Unit 2: Screening & Detection Flashcards
Define coronary heart disease, cerebrovascular disease, peripheral vascular disease.
- Coronary Heart Disease- disease of the blood vessels supplying the heart muscle
- Cerebrovascular Disease: disease of the blood vessels supplying the brain
- peripheral Vascular Disease: disease of the blood vessels supplying the arms and the legs
What is the underlying pathology of cardiovascular disease (CVD)?
Atherosclerosis, thrombus (clotting)
Name the non-modifable risk factors of atherosclerotic CV disease?
Non-modifiable
- Age i.e. >70
- Family history of CV disease (premature heart/CVD i.e. a fatal or non-fatal event (not an established diagnosis) in a 1st degree relative - parent or sibling which occur <65 yo (female) and <55 (male)- would indicate premature disease)
- Gender (male) - oestrogen withdrawal during menopause
- Inflammation
- Heredity (and ethnicity) - south asian, black Caribbean are some ethnicities that have a higher risk of CVD
Explain why one should quit smoking?
Smoking increases the risk of developing blood clots
- 1 in every 2 smokers die of a tobacco related disease
- Tobacco smoke contains over 4,000 chemicals, including tar, which cause cancer
- Smoking can take 10-15 years off your life
- Smokers are 60% more likely to die from heart disease than non smokers
- Within 1 day of quitting - risk of heart attack begins to fall
- Within 2 days - better sense of taste and smell
- Within 3 days - feel less breathless
After 15 years smoke-free your risk of sudden death from a heart attack is almost cut in half
How would you assess or measure smoking status?
How do you calculate pack years?
Self-reported
Breath carbon monoxide
Cotinine (analysis taken from urine or blood)
(no. of years smoked) x (no. of years) / 20 (as 20 cigarettes per pack) = pack-years
Can air pollution cause a heart attack and if so what types of air pollution?
Primary pollutants: nitric oxide (NO), carbon monoxide (CO), ammonia (NH3)
They increase plaque burden, damage endothelial walls causing inflammation
Name the modifiable medical risk factors of atherosclerotic CV disease?
- Hypertension
- Hyperglycaemia (Diabetes)
- Atherogenic dyslipdaemia (high blood cholesterol)
Name the modifiable lifestyle risk factors of atherosclerotic CV disease?
- Diet and nutrition (lifestyle)
- Physical inactivity
- Stress
- Smoking
- Alcohol
- Obesity/overweight
What is the blood pressure target for healthy people. What figure should it be under in average-aged adults?
In someone <69?
In someone >70?
120/80 mmHg
Everyone should be less than 140/90 mmHg - the lower the better once there are no symptoms of low blood pressure
120 - 130/80 mmHg
130-140/80 mmHg
What is the quantifiable method for diagnosing diabetes?
What is the fasting plasma glucose levels in normal (people diabetes), prediabetes and diabetes?
Measuring blood glucose levels
Normal: <5.5 mmol/l
Prediabetes: 5.5 - 6.9 mmol/l
Diabetes: > (or equal to) 7.0 mmol/l
What is the random blood glucose levels in normal and pre-diabetes?
What are the random blood glucose targets for adults with diabetes?
Normal or pre-diabetes: <11.1 mmol/l
Before meals: 4 - 7mmol/L
After meals: <9 mmol/L - type 1 diabetes
< 8.5 mmol/L - type 2 diabetes
How many categories of hypertension (HT) exist?
Grade 1 HT: 140-159 (and/or)/ 90-99 mmHg
Grade 2 HT: 160-179 (and/or)/ 100-109 mmHg
Grade 3 HT: >180 (and/or) / >110 mmHg
What is the blood pressure range for 18-69 year old adults who are being treated for high blood pressure?
Systolic blood pressure (SBP) of 120-130 mmHg
In all age categories of treated patients DBP should be <80mmHg
Outline how to take blood pressure accurately
- No talking
- Cuff has to be on BARE arm
- Support the arm at heart level
- Empty bladder first
- Support back
- Legs uncrossed
- Support feet
- What are the lipid targets for healthy people?
2. What are the lipid targets for people at low- moderate risk of CVD?
- LDL-C: <3 mmol/l
Non-HDL: <4 mmol/l
TG: <1.7 mmol/L
HDL: >1 mmol/L (males), >1.2 mmol/L (females) - LDL-C: <2.6 mmol/l
Non-HDL: <3.4 mmol/l
TG: <1.7 mmol/L
HDL: >1 mmol/L (males), >1.2 mmol/L (females)
How do you calculate non-HDL cholesterol?
Total cholesterol - high cholesterol (HDL)
What is the lipid targets for high risk people (with uncomplicated type 2 diabetes)?
LDL-C: < 1.8 mmol/l
Non-HDL: < 2.6 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L (males), > 1.2 mmol/L (female)
What is the lipid targets for very high risk people (with diabetes/with CVD/target organ damage)?
LDL-C: < 1.4 mmol/l
Non-HDL: < 2.2 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L. (males), >1.2 mmol/L (females)
What type of fats are healthiest?
What type of carbohydrate are healthiest?
Trans fatty acids are most linked to coronary heart disease (found in processed food, cakes, fries, anything with a long shelf-life). They should be replaced with mono unsaturated fatty acids and polyunsaturated fatty acids
Carbohydrates from refined starches/sugars should be replaced with carbohydrates from whole grains
What range of waist circumference for healthy males and females?
Males: 94 - 102 cm
Females: 80 - 88cm
What is the BMI for white European populations?
Underweight: <18.5 kg/m2
Increasing but acceptable risk: 18.5 - 24.9 kg/m2
Increased risk: 25 - 29.9 kg/m2
High risk: 30 kg/m2 or higher
What is the BMI for Asian populations?
Underweight: < 18.5 kg/m2
Increasing but acceptable risk: 18.5 - 22.9 kg/m2
Increased risk: 23 - 27.5 kg/m2
High risk: 27.5 kg/m2 or higher
How do you calculate BMI?
kg / (m)2
Why is physical activity protective for the heart?
Anti-atherosclerotic: Decreases blood pressure, adiposity and inflammation
improves lipids & insulin sensitivity
Psychological: decreases depression and stress, increases social support
Anti-thrombotic: increases fibrinolysis
decreases platelet adhesiveness, fibrinogen and blood viscosity
Anti-ischaemic: decreases Myocardial O2 demand & endothelial dysfunction
increases coronary blood flow, endothelial progenitor cells (EPC’s), circulating angiogenic cells, nitric oxide
Anti-arrhythmic: increases vagal tone & heart rate decreases adrenergic activity
