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Lecture 1: Epidemiology of CVD

Lecture 1: Epidemiology of CVD

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Lecture 1: Epidemiology of CVD

 Prevalence = Proportion of people in a population who have a disease at a specified point

in time; affected by incidence and mortality

 Incidence = Number of new cases of disease developing in population during a specified

time interval

 Risk factor = An attribute that’s associated with disease

 Risk marker = Attribute that’s associated with disease occurrence, but is merely

reflecting or marking another RF that has a causal relation to the disease

 Confounding variable = Extraneous variable that is responsible for, or mediates an

observed association between an exposure and a disease

 Adjustment = Statistically accounting for other known RFs for the disease

 Relative risk = Measure of association that conveys the relative likelihood of disease in

exposed vs. nonexposed people

o RR < 1 = decreased risk

o RR > 1 = increased risk

 Attributable risk = Measure of association that gives information about the absolute effect

of exposure

 Population attributable risk = Proportion of disease in the population that can be

attributed to a particular risk factor

 1° prevention = Prevention of disease in people without clinically overt disease

 2° prevention = Prevention of recurrent events in people with clinical disease

 Smoking

o ASK about smoking at every encounter

o ADVISE all smokers to stop

o ASSIST smoker in stopping

o ARRANGE follow-up

Lecture 2: Obesity, Metabolic Syndrome and Cardiovascular Disease

 BMI: weight(kg)/height(m)

o Overweight = BMI 25 – 29.9

o Obese = BMI ≥ 30

 Waist Circumference

o > 35” in ♀ linked to CHD

o > 40” in ♂ linked to CHD

 Waist-to-hip ratio

o Best predictor of future MI (central obesity)

o > 0.85 in ♀ at ↑ risk

o > 0.9 in ♂ at ↑ risk

 Adipose tissue and CHD

o Angiotensinogen (↑ AGII and ↑ BP)

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o FFA (Toxic to blood vessels, ↑ insulin resistance)

o CRP (↑ inflammation, ↑ CV risk)

o Plasminogen activator inhibitor-1 (↑ thrombosis)

o IL-1, TNF-α (↑ inflammation)

o Resistin (↑ insulin resistance)

 Metabolic Syndrome (THeHOG)

o ≥ 3 of the following 5:

 Abdominal obesity

 ↑ Triglycerides; ≥ 150 mg/dL (or being treated for)

 ↓ HDL (or being treated for)

 < 50 mg/dL in ♀

 < 40 mg/dL in ♂

 HTN (or being treated for)

 ≥ 130 mmHg systolic

 ≥ 80 mmHg diastolic

 ↑ fasting BG (or being treated for)

 ≥ 100 mg/dL

o Most important parts are abdominal obesity and insulin resistance

o ↑ inflammation

o ↑ thrombosis

o Tx

 ↓ risk of HD and DM

 Target individual components (lipids, HTN, DM, wt loss)

 5-10% weight loss improves cardiac function, endothelial function,

insulin resistance,↓ Triglycerides, ↓ BP, ↑ HDL

o Obesity Tx

 Sibutramine: block serotonin and Norepi uptake

 Orilistate: lipase inhibitor

 Phenteremine: Amphetamine derivative

 Rimonabant: CB1 receptor antagonist (depression; not used in US)

 Gastric bypass surgery – only weight loss intervention shown to ↑ lifespan

Lecture 3: Lipid Lowering and Antioxidant Treatment

 ↑ HDL is the strongest predictor of a reduction in CV events

 Colestyramine (bile acid sequestrant)

o ↓ LDL

 Gemfibrozil (fibric acid derivative)

o ↓ LDL

o ↑ HDL

 Statins (HmG CoA reductase inhibitor)

o First 1° prevention that demonstrated ↓ lipids → ↑ survival, ↓ mortality

 Nicotinic acid derivatives (B6)

o ↓ LDL

o ↑ HDL

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Lecture 1: Epidemiology of CVD Prevalence = Proportion of people in a population who have a disease at a specified point in time; affected by incidence and mortality Incidence = Number of new cases of disease developing in population during a specified time interval Risk factor = An attribute that’s associated with disease Risk marker = Attribute that’s associated with disease occurrence, but is merely reflecting or marking another RF that has a causal relation to the disease Confounding variable = Extraneous variable that is responsible for, or mediates an observed association between an exposure and a disease Adjustment = Statistically accounting for other known RFs for the disease Relative risk = Measure of association that conveys the relative likelihood of disease in exposed vs. nonexposed people RR < 1 = decreased risk RR > 1 = increased risk Attributable risk = Measure of association that gives information about the absolute effect of exposure Population attributable risk = Proportion of disease in the population that can be attributed to a particular risk factor 1° prevention = Prevention of disease in people without clinically overt disease 2° prevention = Prevention of recurrent events in people with clinical disease Smoking ASK about smoking at every encounter ADVISE all smokers to stop ASSIST smoker in stopping ARRANGE follow-up Lecture 2: Obesity, Metabolic Syndrome and Cardiovascular Disease BMI: weight(kg)/height(m)2 Overweight = BMI 25 – 29.9 Ob ...
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