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Factors for Cardiovascular Disease Definition Risk of Risk Factor Risk A factor that changes the risk factor or odds that a specific disease or medical event will occur or Risk Factor Experiment Experiment One-third of class that walks across One-third Route 1 can keep their eyes open every time they cross Route 1 time One-third of class that walks across One-third Route 1 has to close their eyes every time they cross Route 1 time One-third of class that walks across One-third Route 1 has to close their eyes every other time they cross Route 1 other Criteria to Determine if Something is a Risk Factor Something Statistical relationship Potential mechanism to Potential explain relationship explain Cardiovascular Disease Risk Factors Factors Age Gender Heredity (Race) Tobacco smoke High cholesterol High blood High pressure pressure Physical inactivity Obesity & Obesity overweight overweight Diabetes mellitus Stress Drinking too much Drinking alcohol alcohol American Heart Association Major Major Cardiovascular Disease Risk Factors Risk Risk factors that independently and Risk significantly increase the risk of heart and blood vessel (CV) disease and American Heart Association Major Major Cardiovascular Disease Risk Factors Risk Age Gender Heredity (Race) Tobacco smoke High cholesterol High blood High pressure pressure Physical inactivity Obesity & Obesity overweight overweight Diabetes mellitus American Heart Association Contributing Contributing Cardiovascular Disease Risk Factors Cardiovascular Other factors that are associated with Other increased risk of CV disease, but their significance and prevalence havent yet been precisely determined been American Heart Association Contributing Contributing Cardiovascular Disease Risk Factors Cardiovascular Stress Excessive alcohol intake Cardiovascular Disease Risk Factors Factors Age Gender Heredity (Race) Tobacco smoke High cholesterol High blood High pressure pressure Physical inactivity Obesity & Obesity overweight overweight Diabetes mellitus Stress Drinking too much Drinking alcohol alcohol Modifiable vs. Non-modifiable CV Disease Risk Factors CV Modifiable Tobacco smoke High cholesterol High blood pressure Physical inactivity Obesity & overweight Diabetes mellitus Stress Excessive alcohol Excessive intake intake Non-modifiable Age Gender Heredity (Race) Cardiovascular Disease in African Americans vs. Caucasians Caucasians CVD death rates (per/100,000) Heart dis. death rates (per/100,000) Stroke death rates (per/100,000) Men Women Men Women AA Cauc AA Cauc Cauc AA Cauc 336 230 217 128 138 138 135 85 64 52 52 26 40 23 Effect of Age and Gender on CV Disease Risk on Age (yrs) 29 to 34 35 to 39 40 to 44 40 45 to 49 45 50 to 54 50 55 to 59 55 60 to 64 60 65 to 69 65 70 to 74 75 to 79 CVD rates/1000/yr Men 3.4 2.9 5.7 9.1 16.5 25.1 27.6 26.7 37.8 53.0 Women Women 0.8 0.7 1.3 3.1 6.1 10.2 18.1 22.1 26.2 50.4 Risk Ratio Risk Also sometimes called odds or mortality Also ratio, or relative risk ratio, Quantifies the increase in risk in one group Quantifies relative to a comparison (control) group Risk Ratio = Risk in One Group Risk Risk in Control Group Risk Bottom line is there is some risk even in the Bottom control group, risk ratio quantifies how much higher the risk is in the other group higher Risk Ratio Example Risk In our Eyes Closed While Crossing Route In 1 Experiment with 10 subjects in each group: 2 medical events in eyes open group, 5 in half eyes-closed group, 7 in all eyes-closed group eyes-closed Relative risk in half eyes-closed group Relative half compared to eyes open group = 5/2 or a relative risk of 2.5 relative Relative risk in all eyes-closed group Relative all compared to eyes open group = 7/2 or a relative risk of 3.5 relative The Pooling Project of Prospective Studies of Diet and Cancer Smoking and Disease Risk Smoking Yugoslavia Greece Italy Finland Netherlands USA Japan < 200mg/dl = desirable For more on the Seven Countries Study (cross-sectional design): http://www.epi.umn.edu/research/7countries/overview.shtm These are people with the SAME ethnic background living in 3 different places! (Cross-sectional with a bonus!) What do you think the biggest difference between these groups is that could affect CVD risk? Multiple Risk Factor Intervention Trial Longitudinal Study Design: Studying the same person over time. How is this good? BAD cholesterol: 10% triglycerides, 45% cholesterol, 22% phospholipid, and 25% protein. Levels: <130 mg/dl, ideally < 100 mg/dl. Also BAD cholesterol: 55-65% triglycerides, 10-15% cholesterol, 1520% phospholipid, and 5-10% protein. Levels: <40 mg/dL. GOOD cholesterol: Low triglycerides and 40-50% protein. Levels: <40mg/dl, ideally > 60 mg/dl. How much info we get about CHD from TC and LDL Which is a better predictor of future CHD? If we were to choose 1 measure, which lipoprotein is the best predictor of CHD? So for every 20mg/dl decrease, your risk of getting CHD is doubled! lo o B e Pr d re su s l ica s hy vity P ti Ac Aerobics Center Longitudinal Study Longitudinal Fitness Group Relative Risk Men 3.44 1.37 3 1.46 4 Highest 20% 1 (low) (low) 2 Lowest (high) (high) Risk 20% 1.17 5 of dying overall 1.00 Women 1 (low) (low) 4.65 2 2.42 3 1.43 4 0.76 5 (high) (high) 1.00 How much physical activity do you need to get to decrease your relative risk for death? Physical Activity, All-Cause Mortality, and Longevity of College Alumni Longevity Paffenbarger, et al (1986) NEJM, 314. Physical Activity Index (kcal/wk) Index Harvard alumni; 16,936 Harvard men aged 35-74 at entry; 16-yr follow-up, 196216-yr 1978 Relative Risk of Relative Death Death <500 1.00 500 999 0.78 1,000 1,499 0.73 1,500 1,999 0.63 2,000 2,499 0.62 2,500 2,999 0.52 3,000 3,499 0.46 3,500 + 0.62 Just a little physical activity can go a long way! et e b Dia s IDDM IDDM Insulin-Dependent Diabetes Mellitus NIDDM ______ Non-Insulin-Dependent Diabetes Mellitus Alternative Name Type 1 ______ Type 2 _______ % of Diabetics 5% ______ 95% _______ Full Name Clinical Information Insulin-Deficiency ______ Insulin injections necessary ______ _______ _______ If untreated, can result in Insulin injections _______ Insulin-Resistance Relative Risks of Developing Cardiovascular Disease in Diabetics versus Nondiabetics Diabetics Relative Risk, Diabetics vs. Nondiabetics Relative Location of Study, Age of Patients, and Duration of Study Study Sex Angina Pectoris Congestive Congestive Heart Failure Heart Myocardial Myocardial Infarction Infarction Framingham, MA, Framingham, 45-74 years, 10 year follow-up follow-up Men Women 1.6 1.9 3.8 5.5 1.5 2.6 Rochester, MI, 30+ Rochester, years, >3,000 person-years of follow-up follow-up Men Women 1.7 2.4 3.0 2.5 2.4 4.7 Those with diabetes have >2.5 times more incidence of hypertension! / i ty s be O rw ve O t igh e Height (with shoes) Desirable Weights for Men Weight in Indoor Clothing, lb Small Frame Medium Frame Large Frame Men 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" 128-134 130-136 132-138 134-140 136-142 138-145 140-148 142-151 144-154 146-157 149-160 152-164 155-168 158-172 162-176 131-141 133-143 135-145 137-148 139-151 142-154 145-157 148-160 151-163 154-166 157-170 160-174 164-178 167-182 171-187 138-150 140-153 142-156 144-160 146-164 149-168 152-172 155-176 158-180 161-184 164-188 168-192 172-197 176-202 181-207 Women Source: Metropolitan Life Insurance Co., 1983 4'10" 102-111 109-121 118-131 5'11" 6'0" 6'1" 6'2" 6'3" Height 6'4" (with shoes) Women Men 4'10" 4'11" 5'2" 5'0" 5'3" 5'1" 5'4" 5'2" 5'5" 5'3" 5'6" 5'4" 5'7" 5'5" 5'6" 5'8" 5'7" 5'9" 5'8" 5'10" 5'9" 5'11" 5'10" 6'0" 5'11" 6'1" 6'0" 146-157 154-166 161-184 149-160 157-170 164-188 Desirable Weights for Women 152-164 160-174 168-192 155-168 164-178 172-197 158-172 Weight in Indoor Clothing, lb 176-202 167-182 162-176 171-187 181-207 Small Frame Medium Frame Large Frame 102-111 103-113 128-134 104-115 130-136 106-118 132-138 108-121 134-140 111-124 136-142 114-127 138-145 117-130 120-133 140-148 123-136 142-151 126-139 144-154 129-142 146-157 132-145 149-160 135-148 152-164 138-151 6'2" 155-168 Source: Metropolitan Life Insurance Co. 6'3" 158-172 6'4" 162-176 109-121 111-123 131-141 113-126 133-143 115-129 135-145 118-132 137-148 121-135 139-151 124-138 142-154 127-141 130-144 145-157 133-147 148-160 136-150 151-163 139-153 154-166 142-156 157-170 145-159 160-174 148-162 118-131 120-134 138-150 122-137 140-153 125-140 142-156 128-143 144-160 131-147 146-164 134-151 149-168 137-155 140-159 152-172 143-163 155-176 146-167 158-180 149-170 161-184 152-173 164-188 155-176 168-192 158-179 164-178 167-182 171-187 172-197 176-202 181-207 Body Mass Index Body Wt (kg) BMI = 2 Ht (m) Underweight Normal < 18.5 kg/m2 18.5 24.9 kg/m2 Overweight Obese 25 29.9 kg/m2 > 30 kg/m2 BMI EXAMPLE & POTENTIAL PROBLEM PROBLEM Overweight/obese does not necessarily mean over fat 61 61 250 Weight (lbs.) 250 33 www.sportsillustrated.com Height BMI (kg/m2) 33 www.cipladoc.com/.../hazards/issue4.htm The higher the BMI, the greater the risk for developing CVD Relationship Between BMI and Relationship Cardiovascular Disease Mortality Cardiovascular Relative Risk of Death 3.0 2.6 2.2 Men Women 1.8 1.4 1.0 0.6 Lean Overweight Obese <18.5 18.5 20.5 22.0 23.5 25.0 26.5 28.0 30.0 32.0 35.0 >40.0 20.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9 Body Mass Index Calle et al. N Engl J Med 1999;341:1097. BodyFat% DEXA:DualEnergyXrayAbsorptiometry BioelectricalImpedance SkinfoldCalipers HydrostaticWeighing Waist-to-Hip Ratio Waist-to-Hip BMI does not tell the whole story A person with an excess of abdominal fat person (apple shape) is at greater risk for CV Disease than a person with fat deposits in the lower body (pear shape) in WAIST-TO-HIP RATIO & RISK RISK In general, increased disease risk is In associated with waist-to-hip ratios of: of: MEN > 1.0 MEN 1.0 WOMEN > 0.8 WOMEN 0.8 ... View Full Document

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