Public Health - Risk factors Flashcards
What has been the trend in CVD prevalence and incidence in Scotland?
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
Modifiable Risk factors of CVD
Smoking Dyslipidaemia Hypertension Diabetes mellitus Obesity Thrombogenic factors Physical activity Alcohol consumption ?Deprivation
Non-modifiable Risk factors
Personal history of CHD
Family history of CHD
Age
Gender
What is the increased risk of CVD associated with having hypertension?
The increased risk of CVD and a cardiovascular incident are incresed 2.5 fold
Reducing BP by 10mmHG reduces the rsk of CVD by
20%
What is the tool used to estimate the 10 year risk of fatal CVD in populations of high CVD risk (has a risk factor)?
SCORE or ASSIGN (which was made specifically for the scottish population
What is taken into account in ASSIGN?
Age Sex Smoking Systolic BP Total cholesterol HDL cholesterol Family history of premature CVD Diagnosis of diabetes Diagnosis of rheumatoid arthritis Deprivation
What are the modifications which should be made to risk factors?
Lose weight, if overweight Limit alcohol intake Increase physical activity Reduce salt intake Stop smoking Limit intake of foods rich in fats and cholesterol
D: Primary Prevention
Reduce incidence in a population
D: Secondary Prevention
Detection and treatment of pre-symptomatic disease
D: Tertiary prevention
Reducinf incidence/ recurrences of chronic incapacity among those with symptomatic disease
Most significant way to reduce smoking and alcohol consumption
increasing the price - the cheaper the price the more consumed
What document will give advice on the what the risk of CVD upon risk factors and what you can do to help prevent them?
The SIGN guidelines for risk estimation and the prevention of CVD
What is the no. 1 cause of death in women over 50?
Heart disease which is second in men of this age
In which gender are the CAD coronary artery disease outcomes worse?
women
What are the barriers to treating CV disease in women?
the evidence base of treatment is mainly based on data from men
What are the limitations of Heart failure with preserved ejection fraction which women are 2x as likely to get?
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
What CV conditions are more common in women?
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
What are the structural features of CAD in women differentiating them from men?
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
What are the functional features of CAD in women differentiating them from men?
Endothelial Dysfunction
Smooth Muscle dysfunction
Inflammation (vasculitis: Takayasu’s, Rheumatoid, SLE, etc)
Outline Pathology of ischemic heart disease in women
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
Symptoms of Heart Attack in women
- ‘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
What are the emerging risk factors or CVD in women?
Preterm delivery Hypertensive disorders of pregnancy Gestational diabetes autoimmune disease early menopause depression
Why are women’s angiography studies often misinterpreted as normal?
because their plaque tends to be diffusely distributed
Female specific CVD Risk factors
- 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
