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Life Support > CHD Epidemiology > Flashcards

CHD Epidemiology Flashcards

1
Q

What are the types of disease prevention?

A

In theory, distinction made based on disease stage

  • primary (no CHD)
  • secondary (early CHD)
  • tertiary (late CHD)
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2
Q

What are the types of prevention in practice?

A
  • primary (no CHD)

- secondary (CHD present)

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3
Q

What is primary prevention?

A

prevention taking place before disease actually present

AIM: to prevent disease from developing

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4
Q

What is secondary prevention?

A

prevention taking place when early disease is present

Aim: to cure or prevent disease progression or complications

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5
Q

What is tertiary prevention?

A

prevention taking place within established or late disease

AIM: to prevent disease progression or complications

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6
Q

How can primary prevention be achieved?

A
  • removal of causal exposure OR
  • enhancement of host resistance OR
  • interfere with disease pathogenesis

AIM: to prevent development or disease incidence

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7
Q

How can secondary prevention be achieved?

A
  • encourage identification of disease (patient-led and screening)
  • early prevention/Rx in Dx cases
  • removal of causal exposure

AIM: ensure early Rx to cure or delay progression

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8
Q

How can tertiary prevention be achieved?

A
  • ensure effective Rx
  • Remove causal exposure

AIM: prevent complications and limit disability and distress

= good medical practice

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9
Q

What are the main approaches for prevention of CHD?

A
  • removal of causal factors

- altering pathogenesis (e.g. aspirin as an anti-platelet)

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10
Q

When does removal of the causal factor have its greatest benefits in CHD prevention?

A
  • more a causal factor is lowered
  • longer duration causal factor is removed for
  • reduction of multiple causal factors (e.g. LDLs, BP, smoking)
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11
Q

What are the trends observed by reducing exposure in CHD prevention?

A
  • given reduction in risk factors correlates with reduced RELATIVE RISK in many types of patients
  • ATTRIBUTABLE risk reductions are greatest in people at high baseline risk
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12
Q

What is the scope for prevention of CHD?

A
  • high potential: especially through reaction of causal factor exposure
  • Combo has best effect: dietary changes and medication-driven
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13
Q

What are the 3 types of CHD prevention approaches?

A
  • PRIMARY: high risk strategy. population strategy

- SECONDARY: patients with established CHD

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14
Q

What is the nature of secondary prevention for CHD?

A

for people with:

  • existing CHD
  • other vascular disease (TIA etc)

people are at high risk of further CHD
death rate ~5% per year

AIM: reduce as many risk factors as much as possible

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15
Q

What types of secondary prevention for CHD are implemented?

A
  • health behaviour changes
  • smoking cessation (-30% reduction risk)
  • dietary changes

medications (also) reduce as many risk factors as possible

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16
Q

How is risk affected when there are multiple causal factors?

A

RRs for each factor are MULTIPLIED together to given the risk for combined effect

17
Q

What are the strengths of secondary prevention?

A
  • can offer intervention appropriate to that individual
  • intervention likely to be effective and cost-effective due to high risk
  • motivation of both patient and doctor are usually high
  • avoids interference with low risk population
18
Q

What are the limitations of secondary prevention?

A
  • not a radical approach

- no effect on disease incidence

19
Q

What are the main features for the HIGH RISK strategy for primary prevention?

A

= CLINICAL APPROACH

  • identify individuals at high risk for CHD
  • reduce their risk
20
Q

What are the main features for the POPULATION strategy for primary prevention?

A

= public health approach

  • reduce risk in whole population
21
Q

What are the challenges with identifying people at high risk of CHD?

A

single risk factors are not good indicators of CHD incidence

=> MULTI-RISK scores are needed to ID pt with 10 year CHD risk of >20%

e.g. QRISK or Framingham score
(based on absolute risk of CHD)

22
Q

What constitutes significant risk in CHD prevention?

A

no fixed value

recent guidelines focuses on annual risk ~2%

23
Q

What approach is used for Rx in CHD prevention?

A

using MULTIPLE medications to reduce risk through different mechanisms
=> BEST APPROACH

24
Q

What is the ‘Polypill’ strategy?

A

-> could largely prevent MIs and stroke if taken by >55yo

= high risk strategy based on age only

25
Q

What is the link between DM and CHD?

A
  • high risk of developing CHD
  • tight glucose control has limited effect on CHD risk
  • Controlled blood cholesterol and BP: most important preventative Mx in DM patients
26
Q

What are the strengths of high risk strategy approaches in primary prevention?

A
  • personalised intervention
  • cost-effective
  • effective
  • high motivation (doctor and pt)
  • approach conducive to medial model
  • avoids interference with low risk population
27
Q

What are the limitations of the high risk strategy of primary prevention?

A
  • involves risk factor screening (imperfective prediction and is expensive)
  • some high risk pt will have developed CHD (moves from primary to secondary)
  • limited impact on CHD incidence
  • impact of labelling pt as abnormal
28
Q

What is the population strategy for CHD prevention?

A
  • population wide changes in diet
  • reduce smoking prevalence (increased price, restrictions, reduced adverts)
  • encouraging physical activity
  • voluntary agreements/legislation
29
Q

What are the strengths of the population strategy for CHD prevention?

A
  • radical: aim to reduce CHD incidence
  • large potential benefits
  • applies to everyone, so individuals are not labelled or singled out
  • does not require screening
  • not dependent on medical services
  • cheaper
30
Q

What are the weaknesses of the population strategy for CHD prevention?

A
  • dependent on the will of public: poor motivation will inhibit benefits
  • population benefit is large, but individual benefit is small ‘prevention paradox’
  • potential effects of exposure to new factor (which could in itself pose new dangers)
31
Q

What is ‘prevention paradox’?

A

the idea that:

Though benefit for the population can be large, the benefit for individuals (even high risk individuals) is small

32
Q

Which type of primary prevention is more effective?

A

= dependent on disease risk distribution in population

Widespread but low average risk: favours population strategy

HIGH RISK, low incidence: favour high risk strategy

33
Q

What is the role of anti-platelet mediations in CHD prevention?

A
  • v. strong evidence of these Rx reducing risk by ~25%
  • effective and widely used by those with CHD and at high risk
  • not recommended: low CHD risk as side effects include major bleeding (outweighs benefits)
34
Q

What are the main challenges that remain with CHD prevention in UK?

A
  • LDL and BP remain higher than ideal
  • need to strengthen population based strategies in reducing CHD risk
  • control co-morbidities: T2DM and obesity
  • understand social and ethnic differences in CHD to reduce risks
  • control CHD epidemic rising in lower income countries

Life Support (13 decks)

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