Studies Flashcards
Standardised case control
52 countries
AMI Risk Factors
Patients who were admitted a cardiac care unit for their first MI
5 accounted for 80% of risk:
- Smoking
- Lipids
- HTN
- Diabetes
- Obesity
9 accounted for 90% of risk in men and 94% in women, above +
- Dietary pattern
- Physical inactivity
- Alcohol
- Psychosocial
Psychosocial factors comparable to HTN and abdominal obesity
Interheart
Prospective case control
32 countries
Stroke Risk Factors
10 risk factors account for 90% of risk
- HTN
- Smoking (current)
- Obesity (abdo)
- Dietary pattern
- Physical inactivity
- Diabetes
- Alcohol
- Stress(psychological)
- Depression
- Cardiac causes
- Lipids
Interstroke
CAD Risk Factors Risk reductions for heart disease:
50% reduction cholesterol
- 50%
Smoking cessation
- 50% (AMI)
Ideal body weight and waist
- 35-55%
150 min+ moderate exercise
- 35-55%
5+ servings of fruit/veg daily
- 20-25%
6mmHg reduction DBP
- 16% (and 42% for stroke)
Risk of CAD is determined by the number of risk factors
If lower risk at middle-age, then better quality of life and older-age (and lower costs)
Chicago Heart Association
Cohort?
Follow over long period
Identify common factors that contribute to CVD
BP > normal (pre hypertension) increases risk of CVD
- SBP 120-139
- DBP 80-89
Elevated SBP is a predictor for CVA amd HF (DBP not more strongly ass’d)
Genetic variant associated with obesity
Framingham Heart Study
Benefits of low risk factors
People wth low risk factor status had:
73-85% lower risk for CVD mortality
40-60% lower total mortality rate
6-10 yrs greater life expectancy
MRFIT
Multiple Risk Factor Intervention Trial
Prospective cohort study
Women
Over 14 years Long term consequences of various factors of heart disease and cancer
5 factors that lower CHD:
1. No smoking
2. BMI < 25
3. Exercise (mod/vig) 30+ mins/day
4. Alcohol (5-30g/day)
5. Healthy diet score
- diet score based on intake of fiber, omega-3, folate
- upper 40% healthy score
CVD
- Mod etoh reduces risk of CHD
- Mediterranean diet reduces risk of CHD/CVA
- Fish reduces risk of CVA
- Nuts and wholegrains red risk of CHD
Breast Cancer
- 1+ etoh/day inc risk
- Red meat inc rik of pre-menopausal BC
Colon Cancer
- 2+ etoh/day increases risk
- Red and processed meat inc risk
- Folate, B6, calcium, Vit D red risk
Nurses Health Study
Propective Cohort Study
Complements Nurses Health Study
Male health professionals
Diet and lifestyle factors related to serious illness
SSB (sugar sw bevs)
- ass’d with long term weight gain, T2DM, CHD, HTN, CVD
- Drinking 2+ SSB per day has 21% higher mortality and 31% higher risk of death from CVD
Red Meat
- 11-15% higher risk of CHD if higher intake
Olive oil
- 1.5 tsp + per day had 14% lower risk of CVD and 18% lower CHD
Vit D Binding Protein
- Higher levels had sig lower morbidity and mortality for colon cancer
Health Professionals Follow Up Study
Long term health study
1974-88
Which components of the Adventist lifestyle give protection from disease (Cancer, CHD, T2D)
7th Day Adventist Church ppl have veg diet and abstain from smoking and alcohol
Cancer
- Vegetarians had lower risk
- High fiber (fruit) had 40% reduced risk of colon cancer
- Fruit twice daily had 75% less risk
- Legumes 2+ time per week have 42% lower risk of colon cancer
- Legumes >3 per week had 47% lowerrisk of prostate cancer
- Legumes reduce pancreatic ca
- Meat several times / wk causes 60% higher risk
- Freq consumption of beef caused 2x risk of bladder ca
- Meat had higher risk of post-menopausal ovarian cancer
CHD
- Beef increased risk in men (not women)
- Wholewheat bread reduces risk
- Nuts reduce risk
Adventist Study 1
Continued follow up of diet and lifestyle on chronic disease
Nuts lowered risk of CHD
Vegans / vegetarians had lower
- Weight
- Chol, T2DM, HTN
Adventist Study 2
RCT
Largest and longest study comparing the Mediterranean diet with a Low-Fat diet
Compares 3 dietary patterns:
- Medi + EVOO
- Medi + nuts
- Control diet of reduced fat
Incidence of major CV events (MI, CVA) was lower in Medi + EVOO / Nuts
PREDIMED
Prevention with Medi Diet
Three-arm trial
Syetmatic review and meta-analysis of 30 RCTs
Effect of dietary patterns on BP in ppl with
DBP of 80-95
2 dietary patterns:
- Fruit & Veg
- Fruit, Veg, LF dairy, low saturated fat
DASH diet reduced:
1. Mean SBP by -3.2 mmHg
2. Mean DBP by -2.5 mmHg
Not affected by HTN status
DASH compared with control reduced:
- SBP to a higher extent where sodium intake > 2400mg
- SBP/DBP more when mean age < 50 y/o
DASH (Diet)
Dietary approaches to stop HTN
RCT
Large scale
Test whether a Mediterranean diet is associated with reduced risk of recurrent MI
Protective effect of Medi diet was maintained up to 4 years after first MI (independent of high BP/Chol)
Study stopped early bc of sig beneficial effects in original cohort
Lyon Diet Heart Study
