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CVD risk - background

CVD risk - background. What are we going to cover? basic epidemiology risk factors what can we do?. CVD risk - background. Cardiovascular disease (CVD) is currently the main cause of death in the UK and was responsible for just under 233,000 deaths in 2003

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CVD risk - background

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  1. CVD risk - background What are we going to cover? • basic epidemiology • risk factors • what can we do?

  2. CVD risk - background Cardiovascular disease (CVD) is currently the main cause of death in the UK and was responsible for just under 233,000 deaths in 2003 CVD includes coronary heart disease (CHD), stroke and peripheral artery disease CHD is most commonly caused by atherosclerosis, which occurs when deposits of cholesterol accumulate to form a plaque accumulate leading to a cascade of inflammatory processes.

  3. What are the risk factors?http://www.cks.library.nhs.uk/ • People who already have CHD, cerebrovascular disease, peripheral artery disease • Diabetes (Type 1 and 2) • Ethnicity (ancestry from India, Pakistan, Bangladesh, or Sri Lanka) • Increasing age • Male gender • Lifetime smoking habit • High ratio of total cholesterol to HDL cholesterol • High systolic BP • Overweight or obesity • Sedentary lifestyle

  4. Risk factors continued…. http://www.cks.library.nhs.uk/ • Alcohol abuse • Socioeconomic deprivation • Familial hypercholesterolaemia, familial mixed dyslipidaemia, or other inherited dyslipidaemias • Family history of premature CVD • Impaired glucose regulation • High triglycerides • Renal dysfunction • Left ventricular hypertrophy

  5. Sever P. Medicine 1998;26:136-140 Increase in the risk of CHD as a result of smoking, hypertension and high cholesterol compared to a 45-year old non-smoking man with systolic BP of 110mmHg and total cholesterol of 4.6mmol/l Data from the Framingham study

  6. Concentrate on main conventional risk factors(smoking, BMI, hypertension, hypercholesterolaemia) Greenland P et al. JAMA 2003;290:891–7 • In 3 large cohort studies, 87 –100% of patients who died of CHD had exposure to at least 1 clinically elevated major risk factor • This challenges claims that CHD events commonly occur in people without risk factors. Khot UN et al. JAMA 2003;290:898–904 • 14 large RCTs conducted in the 1990s • At least 1 of the conventional risk factors was present in 84.6% of the women and 80.6% of the men.

  7. Numbers needed to treat for different secondary interventionsMeReC Bulletin 1999;10:(2) Interventions for secondary prevention of MI Number Needed to Treat (NNT) for five years to avoid one vascular death Mediterranean diet 9 Eating oily fish 19 Stopping smoking 21 Statins 26 Beta-blockers 30 Aspirin 37 Based on patients who have a baseline CHD risk of 3% per year

  8. Summary • CVD is a killer • Risk factors are additive, its synergetic as risk greater than just the sum of the individual risks. • We all need to modify our risk factors – it is never too late

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