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34 Cards in this Set
- Front
- Back
number one cause of death in the US
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coronary artery disease. estimated 490,000 deaths/year
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most common presenting symptom of CAD
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angina
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epidemiological evidence shows ___ is cause of CAD
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lifestyle choices. Ex/japanese that move to US have high CAD rate, not genetic
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Framingham Heart study
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identified common attributes to CAD. Was a cohort study of over 5000 people. went on for over 60 years and they followed the 2nd generation of the initial subjects, too. (followed genetics)
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cohort study
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identify individuals who are healthy at this time who have different lifestyles and watch the disease develop over 10-20 years.
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Findings of the framingham study (what increases risk of CAD)
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1)cigarette smoking significantly increased risk of CAD
2) cholesterol, blood pressure and EKG abnormalities 3) lack of physical activity 4) menopause increased the risk 5) psychosocial, HDL cholesterol |
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What is the strongest predictor of risk for CAD?
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AGE. Men over 45 and women over 55
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List the 10 risk factors for CAD
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1) Age
2) male gender 3) family history 4) HTN 5) cigarette smoking 6) obesity 7) physical inactivity 8) diabetis 9) low HDL cholesterol (less than 35 men, or 45 women) 10) increased LDL (more than 159) |
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Is smoking more detrimental to women or men?
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women
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formula for cholesterol
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Total cholesterol= HDL + LDL + VLDL
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total cholesterol level is not a very good indicator of risk for CHD because:
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there is a combination of good and bad cholesterol. We need to know LDL and HDL levels...
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HDL levels
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desireable level should be greater than 50 in women and greater than 35 in men
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LDL levels
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should be under 160 in asymptomoatic pts, under 130 in pt's with angina, under 70 in pts with hx MI or diabetes ( Lower is better) * he said we don't need to memorize all the cutoff values*
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Dietary protein
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controlled studies keeping everything constant except the amount of protein found that the protein content itself wasn't a risk. The saturated fat in the meat is the risk factor.
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Dietary carbohydrate
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refined sugar has + association with CAD.
there is a negative relationship between complex carbs and CHD. |
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Alcohol and CAD
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in general 20-40% decrease in risk for CAD for those who drink sparingly (1-2 drinks a day.. 5 oz glass of wine)
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alchohol and HDL levels
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evidence that alcohol increases HDL levels, helps break up clots when they form, red wine is the more beneficial type of alcohol
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physical activity and heart disease
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couch potato= 2x more likely to die from CHD.
In the sedentary, 35% of the excess CHD could be eliminated if we were more physicall active |
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Obesity and CHD
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weight gain since youth is strong indicator, not good to be too thin, or obese. U shaped relationship
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Metabolic syndrome
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also called pre-diabetis. combination of 3 things
1) HTN 2) high blood sugar 3) lipidemia |
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Normal fasting glucose.Cut off for diabetis
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less than 100 is normal
greater than 126 is diabetic |
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C-reactive protein
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an inflammatory marker, strong independent risk for CVD. Risk can be significantly reduced by taking ASA
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Cytomegalovirus
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has been isolated from atherosclerotic placques
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helicobacter pylori
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higher rate of sero-positivity among patiens with CHD than normal controls
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Chlamydia pnemoniae
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much higher antibody titers in MI patients than in controls. Clinical trials of macrolides showed dramatic reduction in coronary events in pts with CHD
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HTN
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strong independent factor. recently found that systolic BP is more important than diastolic!
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tobacco smoking
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2x as high as non-smokers, more significant in women than men, for those who quit smoking the risk drops quickly and is minimal after a year of non-smoking
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what does smoking do specifically?
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accelerates blood clotting, increases blood CO levels causing a reduction in the delivery of oxygen, nicotine is vasoconstrictive.
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primary prevention of coronary artery disease
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1) screen for HTN
2) Screen for High cholesterol 3) counsel for tobacco use 4) counsel for physical activity 5) counsel to promote healty diet |
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rheumatic heart disease
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delayed complication of upper respiratory infection with group A strep.
all layers of the heart may be involved |
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prevention of rheumatic heart disease
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throat cultures, + culture should be treated, mass throat cultures in schools have been advocated because many don't seek treatment when sick.
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Carotid artery stenosis
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increased risk for stroke, MI and death. 1/2 % of people in 50's and 10% of people in 80's have stenosis more than 50%
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PAD, peripheral artery disease
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caused by atherosclerosis of the aorta and lower extremity arteries. may cause intermittent claudication (pain in aorta with exertion) strongly associated with CHD. palpation of peripheral pulses is unreliable. routine screen for asyptomatic pts is not recommended.
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AAA
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abdominal aortic aneurism. focal dilation of aorta at least 150% of normal. estimated 8700 deaths/year in US. fatal if ruptures unless promt surgery. abd palpation is helpful during PE, however insufficient evidence for or against routine screening.
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