Epidemiology of coronary heart disease

Question 1

Learning outcomes

Answer 1

Put epidemiology into context
Demonstrate the basics of an epidemiological approach
Use this framework to provide information about coronary heart disease
Demonstrate the relevance to clinical practice

Question 2

How does one perform ‘diagnosis’ in epidemiology

Answer 2

Good sources of data and intelligence
Good sources of analysis

Evidence, evaluation, interpretation

So what does this mean for my patient or community and what works in terms of intervention?

Question 3

What are the main points of TIME study of Scottish heart disease?

Answer 3

2019: 6560 deaths
32% decline over last 10 years but rate of decline has slowed in last 5 years
Hospital admissions increased 11% over last 10 years
2019/20, 93% of people survived 30 days or more following their first heart attack compared with 90% in 2009/10
The death rate for heart failure has reduced by 41% over last 10 years

Question 4

What are risk factors for heart disease

Answer 4

Non-modifiable:
Age, sex, genetic factors.

Modifiable:
Personal - Smoking, diet, physical activity, obesity, high blood pressure, diabetes.
Social/Environmental – deprivation, income, employment, education, housing, air quality

Question 5

What is the prevention paradox

Answer 5

Population-based interventions or high-risk individual targets?
‘There is a “prevention paradox” which shows that interventions can achieve large overall health gains for whole populations but might offer only small advantages to each individual.’

Question 6

What is the point of all this

Answer 6

By using a systematic epidemiological approach:
We can find good data, intelligence and knowledge on CHD and its causes
We can find good studies and research which help analyse and interpret this
We can apply this to the population and our patients
DESCRIBE - UNDERSTAND - ACT