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midterm questions

what pecentage of deaths in 1999 were due to CVD? 50%
how many people died of cvd in 1999? 959,000
how many people died of cancer in 1999? 549,000
what year was CVD NOT the major cause of death in the USA? 1918
how often does someone die of CVD in the US? every 33 seconds
Out of 100 50 year old women, what percentage will die fro, CVD and from breast cancer? 55% from CVD and 10% from breast cancer
what gender does CVD cause more deaths in? women
In what races is CVD the major cause of death? caucasians, african americans, hispanics, american indians, asians/pacific islanders
How has the death rate of CVD changed from 1950 till 1992? has that changed? it dropped 58% but rose in 1993
how does the rate of CVD vary in black men over white men? the CVD death rates are 28% higher in black men than white
how does the rate of CVD differ between black women and white women? CVD death rates are 36% higher in black women
what counties have the highest death rates for CVD? russia, hungary, bolgaria, romania and poland
what counties have the lowest death rates for CVD? switzerland, japan, france, and spain
how does the US rank in death rates for CVD with regards to the highest and lowest rate countries? half of the highest countries' rates and double the lowest countries' rates
what is the single largest cause of death in american men and women? coronary heart disease
how does the rate of coronary heart disease differ between blacks and whites? not much of a difference
what percent of men and what percentage of women have had no symptom before they die suddenly before a heart attack? 48% of men and 63% of women
what is angina pectoris? chest pain
how many americans suffer from amgina pectoris? 7 million
what percentage of heart attacks are preceded by long standing angina pectoris? 20%
what is the 3rd leading individual cause of death in the US after heart attacks and cancer? strokes
how often does someone have a stroke in the US and how often do they die from it? every 33 seconds someone has a stroke and every 3.1 minutes an american dies from a stroke
how do the death rates of stroke differ in black and white men? 46% higher in black men
how do the death rates from stroke differ in black women and white women? 33% higher in black women
what ethnic group has highest risk of strokes? whites (besides black)
how many americans have hypertension? 60 million
what 3 conditions are the most prevelant ones in america today? hypertension, obesity, and physical inactivity
what is defined as high blood pressure? systolic blood pressure greater then 140 or diastolic pressure greater than 90
what percentage of people with hypertension don't even know it? 1 in 3
how do the death rates from hypertension differ in blacks and whites? 3.5 times higher in blacks
how does the risk of kidney failure differ between blacks and whites? 4.2 times greater risk
what percentage of people with hypertension on medicine don't have their blood pressure under control? 25%
how many americans have disability due to CVD? 8 million
what percentage of disabilities are the result of CVD? 19%
what is the leading cause of long term disability? stroke
how many americans with long term disability is it because of hypertension? 2.2 million
what percentage of heart attack patients do not make a complete recovery? 2/3
how many bypass surgerys with there in 1999? 571,000
how many heart transplants were there in 2000? 2,200
how many total cardiovascular surgeries are there each year? 6.1 million
what is the total cost of CVD in the US in 2002? $329 billion
how much do hospital/nursing cost each year? 126 billion
how much do physician services cost each year? 30 billion
how much do medications cost each year? 32 billion
how much does lost work cost each year? 130 billion
what rank is CVD in hospital admissions? 1st (6.3 million)
how many step process is heart disease? usually a complex 3-step process
what is the first step of atherosclerosis? development of fatty streak
what is the 2nd step of artherosclerosis? development of fibrous plaque?
what is the 3rd step of artherosclerosis? development of complicated lesion
what are the 4 layers of the arterial wall? blood, then endothelial layer, intima, media, and adventitia
what is a special quality of the endothemic layer? it's nonthrombogenic, meaning nothing sticks to it
what are the 2 purposes of the endothemic layer? serves as a permiability barrier and helps to regulate its own growth and function
what happens in the intima? where all the "action" takes place with regards to atherosclerosis
what is in the media? its the usual site of smooth muscle in the arterial wall
what is different about the media and the adventitia? they arent directly involved in arthrosclerosis
where does the fatty formation streak step #1 occur? primarily occurs at a bend in the arteries (carotid or coronary arteries)
why do the fatty streaks occur at a bend in the artery? bends cause turbulent blood flow that "injure" the endothelium here
what other actions injure the endothelium? high cholesterol, high blood pressure, obesity, and smoking
what happens in the fatty streak formation step #2? the injury of the endothelial layer allows chemicals to leak through it. this chemical is LDL cholesterol which then becomes trapped and undergoes chemical changes
what happens in the 3rd step of arthrosclerosis? monocytes enter between the endothelial cells to digest the LDL-C to form "foam cells" which lie under endothelial layer and give appearance of a fatty streak. the smooth muscle cells then migrate from the media to intima
what is the 4th step of arthrosclerosis? may not DEFINITELY happen....may make artery wall less smooth which increases the chance of chemicals binding to it, may (or may not) alter size of opening of artery,
in what age is it possible to see evidence of fatty streaks? one year old
what happens after the 4th step of arthrosclerosis? fibrous plaque may develop
how is the development of fibrous plaque characterized? by a fibrous cap
what is the fibrous cap composed of? primarily of smooth muscle, and contains a network of connective tissue and may also contain dead skin cells and calcium deposits and not much lipid
what is in the layer below the fibrous cap? foam cells
what is the initial event in fibrous cap formation and what happens as a result? loss of endothelial layer which allows cells from blood to directly adhere. this causes a chain reaction causing smooth cell muscles to migrate from media to intima which starts to decrease the opening in the arterial vessel
when does a complicated lesion form? when a fibrous plaque hemorrhages or ulcerates
what else can cause a complicated lesion to form? the force of increased blood flow turbulence, hemmorhage within the plaque, or other chemical reasons
what is the result of a complicated lesion forming? increased platelet binding and increased coagulation
what are 3 potential results due to platelet binding or increased coagulation as a result of a complicated lesion? 1) may dissolve without clinical effects 2)may be incorporated into and expand lesion 3) may block artery and cause heart attack
what are several risk factors for CVD? (11) gender, race, age diabetes, smoking (GRADS) high blood pressure, obesity, physcial inactivity (HOP) stress, familu history, cholesterol levels (FSC)
what are the AHA major heart disease risk factors? cholesterol, race, age, physical inactivity, smoking (CRAPS) Blood pressure, gender, family history (BGF)
what are controbuting disease risk factors? contributing but not major risk factors because effect may not be independant or the mechanism it relates to CVD might not be known
what are the AHA contributing CVD risk factors? stress, obesity, diabetes (SOD)
what risk factors of CVD are modifiable? cholesterol, obesity, physical inactivity, stress, (COPS), smoking, blood pressures, diabetes (SBD)
what are nonmodifiable CVD risk factors? family history, race, age, gender (FRAG)
what are the 2 criteria to determine if something is a risk factor? 1)statistical relationship 2) potential mechanism to explain relationship
how does diabetes affect hypertension? it raises chances of having it
how do you determine your BMI? weight in kg divided by ht squared (in meters)
what is BMI for people who are underweight? below 19.9
what is a normal BMI? 20-24,9
what is a BMI for an overweight person? 25-29.9
what is the BMI for an obsese person? 30 or above
what are several ways to determine your body weight? skinfold calipers, bioectrical impedance, hydrostatic weighing, dual energy xray absorptiometry
physical inactivity is associated with which CVD risk factors? increased incidence of NIDDM, increased incidence of hypertension, increased incidence of obesity, and increased incidence of abnormal blood lipids
in 1999-200 approx, how many US adults had hypertension? 28.7% of the population 58.4 million people
what percentage of people are in the first stage of hypertension (140/90)? 67%
what percentage of people are in the second stage of hypertension? (160/100) 22%
what percentage of people are in the 3rd stage of hypertension? (180/110) 11%
what is the prevelance of obesity as a risk factor for CVD? 26%
what is the prevelance of hypertension as a risk factor for CVD? 25%
what is the prevelance of abnormal blood lipids as a risk factor for CVD? 27%
what is the prevelance of smoking as a risk factor for CVD? 29%
what is the prevelance of physical inactivity as a risk factor for CVD? 30%
in men and women, what is the greatest risk factor for CVD? physical inactivity
how did the new models for predicting cardiovascular events work? uses systolic blood pressure, cholesterol levels, age, gender, relative weight, and smoking status
what happens to risk when you shift from male to female, smoker to non smoker? risk goes down
what is the worst case scenario for risk factors? male with blood pressure 180/100, smoker, diabetes, cholestererol 350, hdl 35=50% risk
what is the best case scenario for risk factors? male bp 120/80, cholesterol 200, non smoker, non diabetic, hdl 60=6% risk
what were the 2 goals of the framingham study? 1)define new methods of identifying CVD 2) define factors associated with the development of CVD
why was framingham selected for the study? self contained community, list of residents, previous epidimiological study conducted there, health care provided by 2 hospitals
what th race population opf framingham? 90% white, 4% black, others...
what did they estimate with the study? that within the 5000 tested, 400 would develop CVD within 5 years, 900 in ten years, 1500 in 15 years, and 2150 in 20 years
what did the subjects have to go through during the assesments? 1) extensive medical history 2)careful physical examination 3) xray of heart sizes 4)urinalysis 5) electrocardiogram 6) blood sample for cholesterol, hemoglobin, some brteakdowns of cholesterol, glucose, etc
what were the CVD end points in the framingham study? 1) coronary heart disease 2) stroke 3) peripheral arterial disease 4) congestive heart failure
what were the heart disease classifiications in the framingham study? 1) angina pectoris 2) myocardial infarction 3) coronary insufficiency 4) sudden death 5) coronary heart disease death other than sudden
what were the framingham study stroke classifications? 1) atherothrombotic brain infarction 2) intracerebral hemorrhage 3) subarachnoid hemmorhage 4) cerebral embolism 5) transient inschemic attacks
what was the framingham study's hypothesis #1? coronary heart disease increases with age as do oither manifestations of artheroscleoritc heart disease. occurs earlier and more frequently in men
what was the second hypothesis of the framingham study? people with hypertension develop coronary heart disease at a greater rate than those with normal blood pressure
what was the 3rd hypothesis of the framingham study? evelated blood cholesterol levels are associated with an increased risk of coronary heart disease
what was the 4th hyporthesis of the framingham study? tobbacco smoking is associated with an increased occurence of coronary heart disease
what was the 5th hypoethesis of the framingham study? habitual use of alchohol is associated with an increased occurence of coronary heart disease
what was the 6th hypothesis of the F study? increased physical activity is associated with a decrease in the occurence of coronary heart disease
what the the 7th hypothesis of the F study? an increase in thyroid function is associated with a decrease in the development of coronary heart disease
what was the 8th hypothesis of the F study? a high hemoglobin or hemocrit is associated with an increased rate in the development of coronary heart disease
what was the 9th hypothesis of the F study? an increase in body weight predisposes to coronary heart disease
what was the 10th hypothesis in the F study? there is an increased rate in the devlopment of coronary heart disease in patients with diabetes mellitus
what was the 11th hypothesis in the F study? there is a higher incidence of coronary heart disease in patients with gout
what are the 3 criteria to detemine if something is a risk factor?? (2nd q) 1) statistical relationship 2)potential mechanism to explain relationship 3) if you change the risk factor and the occurence of the medical event is altered
what was the primary hypothesis of the lipid research clinics coronary primary prevention trial? reducing cholesterol levels by the use of cholestyramine resin will reduce the risk of developing CHD
what are 3 types of cholesterol lowering drugs? 1) cholestyramine resin 2)statins (stimvastation, lovastatin) 3) gemfibrozil
what were the results of the experiment on patients treated with cholestyramine resin? treated group had 19% reduction in definite CHD death and/or myocardial infarction, angina pectoris reduced by 20%, coronary bypass surgery reduced by 21%,
how does cholestyramine resin work? binds cholesterol so it cant be absorbed
who were the subjects in the helsinki heart study? men 40-55 with non hdl greater than 200mg with two lipid levels above criterion
what was the procedure in the helsinki heart study? treated with gemfibrozil or placebo and followed for 5 years
what was the primary hypothesis of the helsinki heart study? treatment with gemfibrozil, a lipid lowering agent, will reduce CHd in aymptomatic middle aged men at high risk because of elevated cholesterol levels
what were the results of the helsinki heart study? 34% reduction in incidence of cardiac endpoints in treated men...benefit evident in second year of trial
what is an optimal-above optimal level of LDL cholesterol? less than 100-129 mg
what is borderline high to very high levels of LDL? 130-190 mg and above
what is a desirable level of HDL? 60 mg or higher (40-60 is acceptable)
at what levels is HDL considered a risk factor for CHD? 40 mg and below
who were the subjects in the scandinavian simvastatin survival study? men and women who previous had CHD with cholesterol levels of 5.5-8.0
what was the design study of the SSSS? 8 weeks of lipid lowering diet before random assignment, doses of placebo and active medication administered based on cholesterol levels
what was the primary hypothesis of the SSSS? lipid lowering with simvastin would would improve survival in patients with elevated cholesterol levels and previously diagnosedCHD
what were the results of the SSSS? reduced risk of CHD in treated group, major coronary events reduced from 28% to 19% in treated group, reduced risk of needing bypass surgery in treated group
who were the subjects of the downs and coworkers study? lovastin as medication for men and women with total cholesterol of 180-264 hdl less then 45 or 47
what was the primary an secondary endpoint in the downs and coworkers study? primary: major coronary event secondary: CV mortality or CV event
what was the conclusion for the downs and coworkers study? lipid lowering meds reduce the risk for major coronary events in men and women with average cholesterol and LDL and below average HDL
who were the subjects in the VA cooperative study group? 143 male hypertensives, with diastolic blood pressures ranging 115-129 with no treatment
what was the study design for the VA cooperative study? randomized drug treatment of 3 medications, drug treament graded to reduce blood pressure with the most minimal side effects , patients followed for evidence of CVD
what was special about the VA cooperative study? the trial ended early because of such dramatic results after 20.7 months of average follow up
what are ace inhibitors and what do they do? an angiotensin converting enzyme which relax blood vessels and inhibit fluid retention
what do calcium channel blockers do? they are used to treat hypertension and disorders that affect the blood supply to the heart. they prevent angina and arte effective in the treatment of irregular heartbeat
what was the hypothesis of the VA study of anytihypertensive agents? active treatment of men with marked hypertension will result in reduced incident of CVD
who were the subjects of the medical research council trial of treatment of mild hypertension? men and women 35-64, diastolic blood pressure of 90-109
what was the study design of the medical research trial for mild hypertension? what was the goal? patients were randomized to 4 treatments: diuretic,diuertic placebo, sympathetic nervous system blocker, SNSB placebo goal to reduce DBp to below 90
what was the hypoethesis in the study of treatment of mild hypertension? treatment of mild hypertension will lead to reduce rates of stroke, death due to hypertension, and coronary events
what were the results in the study of the treatment of mild hypertension? the treatment benefits were not so clear cut since it was only mild hypertension
what are new features of the adult treatment panel 3? focus on multiple risk factors, multiple metabolic risk factors, more intensive lifestyle intervention-emphasis on weight managment and PA
what are some cost effectiveness issues? theraputic lifestyle changes, drug-treatment therapy
what does the ATP say to do with to lowel LDL in patients with CHD and CHD risks? intensive lifestyle therapies, maximal control of other risk factors, consider starting LDL lowering drugs simultaneously
what are treatment options for ldl 100-129? LDL loweing therapy, treatment of metabolic syndrome, drug thearpy for other lipid risk factors
what are therapy options for patients with LDL less than 100? no lowering needed, theraputic lifestyle changes recommended, consider treatment of elevated triglycerides and low HDL,
what is the LDl lowering therapy for patients with multiple risk factors and 10 years risk of less than or equal or 20%? LDL cholesterol goal of less than 130, goal to reduce both short term and long term risk, immediate start of theraputic lifestyle changes if LDL is greater than 130, consider drug therapy is LDL is still above 130 after TLC
What should be done for LDL lowering therapy in patients with a 0-1 risk factor? theraputic goal is to reduce long term risk, have LDL less than 160 (if not initiate TLC), if LDL is greater than 190 after 3 months of TLC, drug therapies are optional
what are some general features of the metabolic syndrome? 1) abdominal obesity 2) artherogenic dyslipidemia (elevated triglycerides, small LDL particles, low HDL) 3) raised blood pressure 4) insulin resistance (+- glucose intolerance) 5) prothrombotic state 6) proinflammatory state
what are the major features of the TLC diet? reduced intake of cholesterol inducing ingredients, saturated fat less than 7% of total diet, dietary cholesterol less than 200 mg a day, LDL lowering options
what are some thearputic lifestyle changes in LDL lowering therapy? TLC diet, weight reduction, increased physical activity
what does the JNC say about systolic and diastolic BP? that for persons over 50, SBP is more important than DBP as a risk factor
according to JNC, at what BP point does CVD risk double? starting at 115/75
what is considered to be normal blood pressure? less than 120 over less than 80
what BP levels are considered to be hypertensive? 120-139/80-89
what BP levels are considered to be in stage one hypertension? 140-159/ 90-99
what BP levels are considered to be in stage 2 hypertension? 160 or greater/100 or greater
how much will weight loss affect SBP? approx 5-20 mmper 10 mg weight loss
how much will adopting a new eating plan affect SBP? 8-14 mm
how much will dietary sodium reduction affect SBP? 2-8 mm
how much will physical activity affect reduction of SBP? 4-9 mm
how much will moderation of alchohol consumption affect the reduction of SBP? 2-4 mm
what are the steps to follow in treating hypertension? 1) lifestyle modifiations 2) intial drug choices 3) change doses until optimal blood pressure is achieved
what are the criteria for diagnosis of diabetes? 1) symptoms of diabetes and casual blood glucose greater than 200 mg OR fasting blood glucose greater than 126 OR 2 hour oral glucose tolerance test glucose greater than 200
who should be tested for diabetes and how often? all people above 45 years old especially those with a BMI of over 25 and should be repeated every 3 years
what are the criteria for testing diabetes in young people? 1) BMI less than 25 2) family history 3) hypertensive 4)high risk ethnic group 5) had gestational diabetes 6) physically inactive 7) HDL less than 25 8) previously had impaired glucose tolerance 9) history of vascular disease
what are the treatment goals for glucose for diabetes? hemoglobin < 7%, fastung glucose 90-130 mg, post prandial glucose <180
what is the treatment goal for blood pressure in diabetes? <130/80
what is the treatment goal for plasma lipids in diabetes? LDL <100 TG <150 and HDL > 40
what are 3 ways to treat diabetes? 1) medical nutrition therapy 2) physical activity 3) medications
what 2 steps are required to care for oberweight/obese patents? 1) assesment 2) management
what 2 criteria are used to assess one who is overweight or obese? 1) BMI 2) waist circumference
a man or woman is at high risk if their waist circumference is greater than what? man >102 woman >88
what are the BMIs for obese, level 2 obesity, and extreme obesity? obese-30-34.9 level 2- 35-39.9 extreme- 40 and above
how do you determine absolute risk status for obese people? evaluate 1) disease conditions (sleep apnea, type 2 diabetes) 2) other obesity related diseases 3) cardiovascular risk factors 4) other risk factors ( physical inactivity, high serum triglycerides)
what are the goals of weight management/treatment? 1) prevent further weight gain 2) reduce body weight 3) maintain a lower body weight over long term
what are 3 goal deadlines when losing weight? 1) short term goal: 1-2 lbs a week interim goal: maintnence long term goal: additional weight loss and maintnence
what are actual weight loss goals when losing weight? decrease body weight by 10% from baseline,
after how long should one start weight maintnence efforts rather than weight loss efforts? after about 6 months
what are 6 strategies for weight loss and maintenence? 1) dietray therapy 2) physical activity 3) behavior therapy 4) "combined therapy" 5) pharmocotherapy 6) weight loss surgery
what 3 things should weight loss attempts try to combine? 1)low calorie/fat diets 2) increased physical activity 3) behavior modification
what are 7 benefits of weight loss? 1) decreased caridovascular risk 2) decreased glucose and insulin levels 3) decreased blood pressure 4) decreased LDL and triglycerides, increased HDL 5) decreased severity of sleep apnea 6) reduced symptoms of degenerative joint disease 7) improved gyno
Created by: talibear