Non infectious diseases (CVS)

Question 1

Difference between clinical medicine and epidemiology?

Answer 1

CM - concerned for individual

Epidemiology - concerned for population

Question 2

What is one of the highest killers in the world?

Answer 2

road traffic injuries

more than TB

Question 3

Are CVS diseases increasing?

Answer 3

• heart disease and cancer are increasing due to smoking and diet
• number of patients with CVD increasing, mortality increasing
• deaths from CVD predicted to be stable form 2004-2030 in high income countries but will increase in middle and low income countries
  same trend for CANCER

Question 4

What is reason for reduced ID prevalence?

Answer 4

quality of life
sanitary conditions
hygiene

Question 5

What can influence CHD?

Answer 5

characteristic of person

• number of deaths increase by age
• deaths decrease after 80 because most people die by/after this age so deaths from this age appears smaller

Better to observe death rate rather than number

Question 6

How is CHD mortality influenced by gender?

Answer 6

rate lower in women until menopause differences diminish

Question 7

What are the CHD mortality differences by ethnicity?

Answer 7

• rates of mortality nearly same for Caucasians vs afro-Caribbean
• over time difference in heart disease mortality, afro-Caribbeans much higher rates and white males rate close to rate of mortality in black females

Question 8

What is the distribution of CVD deaths?

Answer 8

• USA 1/3, Africa 10% and Europe 60% of all deaths
• maybe be due to environment/genetics
• suitable trial would be to study migrants with same ancestry/ethnic background living in different countries (study for Japanese men aged 45-69 shows difference in prevalence highlighting mainly due to environmental factors0

Question 9

What are established risk factors for CHD?

Answer 9

• blood cholesterol (10% decrease can decrease CHD by 20-30%)
• high BP
• smoking
• body weight (BMI>27 can increase risk by over 30%)
• reduced physical activity

Question 10

Why is serum cholesterol a goo predictive marker for CHD risk?

Answer 10

well-measured
longitudinal studies show prognostic validity

poor ability to discriminate between cases/non cases of heart diseases as not only cholesterol levels cause CHD - it is multifactorial

Question 11

How does BP increase CHD risk?

Answer 11

• hypertensive risk increases with age
• lifestyle factors (diet) explain differences between populations in the rise in BP with age and consequent prevalence of high BP in elderly
• SBP lower in europeans than afro-Caribbeans
• risk increase gradientially so for every unit increase in BP/cholesterol level risk of CHD also increases
• cut offs used to diagnose dyslipidaemia/hypertension allows focus on high risk people, but also reduced preventative measures - general approach in reducing BP nationwide needed

Question 12

Trend in smoking risk factor for CHD?

Answer 12

• decreasing rates in the UK but slow

- rates of smoking increasing in developing countries

Question 13

Trend in obesity risk factor for CHD?

Answer 13

• increasing obesity

- more in the USA where rates increase from 10-30%

Question 14

Trend in physical inactivity risk factor for CHD?

Answer 14

• worldwide
• rates in Africa slightly lower than in Europe
• explained by increased modernisation through transport, making people lazier
• sedentary lifestyle/social culture contributes to inactivity also