
A - 82% (p18)
B - 74% (p19)
C - 5g (p17)

Question 8

In a study examining the relationship between plant-based diet indices and CHD incidence, which of the following statements is incorrect?
A. Higher adherence to a healthful diet was independently inversely associated with CHD.
B. A plant based diet, whether healthy or unhealthy, was negatively associated with CHD.
C. The most healthy option was healthy plant based foods, with no meat intake.
D. Even a slightly lower intake of animal foods combined with higher intake of healthy plant foods is associated with lower CHD risk.

Answer 8

Correct answer = B

Unhealthful plant based diet was positively associated with CHD (p416)

Question 9

Adventist Health Study 2
In a study evaluating the association between vegetarian dietary patterns and mortality, which of the following statements is correct?
A. Vegetarians had 0.70 times the risk of all-cause mortality of non-vegetarians.
B. Vegetarians had significantly reduced risk in both sexes combined for other mortality (ie non-CVD, non-cancer).
C. For men, there was a significant reduction in CVD mortality and IHD mortality.
D. B and C

Answer 9

Correct answer = D
A - 0.88 (p5)
B - correct
C - correct

Question 10

The Lyon Heart Diet Study
In a study investigating the Mediterranean diet for the prevention of recurrence after a first myocardial infarction, which of the following statements is correct?
A. The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction.
B. The outcomes of the study were assessed as four composite outcome groups, all of which included myocardial infarction and cardiovascular death.
C. Several years after randomisation, most experimental patients were unable to follow the Mediterranean diet recommended to them.
D. Blood pressure and smoking were both significantly and independently associated with recurrence.

Answer 10

Correct answer = A
B - 3 composite outcome (CO) groups (p781)
C - Several years after randomisation, most experimental patients were still closely following the Mediterranean diet recommended to them (p783)
D - Blood pressure, but not smoking, was significantly and independently associated with recurrence (p784)

Question 11

In a paper summarising the DASH Diet, which of the following statements is incorrect?
A. An increased level of physical activity can lower BP, independent of concomitant changes in weight
B. Reductions in alcohol intake can lower BP in normotensive ad hypertensive men who are heavy drinkers
C. High levels of sodium intake is associated with high BP
D. High levels of potassium intake is associated with high BP

Answer 11

Correct answer = D

High levels of potassium are associated with low BP

Question 12

PREDIMED
In a study examining the effectiveness of a Mediterranean diet in the primary prevention of cardiovascular disease, which of the following statements is true?
A. The control group of the study ate a Mediterranean diet.
B. The primary endpoint was a major cardiovascular event (MI, stroke, death from CV causes) and death from any cause.
C. The incidence of a major CV event was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those in the control group.
D. The follow up period for the study was 10 years.

Answer 12

Correct answer = C
A - Control diet was advice to reduce fat
B - Total mortality is a secondary end point
D - 5 years

Question 13

PREMIER Clinical Trial
In a study examining the effect of 2 multicomponent behavioural interventions on blood pressure, which of the following statements is incorrect?
A. BP changes in the established plus DASH group are consistently greater than corresponding changes in the established group, and are statistically significant.
B. Fruit and vegetable intake was increased significantly in the established plus DASH group compared with the other 2 groups, with parallel changes in urinary potassium excretion.
C. The established and established plus DASH groups significantly increased the percentage of individuals who achieved an optimal BP (<120mmHg systolic and <80mmHg diastolic).
D. Both of the behavioural interventions accomplished substantial weight loss, reduced sodium intake and increased physical fitness.

Answer 13

Correct answer = A
BP changes in established plus DASH group consistently greater than corresponding changes in established group, but not statistically significant (p2087)

Question 14

Esselstyn - A Way to Reverse CAD? (2014)
In a group of volunteers who were willing to change to a plant-based diet, which of the following statements is incorrect?
A. Avocados and nuts were not prohibited foods.
B. 89% of patients were willing to make a substantial lifestyle transition to plant-based nutrition and sustain it for an average of 3.7 years.
C. The adverse event rate for non-adherent participants was 62%.
D. 82% of those who adhered were found to no longer require interventions previously recommended.

Answer 14

Correct answer = A
Food prohibited - all added oils, fish and processed foods that contain oil, fish, meat, fowl, dairy products, avocado, nuts, and excess salt, sugary foods, caffeine and fructose (p358)

Question 15

CHIP Lifestyle Program
In a study where a lifestyle program was implemented in a workplace setting, which of the following statements is the most correct?
A. Weight loss was statistically significant.
B. Significant reductions in HbA1c and LDL were seen at 8 weeks.
C. 23.4% of the study population were able to eliminate one, or more, of their medications within a 6-month period.
D. B and C are correct

Answer 15

Correct answer = D

A - Weight loss or gain was not statistically significant (p14)

Question 16

The Effects of a Worksite Chronic Disease Prevention Program (CHIP)
In a study assessing the effectiveness of a lifestyle intervention program in a workplace, which of the following statements is incorrect?
A. The intervention group increased their vegetable consumption by 6 weeks, which remained at a similar level at 6 months.
B. The intervention group increased their step count at 6 weeks and further increased it at 6 months.
C. The intervention group improved significantly in their resting HR and LDL at 6 weeks, but not at 6 months
D. The intervention group improved significantly in their BMI, weight, body fat, cholesterol and HDL at 6 weeks and at 6 months

Answer 16

Correct answer = B
Step count: 25% increase at 6 weeks, dropped to 16% increase from baseline at 6 months; unchanged in control group (p561)

Question 17

EPIC Study
In a study investigating the effect on dietary protein on the risk of developing type 2 diabetes, which of the following statements is false?
A. Diabetes risk increased with higher total protein intake.
B. Diabetes risk increased with higher animal protein intake.
C. Diabetes risk increased with vegetable protein intake.
D. Consuming 5 energy % from total or animal protein at the expense of 5 energy % from carbohydrates or fat increased diabetes risk by ~30%.

Answer 17

Correct answer = C (p45 & 46)

Question 18

Adventist Health Study 1 (1985)
Regarding Adventist Health Study 1, which of the following statements is correct?
A. Meat consumption was positively associated with mention of diabetes on the death certificate in males both males and females.
B. Meat consumption was positively associated with self-reported diabetes prevalence in males, but not in females
C. The prevalence of diabetes was lower in vegetarians than non-vegetarians.
D. A and B

Answer 18

Correct answer = C
A - Meat consumption also was positively associated with mention of diabetes on the death certificate in males, but not in females (p510)
B - Meat consumption was positively associated with self-reported diabetes prevalence in both males and females (p510)

Question 19

Low-carbohydrate diet scores and risk of type 2 diabetes in men
In a study comparing the associations of low-carbohydrate diets with incidence of type 2 diabetes, which of the following is incorrect?
A. A high vegetable protein and fat score was not significantly associated with T2D.
B. Low-carbohydrate diets should obtain protein and fat from red and processed meat to minimise T2D risk.
C. Intakes of animal fat, heme iron, and red and processed meat were responsible for the relation between the high animal protein and fat score and T2D.
D. A score representing a low-carbohydrate diet high in animal protein and fat was positively associated with the risk of T2D in men.

Answer 19

Low-carbohydrate diet scores and risk of type 2 diabetes in men
Correct answer = B (p850)

Question 20

The Lifestyle Heart Trial (Ornish Lancet 1990)
In regards to The Lifestyle Heart Trial, which of the following statements is correct?
A. The experimental group reported no change in the frequency, duration or severity of angina.
B. The overall adherence to the lifestyle measures in the intervention group was poor.
C. The average change in coronary atherosclerosis was in the direction of regression in the control group and in the direction of progression in the control group.
D. The severely stenosed lesions showed the least improvement.

Answer 20

Correct answer = C (p132)
A - Patients in the experimental group reported a 91% reduction in the frequency of angina, a 42% reduction in duration of angina, and a 28% reduction in the severity of angina (p132)
B - Adherence to the diet, exercise, and stress management components of the lifestyle programme in the experimental group was excellent (p131)
D - the severely stenosed lesions showed the greatest improvement (p133)

Question 21

A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure (DASH 1997)
In regards to the study of the effects of diet on hypertension, which of the following statements is false?
A. The reduction in blood pressure began within two weeks and was maintained for the next six weeks.
B. The fruit and vegetables diet reduced systolic and diastolic BP more than the control diet.
C. The combination diet reduced systolic and diastolic BP more than the control diet.
D. The fruit and vegetables diet reduced both systolic and diastolic BP as much as the combination diet.

Answer 21

Correct answer = D
When compared with the fruits-and-vegetables diet, the combination diet reduced systolic blood pressure by 2.7 mmHg more (P<0.001) and diastolic blood pressure by 1.9 mmHg more (P<0.002). (p1121)