Flashcards in 266e - Epidemiology of Cardiovascular Disease Deck (33):
Summarize the global epidemiology of cardiovascular diseases.
"Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes, and CVD was the responsible for less than 10% of all deaths. In 2010, CVD accounted for approximately 16 million deaths worldwide (30%), including nearly 40% of deaths in high.income countries and about 28% in low- and middle-income countries."
What are the five stages of the epidemiologic transition?
Pestilence and famine, receding pandemics, degenerative and man-made diseases, delayed degenerative diseases, and epidemic of inactivity and obesity.
Characterize the age of pestilence and famine.
"The age of pestilence and famine is marked by malnutrion, infectious diseases, and high infant and child mortality that are offset by high fertility. Tuberculosis, dystentery, cholera, and influenza are often fatal, resulting in a mean life expectancy of about 30 years. CVD, which accounts for less than 10% of deaths, takes the form of rheymatic heart disease and cadiomyopathies due to infection and malnutrition. Approximately 10% of the world's population remains in the age of pestilence and famine."
Characterize the receding pandemic age.
"Per capita income and life expectancy increase during the age of receding pandemics as the emergence of public health systems, cleaner water supplies, and improved nutrition combine to drive down deaths from infectious disease and malnutrition. Infant and childhood mortality also decline, but deaths due to CVD increase to between 10 and 35% of all deaths. Rheumatic valvular disease, hypertension, coronary heart disease, and stroke are the predominant forms of CVD. Almost 40% of the world's population is currently in this stage."
Characterize the age of degenerative and man-made diseases.
"The age of degenerative and man-made diseases is distinguished by mortality from noncommunicable diseases - primarily CVD - surpassing mortality from malnutrition and infectious diseases. Caloric intake, particularly from animal fat, increases. CHD and stroke are prevalent, and between 35 and 65% of all deaths can be traced to CVD. Typically, the rate of CHD deaths exceeds that of stroke by a ratio of 2:1 to 3:1. During this period, average life expectancy surpasses the age of 50. Roughly 35% of the world's population falls into this category."
Characterize the age of delayed degenerative diseases.
"In the age of delayed denenerative diseases, CVD and cancer remain the major causes of morbidity and mortality, with CVD accounting for 40% of all deaths. However, age-adjusted CVD mortality declines, aided by preventive strategies (for example, smoking cessation programs and effective blood pressure control), acute hospital management, and technologic advances, such as the availability of bypass surgery. CHD, stroke, and congestive heart faiulure are the primary forms of CVD. About 15% of the world's population is now in the age of delayed degenerative diseases or is exiting this age and moving into the fifth stage of the epidemiologic transition."
Summarize the percentage of the world in the different era ages and the rate of cardiovascular deaths in those countries.
- Pestilence and famine: 10% world, less than 10% CVD deaths;
- Receding pandemics: 40% world, 10-35% CVD deaths;
- Degenerative and man-made: 35% world, 35-65% CVD deaths;
- Delayed degenerative: 15% world, 40% CVD deaths.
Name the etiology of cardiovascular diseases in the countries in different era ages.
- Pestilence and famine: rheumatic valvular disease;
- Receding pandemics: rheumatic valvular disease, hypertension, coronary heart disease, and stroke;
- Degenerative and man-made: coronary heart disease and stroke;
- Delayed degenerative: coronary heart disease, stroke, and congestive herat failure.
High-income countries experienced declines in CVD death rates by as much as 50-60% over the last 60 years, whereas CVD death rates increased by 15% over the past 20 years in the low- and middle-income range.
True or False?
Summarize the historic evolution of eras age in the United States related to CVD.
" The age of pestilence and famine occured before 1900, with a largely agrarian economy and population. Infectious diseases accounted for more deaths than any other cause. By the 1930s, the coutnry proceeded through the age of receding pandemics (...) Lifestyle changes due to rapid urganization resulted in a simultaneous increase in CVD mortality rates, reaching approximately 390 per 100 000.. Between 1930 and 1965, the country entered the age of degenerative and man-made diseases. Infectious disease mortality rates fell to fewer than 50 per 100 000 per year (...) The age of delayed degenerative diseases took place between 1965 and 2000."
Specify the decline CVD death rate in the United states through 1970s to 2000s.
"Currently, the United States is entering what appears to be a fifth fase. The decline in the age-adjusted CVD death rate of 3% per year through 1970s and 1980s has tapared off in the 1990s to 2%. However, CVD death rates have declined by 3-5% per yer during the first decade of the new millennium."
What are the rates of CVD to stroke rates in high-income countries?
5 to 1
Compare the mortality rates in northern versus central and southern Europe.
"... southern and central European countries experienced a more gradual rise and fall in rates. More specifically, central European countries declined at slower rates compared to their northern counterparts. Countries such as Portugal, Spain and Japan never reached the high mortality rates that the United States and other countries did, with CHD mortality rates at 200 per 100 000, or less. Europe also exhibit a clear north/south gradient in absolute rates of CVD, with rates highest in northern countries and lowest in Mediterranean countries."
Japan is unique most likely due to the unique dietary patterns of its population. Stroke rates increasd dramatically but CHD rates did not rise as sharply in Japan.
True or False?
CVD is a major cause of death in China, but like Japan, stroke causes more deaths than CHD in a ratio of about three to one.
True or False?
Which countries have the highest CVD mortality rate?
"The Eastern Europe and Central Asia regions, however, are firmly in the peak of the third phase, with the highest death rates due to CVD (~66%) in the world."
What are the main causes for years of life lost (YLLs) and disability-adjusted life-years (DALYs)?
"In 2010, CHD accounted for 13,3% of all deaths globally and the largest portion of blobal years of YLLs and DALYs. The second largeste cause of death was stroke (11,1%), which was also the third largest contributor to global YLLs and DALYs."
How many CHD occured worldwide due to CVD?
10 million in low-income countries and 5,6 millions in high-income countries.
Between 1990 and 2010, the number of CVD deaths increased by 31%, but age-adjusted death rates decreased by 21,2% in the same period.
True or False?
How many deaths wordwide were due to tobacco use? How many of those were CVD-related deaths?
"Over 1,3 billion people use tobacco worldwide, a number that is projected to increase to 1,6 billion by 2030. Tobacco use currently causes about 5 milion deaths annually (9% of all deaths), approximately 1,6 million of which are CVD-related. (...) Secondhad somke is another well-established cause of CHD, responsible for 600 000 deaths of nonsmokers in 2011."
High-income countries have an increased intake of saturated animal fat (which appear to be decreasing) and carbohydrates but a decreased intake of plant-based foods.
True or False?
How many individuals do not engage in any physical activity in the United States? How many do engage in a physical activity three or motre times per week?
One-quarter and 51,6%, respectively.
Mean population cholesterol levels are falling in high-income countries, wheares wide variation is seen in those of low- to middle-income.
True or False?
"mean serum total cholesterol levels have decreased globally between 1980 and 2008 by 0,08mmol/L per decade in men and 0,07 mmol/L per decade in women."
What is the mean total cholesterol in men and women in 2009?
179,4mg/dL and 184,2mg/dL, respectively.
How many stroke and ischemic events are attributable to either high cholesterol and hypertension?
- High cholesterol: 56% ischemic heart disease and 18% strokes;
- Hypertension: 49% coronary heart disease and 62% strokes.
Remarkably, nearly half of the CHD and stroke burden due to elevated blood pressure occurs in those with systolic blood pressure less than 140mmHg.
True or False?
How might one explain the higher stroke rates in lower- and middle-income countries?
Higher rate of undetected and, therefore untreated, hypertension.
What is the trending in mean systolic blood pressure worldwide?
"Globally, however, mean systolic blood pressure has decreased among both genders (0,8mmHg per decade among men; 1,0mmHg per decade among women)."
Summarize the epidemiology of obesity in children and women, as well as high- versus low-income countries.
"Obesity is increasing throughout the world, particularly in developping countries, where the trajectories are steeper than those experienced by the developed countries. (...) Currently, 1 in 10 children are estimated to be overwiehgt, a number that is increasing worldwide. Women are also more affected than men, with the number of overweight women generally exceeding underwieght women"
Summarize the trends in lipid levels, blood pressure, obesity and diabetes mellitus worldwide.
- Lipid levels: decreasing;
- Blood pressure: decreasing;
- Obesity: increasing;
- Diabetes mellitus: increasing.
Compare the presence of high cholesterol levels, hypertension, obesity and diabetes in women versus men.
- Lipid levels: higher in women;
- Obesity: higher in women;
- Diabetes mellitus:
Migration studies suggest that South Asians and Indians tend to be at higher risk than those of European extraction.
True or False?