Section 2: Risk factors for Coronary Heart Disease

Question 1

What is meant by Primary and Secondary prevention or Coronary Heart Disease?

Answer 1

Primary - Aims to reduce incidence of coronary heart disease by identifying high-risk groups and effective ways of lowering risk
Secondary - Aims to halt or retard progression of the disease in those already with CHD.

Question 2

What is a independent risk factor?

Answer 2

Risk factor for CHD that occurs without the presence of other risk factors.

Question 3

What are the 5 independent risk factors for CHD?

Answer 3

Smoking
Hyperlipidemia 
Obesity 
Hypertension
Inactivity

Question 4

What are the 4 Non-modifiable risk factors of CHD?

Answer 4

1) Age (Increase with age)
2) Gender (Men until post-menopause)
3) Family history (First-degree relative)
4) Ethnic origin (Bangladeshi/Pakistani)

Question 5

What are the 9 Modifiable risk factors of CHD?

Answer 5

1) Smoking
2) Hyperlipidemia
3) Hypertension
4) Inactivity
5) Obesity
6) T2DM
7) Fibrinogen levels
8) Alcohol
9) Psychological factors

Question 6

What are the 3 acute/immediate effects of smoking that damage the coronary vessels?

Answer 6

1) Increased heart rate and blood pressure
2) Vasospasm of coronary arteries
3) Reduction in the oxygen-carrying capacity of the blood

Question 7

What are the 4 chronic/long term effects of smoking that can lead to CHD? What is the overall effect of this?

Answer 7

1) Reduced HDL
2) Damage lining of coronary arteries
3) Increase platelet stickiness and therefore thrombus formation
4) Loss of oestrogen with menopause occurring 2-3 years earlier
Smokers have 2-3x increased risk of developing CHD than non-smokers

Question 8

How much does cessation of smoking reduce the risk of premature death or further MI?

Answer 8

50%

Question 9

How does increased blood pressure increase the risk of CHD?

Answer 9

• High blood pressure means the heart has to work harder to eject blood into the systemic circulation
• The heart will become enlarged/thickened over time
• Heart rate requires more oxygen due to increased effort/size
• O2 demand may not be met particularly in those already with CHD leading to angina

Question 10

What are the 7 ways to reduce blood pressur?

Answer 10

1) Antihypertensive medication
2) Regular exercise
3) Stop smoking
4) Reduce weight to appropiate level
5) Reduce salt intake
6) Avoid excess alcohol intake
7) Practice stress management

Question 11

Who is most susceptible to hypercholesterolaemia?

Answer 11

People with genetic condition called hypercholesterolaemia - cholesterol production does not reduce in response to intake

Question 12

What are the british guidelines for cholesterol concentration?

Answer 12

Total cholesterol >4.0mmol/l
HDL <1.0mmol/l
LDL >2.0mmol/l
Triglyceride >1.7mmol/l
Total cholesterol:HDL, 3:1 more desirable

Question 13

What is the cholesterol threshold limit for treating people with a statin in the UK?

Answer 13

Total cholesterol >4.0 mmol/l

LDL >2.0 mmol/l

Question 14

What are the 7 secondary prevention methods for lowering lipid?

Answer 14

1) Reduce intake of fat intake and saturated fat
2) Increase intake of fire
3) Increase intake of oily fish
4) Participate in more exercise
5) Control weight
6) Stop smoking
7) Moderate alcohol intake

Question 15

What are the 4 methods by which physical activity contributes towards reduced CHD risk?

Answer 15

1) Decreased total cholesterol and LDL with increased HDL
2) Reduced total body fat and intraabdominal fat
3) Improved insulin sensitivity
4) Reduced systolic and diastolic blood pressure

Question 16

What are the methods by which exercise reduces triggers for cardiac events?

Answer 16

1) Preventing thrombus formation
2) Improving endothelial function
3) Reducing the potential for serious arrhythmias

Question 17

What is the impact of exercise-only rehabilitation?

Answer 17

19% reduction in a combined end point of mortality, non-fatal heart attack and revascularisation, compared with usual care

Question 18

What are the cut off points for waist circumference, the waist-to-hip ratio in relation to CHD

Answer 18

Men WHR: >0.95 high risk
Women WHR: >0.85 high risk
Men WC: >94cm risk, 102cm severe risk
Women WC: 88cm risk

Question 19

What is the significance of T2DM in relation to coronary heart disease?

Answer 19

• 2 to 4 times higher risk of developing CHD

- Half of the patients with T2DM will die of CHD

Question 20

What is the significance of alcohol in relation to CHD? What are the recommendations?

Answer 20

• Protective effect with consumption of 1-2 units for women and 2-3 for men per day (favorable effect on clotting and HDL levels)
• Above this increases risk of CHD mortality, secondary to arrhythmias, hypertension and cardiomyopathy
• 2-3 alcohol free days a week and do not exceed weekly consumption of 14 units for men and women