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3 Risk Factors for CVD.ppt - Risk...

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3 Risk Factors for CVD.ppt

3 Risk Factors for CVD.ppt - Risk...

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Unformatted text preview: Risk FactorsforCardiovascularDiseaseDefinition ofRisk FactorRiskA factor that changes the riskfactoror odds that a specific diseaseor medical event will occurorRisk FactorExperimentExperimentOne-third of class that walks acrossOne-thirdRoute 1 can keep their eyes open everytime they cross Route 1timeOne-third of class that walks acrossOne-thirdRoute 1 has to close their eyes everytime they cross Route 1timeOne-third of class that walks acrossOne-thirdRoute 1 has to close their eyes everyother time they cross Route 1otherCriteria to Determine ifSomething is a Risk FactorSomethingStatistical relationshipPotential mechanism toPotentialexplain relationshipexplainCardiovascular Disease RiskFactorsFactorsAgeGenderHeredity (Race)Tobacco smokeHigh cholesterolHigh bloodHighpressurepressurePhysical inactivityObesity &ObesityoverweightoverweightDiabetes mellitusStressDrinking too muchDrinkingalcoholalcoholAmerican Heart AssociationMajorMajorCardiovascular DiseaseRisk FactorsRiskRisk factors that independently andRisksignificantly increase the risk of heartand blood vessel (CV) diseaseandAmerican Heart AssociationMajorMajorCardiovascular DiseaseRisk FactorsRiskAgeGenderHeredity (Race)Tobacco smokeHigh cholesterolHigh bloodHighpressurepressurePhysical inactivityObesity &ObesityoverweightoverweightDiabetes mellitusAmerican Heart AssociationContributingContributingCardiovascular Disease Risk FactorsCardiovascularOther factors that are associated withOtherincreased risk of CV disease, but theirsignificance and prevalence havent yetbeen precisely determinedbeenAmerican Heart AssociationContributingContributingCardiovascular Disease Risk FactorsCardiovascularStressExcessive alcohol intakeCardiovascular Disease RiskFactorsFactorsAgeGenderHeredity (Race)Tobacco smokeHigh cholesterolHigh bloodHighpressurepressurePhysical inactivityObesity &ObesityoverweightoverweightDiabetes mellitusStressDrinking too muchDrinkingalcoholalcoholModifiable vs. Non-modifiableCV Disease Risk FactorsCVModifiableTobacco smokeHigh cholesterolHigh blood pressurePhysical inactivityObesity & overweightDiabetes mellitusStressExcessive alcoholExcessiveintakeintakeNon-modifiableAgeGenderHeredity (Race)Cardiovascular Disease inAfrican Americans vs.CaucasiansCaucasiansCVD death rates(per/100,000)Heart dis. death rates(per/100,000)Stroke death rates(per/100,000)MenWomenMenWomenAA Cauc AA CaucCauc AA Cauc336 230 217 12813813813585645252264023Effect of Age and Genderon CV Disease RiskonAge (yrs)29 to 3435 to 3940 to 444045 to 494550 to 545055 to 595560 to 646065 to 696570 to 7475 to 79CVD rates/1000/yrMen3.42.95.79.116.525.127.626.737.853.0WomenWomen0.80.71.33.16.110.218.122.126.250.4Risk RatioRiskAlso sometimes called odds or mortalityAlsoratio, or relative riskratio,Quantifies the increase in risk in one groupQuantifiesrelative to a comparison (control) groupRisk Ratio = Risk in One GroupRiskRisk in Control GroupRiskBottom line is there is some risk even in theBottomcontrol group, risk ratio quantifies how muchhigher the risk is in the other grouphigherRisk Ratio ExampleRiskIn our Eyes Closed While Crossing RouteIn1 Experiment with 10 subjects in eachgroup: 2 medical events in eyes opengroup, 5 in half eyes-closed group, 7 in alleyes-closed groupeyes-closedRelative risk in half eyes-closed groupRelativehalfcompared to eyes open group = 5/2 or arelative risk of 2.5relativeRelative risk in all eyes-closed groupRelativeallcompared to eyes open group = 7/2 or arelative risk of 3.5relativeThe Pooling Project of Prospective Studies of Diet and CancerSmoking and Disease RiskSmokingYugoslaviaGreeceItalyFinlandNetherlandsUSAJapan< 200mg/dl = desirableFor more on the Seven Countries Study (cross-sectional design):http://www.epi.umn.edu/research/7countries/overview.shtmThese are people with the SAME ethnic background livingin 3 different places! (Cross-sectional with a bonus!)What do you think the biggest difference betweenthese groups is that could affect CVD risk?Multiple Risk Factor Intervention TrialLongitudinal 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 weget about CHDfrom TC and LDLWhich 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 oBePrdresuslicashy vityP tiAcAerobics Center Longitudinal StudyLongitudinalFitness GroupRelative RiskMen3.441.3731.464Highest 20%1 (low)(low)2Lowest 20%1.175 (high)(high)Risk ofdyingoverall1.00Women1 (low)(low)4.6522.4231.4340.765 (high)(high)1.00How much physical activity do you need to get to decrease your relative risk for death?Physical Activity, All-Cause Mortality, andLongevity of College AlumniLongevityPaffenbarger, et al (1986) NEJM, 314.Physical ActivityIndex (kcal/wk)IndexHarvard alumni; 16,936Harvardmen aged 35-74 at entry;16-yr follow-up, 196216-yr1978Relative Risk ofRelativeDeathDeath<5001.00500 9990.781,000 1,4990.731,500 1,9990.632,000 2,4990.622,500 2,9990.523,000 3,4990.463,500 +0.62Just a little physical activity can go a long way!et ebDiasIDDMIDDMInsulin-DependentDiabetes MellitusNIDDM______Non-Insulin-DependentDiabetes MellitusAlternative NameType 1______Type 2_______% of Diabetics5%______95%_______Full NameClinical Information Insulin-Deficiency______Insulin injectionsnecessary____________________If untreated, can result inInsulin injections_______Insulin-ResistanceRelative Risks of DevelopingCardiovascular Disease inDiabetics versus NondiabeticsDiabeticsRelative Risk, Diabetics vs. NondiabeticsRelativeLocation of Study,Age of Patients,and Duration ofStudyStudySexAngina PectorisCongestiveCongestiveHeart FailureHeartMyocardialMyocardialInfarctionInfarctionFramingham, MA,Framingham,45-74 years, 10 yearfollow-upfollow-upMenWomen1.61.93.85.51.52.6Rochester, MI, 30+Rochester,years, >3,000person-years offollow-upfollow-upMenWomen1.72.43.02.52.44.7Those with diabetes have >2.5 times more incidence of hypertension!/i tysbeOrwveOtigheHeight(with shoes)Desirable Weights for MenWeight in Indoor Clothing, lbSmall FrameMedium FrameLarge FrameMen5'2"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"128-134130-136132-138134-140136-142138-145140-148142-151144-154146-157149-160152-164155-168158-172162-176131-141133-143135-145137-148139-151142-154145-157148-160151-163154-166157-170160-174164-178167-182171-187138-150140-153142-156144-160146-164149-168152-172155-176158-180161-184164-188168-192172-197176-202181-207WomenSource: Metropolitan Life Insurance Co., 19834'10"102-111109-121118-1315'11"6'0"6'1"6'2"6'3"Height6'4"(with shoes)WomenMen 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"146-157154-166161-184149-160157-170164-188Desirable Weights for Women152-164160-174168-192155-168164-178172-197158-172 Weight in Indoor Clothing, lb 176-202167-182162-176171-187181-207Small FrameMedium FrameLarge Frame102-111103-113128-134104-115130-136106-118132-138108-121134-140111-124136-142114-127138-145117-130120-133140-148123-136142-151126-139144-154129-142146-157132-145149-160135-148152-164138-1516'2"155-168Source: Metropolitan Life Insurance Co.6'3"158-1726'4"162-176109-121111-123131-141113-126133-143115-129135-145118-132137-148121-135139-151124-138142-154127-141130-144145-157133-147148-160136-150151-163139-153154-166142-156157-170145-159160-174148-162118-131120-134138-150122-137140-153125-140142-156128-143144-160131-147146-164134-151149-168137-155140-159152-172143-163155-176146-167158-180149-170161-184152-173164-188155-176168-192158-179164-178167-182171-187172-197176-202181-207Body Mass IndexBodyWt (kg)BMI =2Ht (m)UnderweightNormal< 18.5 kg/m218.5 24.9 kg/m2OverweightObese25 29.9 kg/m2> 30 kg/m2BMI EXAMPLE & POTENTIALPROBLEMPROBLEMOverweight/obese does not necessarily mean over fat6161250Weight(lbs.)25033www.sportsillustrated.comHeightBMI(kg/m2)33www.cipladoc.com/.../hazards/issue4.htmThe higher the BMI, the greater the risk for developing CVDRelationship Between BMI andRelationshipCardiovascular Disease MortalityCardiovascularRelative Risk of Death3.02.62.2MenWomen1.81.41.00.6LeanOverweightObese<18.5 18.5 20.5 22.0 23.5 25.0 26.5 28.0 30.0 32.0 35.0 >40.020.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9Body Mass IndexCalle et al. N Engl J Med 1999;341:1097.Body Fat %DEXA: Dual Energy Xray AbsorptiometryBioelectrical ImpedanceSkinfold CalipersHydrostatic WeighingWaist-to-Hip RatioWaist-to-HipBMI does not tell the whole story A person with an excess of abdominal fatperson(apple shape) is at greater risk for CVDisease than a person with fat depositsin the lower body (pear shape)inWAIST-TO-HIP RATIO &RISKRISKIn general, increased disease risk isInassociated with waist-to-hip ratiosof:of: MEN> 1.0MEN1.0 WOMEN > 0.8WOMEN0.8...
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