Unit 2: Screening & Detection Flashcards
Define coronary heart disease, cerebrovascular disease, peripheral vascular disease.
- Coronary Heart Disease- disease of the blood vessels supplying the heart muscle
- Cerebrovascular Disease: disease of the blood vessels supplying the brain
- peripheral Vascular Disease: disease of the blood vessels supplying the arms and the legs
What is the underlying pathology of cardiovascular disease (CVD)?
Atherosclerosis, thrombus (clotting)
Name the non-modifable risk factors of atherosclerotic CV disease?
Non-modifiable
- Age i.e. >70
- Family history of CV disease (premature heart/CVD i.e. a fatal or non-fatal event (not an established diagnosis) in a 1st degree relative - parent or sibling which occur <65 yo (female) and <55 (male)- would indicate premature disease)
- Gender (male) - oestrogen withdrawal during menopause
- Inflammation
- Heredity (and ethnicity) - south asian, black Caribbean are some ethnicities that have a higher risk of CVD
Explain why one should quit smoking?
Smoking increases the risk of developing blood clots
- 1 in every 2 smokers die of a tobacco related disease
- Tobacco smoke contains over 4,000 chemicals, including tar, which cause cancer
- Smoking can take 10-15 years off your life
- Smokers are 60% more likely to die from heart disease than non smokers
- Within 1 day of quitting - risk of heart attack begins to fall
- Within 2 days - better sense of taste and smell
- Within 3 days - feel less breathless
After 15 years smoke-free your risk of sudden death from a heart attack is almost cut in half
How would you assess or measure smoking status?
How do you calculate pack years?
Self-reported
Breath carbon monoxide
Cotinine (analysis taken from urine or blood)
(no. of years smoked) x (no. of years) / 20 (as 20 cigarettes per pack) = pack-years
Can air pollution cause a heart attack and if so what types of air pollution?
Primary pollutants: nitric oxide (NO), carbon monoxide (CO), ammonia (NH3)
They increase plaque burden, damage endothelial walls causing inflammation
Name the modifiable medical risk factors of atherosclerotic CV disease?
- Hypertension
- Hyperglycaemia (Diabetes)
- Atherogenic dyslipdaemia (high blood cholesterol)
Name the modifiable lifestyle risk factors of atherosclerotic CV disease?
- Diet and nutrition (lifestyle)
- Physical inactivity
- Stress
- Smoking
- Alcohol
- Obesity/overweight
What is the blood pressure target for healthy people. What figure should it be under in average-aged adults?
In someone <69?
In someone >70?
120/80 mmHg
Everyone should be less than 140/90 mmHg - the lower the better once there are no symptoms of low blood pressure
120 - 130/80 mmHg
130-140/80 mmHg
What is the quantifiable method for diagnosing diabetes?
What is the fasting plasma glucose levels in normal (people diabetes), prediabetes and diabetes?
Measuring blood glucose levels
Normal: <5.5 mmol/l
Prediabetes: 5.5 - 6.9 mmol/l
Diabetes: > (or equal to) 7.0 mmol/l
What is the random blood glucose levels in normal and pre-diabetes?
What are the random blood glucose targets for adults with diabetes?
Normal or pre-diabetes: <11.1 mmol/l
Before meals: 4 - 7mmol/L
After meals: <9 mmol/L - type 1 diabetes
< 8.5 mmol/L - type 2 diabetes
How many categories of hypertension (HT) exist?
Grade 1 HT: 140-159 (and/or)/ 90-99 mmHg
Grade 2 HT: 160-179 (and/or)/ 100-109 mmHg
Grade 3 HT: >180 (and/or) / >110 mmHg
What is the blood pressure range for 18-69 year old adults who are being treated for high blood pressure?
Systolic blood pressure (SBP) of 120-130 mmHg
In all age categories of treated patients DBP should be <80mmHg
Outline how to take blood pressure accurately
- No talking
- Cuff has to be on BARE arm
- Support the arm at heart level
- Empty bladder first
- Support back
- Legs uncrossed
- Support feet
- What are the lipid targets for healthy people?
2. What are the lipid targets for people at low- moderate risk of CVD?
- LDL-C: <3 mmol/l
Non-HDL: <4 mmol/l
TG: <1.7 mmol/L
HDL: >1 mmol/L (males), >1.2 mmol/L (females) - LDL-C: <2.6 mmol/l
Non-HDL: <3.4 mmol/l
TG: <1.7 mmol/L
HDL: >1 mmol/L (males), >1.2 mmol/L (females)
How do you calculate non-HDL cholesterol?
Total cholesterol - high cholesterol (HDL)
What is the lipid targets for high risk people (with uncomplicated type 2 diabetes)?
LDL-C: < 1.8 mmol/l
Non-HDL: < 2.6 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L (males), > 1.2 mmol/L (female)
What is the lipid targets for very high risk people (with diabetes/with CVD/target organ damage)?
LDL-C: < 1.4 mmol/l
Non-HDL: < 2.2 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L. (males), >1.2 mmol/L (females)
What type of fats are healthiest?
What type of carbohydrate are healthiest?
Trans fatty acids are most linked to coronary heart disease (found in processed food, cakes, fries, anything with a long shelf-life). They should be replaced with mono unsaturated fatty acids and polyunsaturated fatty acids
Carbohydrates from refined starches/sugars should be replaced with carbohydrates from whole grains
What range of waist circumference for healthy males and females?
Males: 94 - 102 cm
Females: 80 - 88cm
What is the BMI for white European populations?
Underweight: <18.5 kg/m2
Increasing but acceptable risk: 18.5 - 24.9 kg/m2
Increased risk: 25 - 29.9 kg/m2
High risk: 30 kg/m2 or higher
What is the BMI for Asian populations?
Underweight: < 18.5 kg/m2
Increasing but acceptable risk: 18.5 - 22.9 kg/m2
Increased risk: 23 - 27.5 kg/m2
High risk: 27.5 kg/m2 or higher
How do you calculate BMI?
kg / (m)2
Why is physical activity protective for the heart?
Anti-atherosclerotic: Decreases blood pressure, adiposity and inflammation
improves lipids & insulin sensitivity
Psychological: decreases depression and stress, increases social support
Anti-thrombotic: increases fibrinolysis
decreases platelet adhesiveness, fibrinogen and blood viscosity
Anti-ischaemic: decreases Myocardial O2 demand & endothelial dysfunction
increases coronary blood flow, endothelial progenitor cells (EPC’s), circulating angiogenic cells, nitric oxide
Anti-arrhythmic: increases vagal tone & heart rate decreases adrenergic activity
What are psychosocial risk factors? (7)
- Social isolation
- Depression
- Anxiety
- Hostility
- Post-traumatic stress disorder
- Work and family stress
- Low socio-economic status
What co-morbidities increase risk of developing CVD ? (11)
- Hypertension
- Diabetes mellitus
- Chronic kidney disease
- Dyslipidaemia
- Auto-immune conditions (e.g. Rheumatoid arthritis)
- Treated for cancer
- Influenza
- Serious mental health problems
- Periodontitis (a severe gum infection)
- HIV
- Infection
Why is it important to screen for COPD and how does COPD increase the risk for CV death?
There is an inflammatory component to COPD and there is a hypoxia component - which leads to ischaemia -> arrhythmias - ischaemic heart disease
Any inflammatory condition increases cardiovascular death, myocardial infarction and heart failure eg ankylosing spondylitis and psoriatic arthritis
How is erectile dysfunction the first indication of?
Erectile dysfunction is the first indication of atherosclerotic disease
Explain the link between sleep and CV disease?
Sleep apnea is linked to increases in blood pressure, hypoxia
Insufficient sleep is linked to type 2 diabetes, CV disease, obesity and depression
Obstructive sleep apnea is a predictor of CV disease
How would you estimate CVD risk?
The European Society of Cardiology SCORE (Systematic Coronary Risk Evaluation) tool is a popular choice in many European countries. Risk charts such as SCORE-2 are intended to estimate risk in apparently healthy individuals and are not intended for use among patients with established CVD as these patients are automatically considered high-risk and require intensive risk factor management (e.g. diabetes). SCORE predicts the likelihood of CVD events in the next 10-years
How can patients figure out their risk of diabetes at home?
Using the diabetes risk calculator on riskscore.diabetes.org.uk
Checks your weight, height, waist measurement, blood pressure, familial diabetes
What are the HbA1c targets for people without diabetes?
Without diabetes: <42 mmol/mol
Pre-diabetes: 42 - 47 mmol/mol
May indicate diabetes: >48 mmol/mol
What are the HbA1c targets for people with diabetes?
48 - 58 mmol/mol
Ideally < 48 mmol/mol
