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Title: Heart Disease/ Epidemiology
Description: This is a lecture that is part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
Description: This is a lecture that is part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
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CHD pathology
Eventually 75% blocked
Symptoms:
Chest pain
Angina
Total occlusion: Acute MI
Progression
Symptoms for CHD begin at middle age
and the likelihood for having CHD
symptoms increases with age
Plaque formation begins in childhood!
CHD clinical presentations
Sudden Cardiac death
Heart attack/MI
Angina
Progressive heart failure (SOB, ankle oedema & fatigue)
Many patients - Poor quality of life due to progressive symptoms
Survival following Acute MI
50 % of people undergo sudden cardiac death (No chance of life saving treatment) - heart
just stops
25% of people still alive >10 yrs after MI
Heart failure has a much worse prognosis than Acute MI (HF has the most impact on
survival)
HF 5 yr survival after hospital admission is worse than common cancers
CHD stats
CV diseases account for 45% of all UK deaths (2004)
Many CHD deaths premature (<75 yrs) - high mortality rates
CHD risk factors
Smoking
High BP
High Cholesterol
CHD mortality
Mortality higher in males but women catch up around their 50s after menopause
Mortality also increases as deprivation increases - more apparent in deprived young
people (as already dead)
Mid lecture summary
CHD is caused by atheroma & thrombosis
Coronary atheroma
Develops silently from childhood
Manifests as adult disease or death
Terminology: Risk factor
Any characteristic which identifies a group at increased risk of disease
They need not be:
Independent
Causal
Modifiable
Classic example is age
Terminology: Cause
Cause is a factor which itself increases risk of disease (prevalence, incidence, mortality)
Cause = a biological phenomenon
Smoking is the most important modifiable risk factor
Major modifiable risk factors
Smoking
Hypertension
Lipids*
Abdominal obesity*
Diabetes*
Fruit and veg*
Alcohol*
Exercise
Psychosocial
A CHANGE IN DIET CAN ELIMINATE 50% OF RISK
Prevention
Primary prevention (prevention in people who are free from CHD)
Before disease presents
Secondary prevention (prevention in people who already have CHD)
Reduce complications
Tertiary prevention
Rehabilitation
CHD has a long asymptomatic phase and short clinical phase
Many people (50%) experience death as their first symptom!
Secondary prevention can postpone death and control symptoms
Primary prevention can postpone and PREVENT death and symptoms (increase the
asymptomatic phase until you die from something else)
Treatments and intervention
Acute MI
Thrombolysis
Beta Blockers
ACE inhibitors
Aspirin
CPR
Secondary prevention
Angina drugs
CABG surgery
Angioplasty
Preventing Coronary Heart Disease
Identify high risk subjects
Categorise by sex, age, diabetic, smoker, BP and cholesterol (Risk of major CV event
within 10 yrs)
Reduce risk in population
QRISK2 score
Identify subjects with 10yr CVD risk of 20 or >20%
Absolute risk of CHD:
Age & sex (Age most important risk factor)
Systolic BP
Total cholesterol
Smoker?
ECG (LVH)
Diabetes
Chronic kidney disease
Family History
Combination therapy in high risk prevention of CHD
'Polypill' or drugs taken separately:
Anti platelet
Statin
Beta-blocker
ACE inhibitor
BP combination
Folate
As your blood pressure rises, your risk of CHD increases and rises dramatically after
reaching about 185 mmHg
Number of deaths are higher in slightly raised BP values
CVD causal pathways
Upstream (determinants) --> Downstream (causes)
Food --> Salt --> BP
Food --> Saturated Fats/Trans Fats --> Cholesterol
Title: Heart Disease/ Epidemiology
Description: This is a lecture that is part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
Description: This is a lecture that is part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.