Midterm Flashcards
What is the population of the United States?
Around 335 Million
What percent of the US is white? Hispanic? African American? Asian?
68% White, 15% Hispanics, 13% African American, and 4% asian
What was the mortality/ number of deaths in 2023
3,383,729
What was the death rate in the United States in 2023
1,027 deaths per 100,000 population
What are the top three causes of death in the United States?
Heart Disease, Cancer, and Covid-19
What is the life expectancy in 2023?
77.0
In 1900, the life expectancy was 47.3. How many years has life expectancy increased since then?
by 22.3 years
What are the 5 parts of dynamic health?
Physical, emotional, social, spiritual, and intellectual health
What is the definition of epidemiology?
the study of the determinants and distribution of disease or injury in large populations
What is behavioral epidemiology?
Study of individuals behaviors and habits in relation to health outcomes
Select all that apply: Which of these are the purposes of epidemiology?
A. To search for causes of health and disease
B. To estimate individual risk from group experiences
C. To study the history of health in a population, subsets within a population and the effects of health services
D. To diagnose the health of a population and track a disease
E. All of the above
E. All of the above. The purposes of epidemiology include: searching for causes of health and disease, estimating individual risk from group experiences, studying the history of health in a population, subsets within a population and the effects of health services, and to diagnose the health of a population and track a disease
What does mortality refer to?
Death
What does morbidity refer to?
Disease
The incidence rate is the number of:
new cases of a disease in a population over a period of time
The prevalence rate is the number of:
cases in a population who have a disease at any given time
What are the 6 criteria that a risk factor must meet to be clinically useful?
strength of association, consistency, temporal relationship, gradient, biological plausibility, experimental and clinical evidence
list some unmodifiable risk factors
age, race, gender, family history
Does a positive risk factor increase or decrease your risk for disease?
Increases
When risk factors work together to multiply the risk for disease, what is this called?
Synergism
CVD is an umbrella term covering diseases of what?
The heart (cardiovascular) and blood vessels (vascular)
For both men and women, age is a risk factor for cardiovascular disease. At what age does this occur?
For men- equal to or more than > 45 years
For women- equal to or > more than 55
When is cigarette smoking a risk factor for CVD?
When the patient is currently smoking or has quit in the previous 6 months
What is the criteria for CVD in the sense of physical activity
500-1,000 MET-min of moderate-to-
vigorous physical activity or 75-150
min per week of moderate-to-
vigorous intensity physical activity
What are the BMI and Waist Circumference standards for increased risk of CVD?
BMI more than or equal to 30 OR a waist girth of more than 102 cm for men, and more than 88 for women
What was the purpose and findings of the Alameda County Study?
The purpose was to determine the predictors of “survivability” and the findings were called the “Alameda 7” which included not smoking, moderate alcohol intake, normal weight, moderate physical activity, 7.9 hours of sleep, social connectedness, and eating breakfast.
What was the purpose of the Framingham Heart Study? (FHS)
prospective study to determine the causes of CHD and stroke
A true experiment includes what 4 things?
A treatment, random assignment of subjects, a treatment group and a control group
What is a good number for HDL?
HDL value more than or equal to 60
What is the defining criteria for Fasting Blood Glucose levels in relation to it being a CVD risk factor?
Fasting plasma glucose equal to or >100 mg/dL
What is the defining criteria for Blood Pressure in relation to it being a CVD risk factor?
Systolic blood pressure equal to or > 130 mm Hg and/or
diastolic equal to or >80 mm Hg,
What is the defining criteria for LDL values in relation to it being a CVD risk factor?
equal to or >130 mg/dL
What is the underlying disease that leads to strokes?
cerebrovascular disease
How many CVA’s occur each year? How many of those are recurrent?
800,000, 200,000 are recurrent
What is the mortality of CVA’s?
150,000
What percentage of strokes are considered to be Ischemic?
87%, due to blood clots
What percentage of strokes are hemorrhagic?
13% of all strokes
What is the “classic” symptom of a stroke that lasts no longer than 24 hours?
Transient Ischemic Attack (TIA) also referred to as a “mini-stroke”
What are the warning signs of a stroke?
Sudden numbness or weakness of face, arm, leg, especially on one side of the body, confusion, trouble speaking or understanding, trouble seeing in one or both eyes, dizziness, sudden severe headache
What race group has a higher risk of stroke?
African Americans
What are the 4 initial treatments for an ischemic stroke?
Tissue plasminogen activator (tPA), anticoagulant therapy, blood thinners, MERCI Retrieval system
What are the two initial treatments for hemorrhagic stroke?
aneurysm clipping and coil embolization
What are the long term treatments for stroke?
Medication, blood pressure control, stop smoking, Dietary changes such as the DASH diet, regular exercise, and weight loss
What is PAD or PVD?
Peripheral arterial disease or peripheral vascular disease which means atherosclerosis of the extremities
True or False: people with PAD have a 4-5 times higher risk of a heart attack or stroke.
True: people with PAD have a 4-5 times higher risk of a heart attack or stroke.
What is the classic symptom of PAD?
Intermittent claudication
What is intermittent claudication?
It is painful cramping in the hips, thighs or calves when
engaging in any form of PA or Ex (caused by Ischemia).
Where is PVD normally found?
The femoral and/or iliac arteries
True or False: The risk factors for CVD are the same for PVD
True: The risk factors for CVD are the same for PVD
What is the ankle-brachial index?
It is a test to check for PAD, where blood pressure measured at the ankle is compared to blood pressure measured at the arm.
A low ankle-brachial index number can indicate what?
A low ankle-brachial index number can indicate narrowing or blockage of the arteries in the legs
What are the two types of collateral circulation, and what is collateral circulation stimulated by?
Angiogenesis and arteriogenesis. collateral circulation is stimulated by physical activity
Angiogenesis is:
Angiogenesis is: a physiological process
involving the growth or formation of new blood vessels from pre-existing vessels.
Arteriogenesis refers to an increase in what?
Arteriogenesis refers to an increase in the diameter of
existing arterial vessels (or a structural enlargement the arteries)
What is a false positive?
no abnormality or disease, but abnormal results.
What is a false negative?
Abnormal/disease, but normal results
What is a true positive?
Abnormality and abnormal results
What is a true negative?
No abnormality and normal results
What refers to how often a test uncovers an abnormality or disease in a population of individuals who have the abnormality or disease?
Sensitivity
What is specificity?
The percentage of tests that are negative or normal in a population without abnormality or disease
How many people die from CVD?
Around 928,700
True or False: CVD is the leading cause of permanent disability
True
Has CVD mortality declined since the 1960s? Why or why not?
Yes, because of changes in lifestyle, pharmacology, knowledge of warning signs and better medical care.
What does CHD/CAD lead to?
Myocardial infarction AKA a heart attack
How many Myocardial infarctions are there every year?
around 800,000–> 600,000 are first time, and 200,000 are recurrent
How many die within one hour of the onset of symptoms of a heart attack?
225,000
How many myocardial infarctions take place at home?
75%
Cerebrovascular Disease often results in what?
A stroke or cerebrovascular accident (CVA)
How many CVA’s are there each year?
800,000
What is the mortality rate of CVA?
160,264
What is ischemia?
Inadequate blood flow where the supply is less than the oxygen demand
What is occlusion?
The state of being closed. could be total or partial
What is stenosis?
A narrowing of a vessel
What is perfusion and reperfusion?
Perfusion is the blood flow to the tissues. Reperfusion is the restoration of blood flow
What is arrhythmia?
Irregular rhythm of the heart/disorders of heart rhythm
What is bradycardia?
When the heart beat is slow <60 bpm
What is tachycardia?
A fast heart beat >100 bpm
What is the underlying disease causing the vast majority of heart attacks?
Coronary Heart Disease (CHD) also known as Coronary artery disease (CAD)
Infarction is an area of
necrosis (tissue death)
Break down the word Coronary thrombosis
Coronary= blood vessels of the heart
thrombus= blood clot
Embolus = “wandering” clot
What is the main underlying cause for coronary occlusion
Atherosclerosis (AS)
What is atherosclerosis (AS)
AS is the build up or accumulation of plaque within the arterial wall
What is a classic symptom of CHD?
Angina pectoris
What is angina pectoris?
Caused by ischemia, reduced blood flow to the heart
What are the signs of a heart attack?
Chest discomfort, upper body discomfort in one or both arms, back, neck jaw, upper part of stomach, Shortness of breath, nausea, vomiting, light headedness or dizziness, cold sweat, sleep problems, fatigue, or lack of energy
What is thrombolysis?
The term given to breaking up a thrombus.
What is PCI?
Percutaneous coronary intervention- used to unclog arteries
Definition for Arteriosclerosis
General term used to describe thickening and hardening of arteries
Definition of Atherothrombosis?
emphasizes that the processes of atherosclerosis and thrombosis are interrelated.
Heart valves maintain a unidirectional or multidirectional blood flow?
unidirectional
The channel for flow of blood within an artery is called the
Lumen
Which system carries blood away from the heart? What 4 things is it made up of?
Arterial system, aorta, arteries, arterioles, capillaries
What does the endothelium protect against? What are the two things that it produces?
The endothelium protects against the development of atherothrombosis and produces nitric oxide (vasodilator), and plasminogen (inhibits thrombosis formation)
True or False: There is no evidence to suggest that the incidence of atherosclerosis bears any relation to the concentration of cholesterol in the blood.
False. There is evidence to suggest that atherosclerosis does bear relation to the concentration of cholesterol in the blood
What is Dyslipidemia?
an abnormal amount of lipids (ex. cholesterol) in the blood. Further defined by the presence of elevated levels of LDL and triglycerides, or low levels of HDL.
Cholesterol is essential for:
Cholesterol is essential for the manufacture of hormones, bile acids, and cell membranes
Can cholesterol be produced without adding it to the diet?
Yes, cholesterol can be produced without adding it to the diet.
What are the two ways cholesterol can be produced?
Endogenous- produced by the body, and exogenous- from the diet.
What is the mean production of cholesterol in the body?
The mean production of cholesterol in the body through the endogenous process is 1,000 mg a day
What is the mean intake from the diet for cholesterol?
In the exogenous form of intake from cholesterol, the mean intake is 290 mg per day
True or False: High cholesterol is a critical risk factor for CHD.
True: High cholesterol is a critical risk factor for CHD.
A 1 mg decrease in HDL increases the risk for CVD for men and women by what?
A 1 mg decrease in HDL increases the risk of CHD by 2% in men, and 3% in women
What 2 types of of lipoproteins are atherogenic?
LDL (low density lipoprotein) and VLDL (very low density lipoprotein).
What is the type of lipoprotein at is considered to be anti-atherogenic?
HDL- High density lipoprotein. This carries excess cholesterol away from the arterial wall
What is the equation used to find total cholesterol?
TC= VLDL+ LDL + HDL
What equation do you use to find the amount of non-HDL cholesterol?
VLDL+ LDL
What is the prevalence percentage for dyslipidemia?
30%
Give the total cholesterol numbers that fit within each category for total cholesterol
Desirable, Borderline High, and high
Desirable = <200 mg/dL = desirable
Borderline high= 200-239 mg/dL
High= > or equal to 240 mg/dL
Give the categories for rating LDL and the numbers associated with them
Optimal= <100 mg/dL
Near optimal/above optimal= 100-129 mg/dL
Borderline high= 130-159 mg/dL
High= 160-189 mg/dL
Very high = > or equal to 190 mg/dL
Give the categories and numbers for each for HDL
High HDL= > or equal to 60 mg/dL
Low LDL= Less than 40
Give the categories for Triglycerides and the numbers for each
Normal= <150 mg/dL
Borderline High= 150-199 mg/dL
High= 200-499 mg/dL
Very high= > or equal to 500
Give the ratio for total cholesterol
Less than or equal to 3:1 = optimal
More than or equal to 5:1 = high risk
What are three ways to increase HDL
Aerobic exercise, stop smoking and moderate alcohol consumption
What are ways to decrease LDL?
Reduction in dietary saturated fats, and reduction in weight, increase in dietary polyunsaturated, mono-saturated fatty acids and soluble fiber.
How does Saturated fat and cholesterol affect LDL and HDL levels?
Saturated Fat= increase in LDL, no effect in HDL
Cholesterol= Increase in LDL, no affect in HDL
How does trans fatty acid affect LDL and HDL?
Increases LDL and decreases HDL
How does polyunsaturated and monosaturated fat affect HDL and LDL?
Polyunsaturated fat decreases both LDL and HDL
Monounsaturated fat decreases LDL and doesn’t have an effect on HDL
How does soy protein and soluble fiber have an affect on HDL and LDL?
Soy protein decreases LDL and keeps HDL the same
Soluble Fiber decreases LDL and keeps HDL the same
True or False: Alcohol Lowers LDL and increases HDL
False: Alcohol keeps LDL the same, and increases HDL
What is the percentage of Americans currently taking at least one prescription medicine?
55%
Lipoproteins transport/carry cholesterol throughout the body. Because of this, lipoproteins may be called:
carrier mechanisms
What organ regulates the body’s production of cholesterol?
Liver
What is the definition of blood pressure?
the force the blood exerts on the walls of the arteries as it is pumped throughout the body
What are the units of measurements for BP?
Millimeters of mercury (mm HG)
What is blood pressure regulated by?
Kidneys
What is a high BP called?
hypertension (HTN)
What is hypertension?
High blood pressure
What is a normal BP called?
normotension
HTN is a major risk factor for?
CVD (CAD, CVA, PAD, atrial fibrillation, aortic aneurysm), kidney failure/end-stage renal disease, retinal disease/retinopathy, and impotence
What is a normal systolic/diastolic blood pressure value?
120mm HG /80 mm
True or False: Essential or Primary hypertension has no specific cause or underlying medical condition
True
How many cases of HTN are essential/primary that has no specific cause or underlying medical condition?
95% of all cases
True or false: Does Secondary HTN have a specific cause?
Yes. For example- chronic kidney disease, sleep apnea, medication side effects etc.
What is the prevalence rate of HTN in adults?
50% of all adults
What is the prevalence of elevated HTN in adults?
25% of all adults
What is the prevalence of normal HTN in adults?
25% of all adults
What percentage of people are aware of their HTN condition?
83%
What percentage of US adults with HTN are using antihypertensive medication?
the percentage of US adults with HTN are using antihypertensive medication is 79%
What percentage of the adult US population has their HTN condition controlled?
the percentage of the adult US population has their HTN condition controlled is 26%
What are the risk factors of HTN?
Age, family history, race, DM, obesity, excessive alcohol, sedentary lifestyle, smoking, stress, oral contraceptive use, dietary factors
What are the dietary factors that increase HTN?
High sodium, low potassium, calcium and magnesium
What is the average amount of salt consumed per day?
3,393 mg per day, with a range of 2,000 to 5,000
What are treatment options for hypertension/high blood pressure?
Increase physical activity, decrease weight, relaxation/stress management, stop smoking, moderation of alcohol, dietary factors
How many drinks should men and women drink
Males should consume 2 or less drinks per day, and females should consume 1 or less drink per day
What is the DASH diet?
Dietary approaches to stop hypertension
What does the dash diet include?
Rich in fruits, vegetables and low fat dairy products, low in total fat and cholesterol, high in fiber, K, Ca, and Mg
What are the four types of blood pressure lowering medications?
Diuretics, B-blockers, calcium channel blockers and ace inhibitors
What is the recommended amount of potassium per day?
More than 4,000 grams
What is considered to be a elevated blood pressure?
120-129 AND less than 80
What is considered to be a stage one hypertensive blood pressure?
130-139 OR 80-89
What is considered to be stage 2 hypertensive blood pressure?
More than or equal to 140 OR more than or equal to 90
Environmental Tobacco Smoke (ETS) is also referred to as:
secondhand smoke
Smoking related excess risk of CHD is down by what percent within one year of quitting?
Smoking related excess risk of CHD is down by 50% within one year of quitting
What is the smoking prevalence?
13%
What is metabolic syndrome (metsyn)?
It is when you have three or more of the following abnormalities- high waist circumference, high serum triglyceride levels, low HDL, high blood pressure, or high fasting blood glucose
People with metabolic syndrome are at an increased risk for what?
People with metabolic syndrome are at an increased risk for developing diabetes and cardiovascular disease as well as increased mortality from CVD and all causes
What is the prevalence in adults for metabolic syndrome?
35%
