Public Health - Risk factors

Question 1

What has been the trend in CVD prevalence and incidence in Scotland?

Answer 1

Over the past 10 or so years the incidence and prevalence have been falling
Men have higher incidence and rates of CVD
CVD is much more common in areas of social deprivation

Question 2

Modifiable Risk factors of CVD

Answer 2

Smoking
Dyslipidaemia
Hypertension
Diabetes mellitus
Obesity
Thrombogenic factors
Physical activity
Alcohol consumption
?Deprivation

Question 3

Non-modifiable Risk factors

Answer 3

Personal history of CHD
Family history of CHD
Age
Gender

Question 4

What is the increased risk of CVD associated with having hypertension?

Answer 4

The increased risk of CVD and a cardiovascular incident are incresed 2.5 fold

Question 5

Reducing BP by 10mmHG reduces the rsk of CVD by

Answer 5

20%

Question 6

What is the tool used to estimate the 10 year risk of fatal CVD in populations of high CVD risk (has a risk factor)?

Answer 6

SCORE or ASSIGN (which was made specifically for the scottish population

Question 7

What is taken into account in ASSIGN?

Answer 7

Age
Sex
Smoking
Systolic BP
Total cholesterol
HDL cholesterol
Family history of premature CVD
Diagnosis of diabetes
Diagnosis of rheumatoid arthritis
Deprivation

Question 8

What are the modifications which should be made to risk factors?

Answer 8

Lose weight, if overweight
Limit alcohol intake
Increase physical activity
Reduce salt intake
Stop smoking
Limit intake of foods rich in fats and cholesterol

Question 9

D: Primary Prevention

Answer 9

Reduce incidence in a population

Question 10

D: Secondary Prevention

Answer 10

Detection and treatment of pre-symptomatic disease

Question 11

D: Tertiary prevention

Answer 11

Reducinf incidence/ recurrences of chronic incapacity among those with symptomatic disease

Question 12

Most significant way to reduce smoking and alcohol consumption

Answer 12

increasing the price - the cheaper the price the more consumed

Question 13

What document will give advice on the what the risk of CVD upon risk factors and what you can do to help prevent them?

Answer 13

The SIGN guidelines for risk estimation and the prevention of CVD

Question 14

What is the no. 1 cause of death in women over 50?

Answer 14

Heart disease which is second in men of this age

Question 15

In which gender are the CAD coronary artery disease outcomes worse?

Answer 15

women

Question 16

What are the barriers to treating CV disease in women?

Answer 16

the evidence base of treatment is mainly based on data from men

Question 17

What are the limitations of Heart failure with preserved ejection fraction which women are 2x as likely to get?

Answer 17

A complex condition
Under detected due to lack of specific diagnostic biomarkers, tests
No proven effective treatment
Associated with poor quality of life and depression
Survival rate remains poor

Question 18

What CV conditions are more common in women?

Answer 18

Hypertension more common in older women. Secondary LVH is more common with less regression with antihypertensive treatment
Stroke: more stroke events in women due to longer lifespan, worse outcomes compared to men
Atrial fibrillation: women have higher risk of stroke
Aortic Aneursyms : uncommon in women , but complications and outcomes are worse.
MI and re-infarction rates are higher in women

Question 19

What are the structural features of CAD in women differentiating them from men?

Answer 19

Smaller size of vessels
Increased stiffness (fibrosis, remodeling)
More diffuse disease
In younger women
more plaque erosion and micro-embolisation, coronary dissection versus rupture and thrombus
Less obstructive disease

Question 20

What are the functional features of CAD in women differentiating them from men?

Answer 20

Endothelial Dysfunction
Smooth Muscle dysfunction
Inflammation (vasculitis: Takayasu’s, Rheumatoid, SLE, etc)

Question 21

Outline Pathology of ischemic heart disease in women

Answer 21

After menopause or as a consequence of visceral obesity estradiol os released
Estradiol invreases the likelihood of hypertension, obesity and hyperlipidemia
This them causes inflammatory milieu and as a result there is
abnormal coronary reactivity - metabolic changes and decreased perfusion and
Positive coronary remodeling increasing the wall thickness and plaque erosion as well as distal embolization

Question 22

Symptoms of Heart Attack in women

Answer 22

• ‘classic’ symptoms except less common in women
• Milder symptoms (without chest pain) especially in younger women.
• Shortness of breath
• sudden onset of weakness , fatigue
• body aches,
• overall feeling of illness (without chest pain)
• Unusual feeling or mild discomfort in the back, chest, arm, neck, or jaw (without chest pain)
• Heartburn
• nausea
• vomiting
• abdominal pain
  Symptoms may occur up to a month before MI:
• fatigue
• sleep disturbance
• SOB
• anxiety
• indigestion
• palpitations

Question 23

What are the emerging risk factors or CVD in women?

Answer 23

Preterm delivery 
Hypertensive disorders of pregnancy 
Gestational diabetes 
autoimmune disease
early menopause
depression

Question 24

Why are women’s angiography studies often misinterpreted as normal?

Answer 24

because their plaque tends to be diffusely distributed

Question 25

Female specific CVD Risk factors

Answer 25

• diabetes has a larger impact on female CVD than male
• Hypertension in pregnancy and pre-eclampsia increase risk of HBP and CVD in later life
• Gestational diabetes
• Autoinmmune conditions - chronic inflammation causing endothelial injury
• Depression and other forms of mental stress
• Low socioeconomic status
• women also have a lack of education about symptoms and CVD specific to them