Flashcards in Lifestyle factors and CVD Deck (28)
3 pathways in which lifestyle factors affect CVD
1. Via health-related behaviours
2. By causing acute or chronic physiological changes that lead to CHD.
3. Via access to and use of medical care.
Physical, immutable CVD risk factors.
Psychosocial, modifiable CVD risk factors
Factor than increases CVD risk, described as:
Being overweight and have great abdominal fat distribution.
5+ fruit and veg a day and risk of CVD
Those who were not having 5+ a day:
1.7 x likely to die early from CVD
1.4 x more likely to have a stroke.
Fat intake and risk of CVD
Those in top 20% of total fat intake:
1.3 x more likely to develop CVD
Top 20% saturated fat:
1.5 x more likely to develop CVD.
Smoking and CVD risk
Compared to non-smokers:
1.9x more likely to die early from CVD
1.7 x more likely to have a stroke.
Compared to CHD patients who keep smoking, those quitted had:
36% lower risk of premature death
32 % lower risk of re-infarct.
Exercise and CVD health risk
Those below activity threshold:
1.3 x more likely to die early from CVD.
1.3 x more likely to have a stroke.
Demographic and psychosocial factors on CVD risk
Lower classes have greater CVD risk:
Compared to top 20% income, bottom 20% have
2.7 x risk of CVD death
4.3 x greater risk of AML.
However, adjustment for behavioural risk factors:
lower 20% have no greater risk of CVD compared to top 20%
Have A 2.8 X greater risk of AMI.
Association between socioeconomic status and CVD
Those in a lower SES more likely to develop CVD
Large part of this is attributed to differences in:
Biological markers: more likely to have hypertension and cholesterol
More likely to smoke, have a worse diet, exercise less.
More likely to be depressed and have social support.
Why do people risk their health?
Biased risk perception:
Health optimism, don't think it would happen to them
General risk vs Personal risk; even though there are stats for risk in the general population, it is difficult to personalise that risk.
People underestimate the impact of diet and exercise, whilst acknowledge other risk factors for MI and other CVD.
Patients and their underestimation of what they think caused MI
Those in hospital and 2-2.5yrs after discharge mainly attributed the cause to stress and smoking.
25% in hospital didn't know.
Men more likely to cite poor diet and hard work.
Women more likely to cite chance/ bad luck.
Factors that affect getting to hospital on time- speed of treatment
Believing MI has more serious consequences
Active coping style
More non-pain symptoms
Physical responses to stress
Physical: fight/flight, acute situations.
Behavioural response to stress
Causes chronic stress- increase CVD risk
Emotional response to stress
Chronic stress- Increase risk of CVD
Cognitive response to stress
Lack of concentration- acute/ chronic
Coping responses to stress
Problem solving: managing the stress in short and long term.
Psychological/ Behavioural distraction: avoidance.
Not thinking about it or eatin/smoking to cope with stress.
Epidemiological studies on stress
Acute stress associated with MI and cardiac death
MI and CD increase after disasters- 9/11, world cup.
Animal studies on stress
Showed that chronic stress induces atherosclerosis
Lowere threshold for arrhythmia
Experimental studies on stress
Shows that acute stress triggers ischaemia in patients with CHD
Acute stress is also associated with CV changes; BP, HR.
Stress and ischaemia
Acute stress triggers iscahemia in CHD patients.
Intense physical activity
Stressful mental activity
feeling tense, frustrated, angry or sad.
Job strain- chronic stress
Associated with increased CVD risk
- demand in workplace is high
- Control of stress is low
- Lack of support in workplace
Personality and CVD risk
Type A personality:
Hard driving competitive behaviour
Vigorous speech characteristics
Potential for hostility
May be a risk factor for CHD in health people but not for those who already have CHD.
Hostility is the most important component.
Hostility and CHD
Independent predictor of CHD incidence.
Significant interaction with waist-to-hip ratio
Emotional impact of CHD
Up to 30% are depressed
Around 40% have anxiety
Up to 15% have PTSD
Depression and MI
2-3x more common after MI compared to other times in life.
Independant predictor of premature death in CHD patients
Associated with poor adherence to medication or lifestyle modification post MI.
Effective treatment of depression may improve survival in MI patients.
Health education and promotion
Psychotherapy for depression and anxiety
SMART goals and Dual-process model is used to tailor needs and preference of patient.