Lecture notes
Unit 2 Summary
- Module
- Cardiovascular (HH5607)
- Institution
- Brunel University (BU)
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Unit 2- Screening and DetectionPart 1: Risk Factors for Atherosclerotic CVD
Coronary Heart Disease: disease of the BV supplying heart
Cerebrovascular Disease: disease of BV supplying brain
Peripheral vascular disease: disease of BV supplying arms and legs
Task 1: Causes of atherosclerotic CVD
Behavioural Risk Factors Non-modifiable risk factors Environmental and social
tobacco Age Income/ financial inequalities
Unhealthy diet sex education
Physical inactivity genetics Living conditions
Alcohol abuse ethnicity Working conditions
High BP/ High cholesterol Family history
diabetes inflammation
Task 2: Lecture on CVD Risk Factors
• Concept called 3-4-50, meaning 3 risk factors linked to 4 chronic conditions (CVD,
cancer, diabetes, respiratory conditions), count for 50% of mortalities
• Once you reach 55, your risk doubles for every decade for incidence of stroke
• Men have higher risk of heart attack than pre-menopausal women (due to hormonal
protection). Once they reach menopause, risk evens out with men.
• Family history: when talking about this its more specific to pre-mature heart disease.
Where male has heart attack under 55 or under 65 for women, would indicate
premature disease. Might find that they have familial hypercholesteremia (FH)
• SA in UK twice as likely to develop coronary heart disease. African-Caribbean also have
higher risk of high BP and increased risk of stroke
Smoking
• Smoking: increases risk of blood clots, 1 in every 2 smokers die of tobacco related heart
disease, smokers 60% more likely to die from hear disease than non smokers
o Quitting: BP and pulse rates return to normal within 20 minutes, risk of heart
attack falls within 1 day, and after 1 year your risk of sudden death from heart
attack is almost cut in half and risk of cancer reduced.
o Have to be smoke free for 15 years to return to risk of non smokers
• How does smoking cause CVD
o Consider nicotine and how it increases BP, shear forces, damamging
endothelium, and plaque formation
o Carbon monoxide binds to haemoglobin in preference to oxygen. Lowered
oxygen increases vulnerability to myocardial ischemia and mismatch between
supply and demand and this is linked to arrhythmia and myocardial infarct.
, o All types of smoking including e-cigarettes can increase toxicity and most have
nicotine. Huka still uses tobacco. Cannabis can trigger heart attack, risk of cardiac
event increases 5 fold in first hour. It increases SBP and HR (Increases stress on
walls) and these are oxygen consuming and increasing vulnerability to ischemia
and increased risk of infarct.
• Assessment and Measurement of Smoking Status
o Self reported (current smoking status- pack years- motivation to quit-
dependence etc)
o Breath CO
o Cotinine (urine or blood) is gold standard
o Pack years: number of years smoked x average number of packs smoked per
day= pack years
Can you inhale a heart attack? Air pollution/quality is linked to CV health. Annually, though 3.5
million deaths worldwide caused by ambulant air pollution. CO is one of the primary pollutants.
MET levels- should be 10 or more in men, more than 9 in women
The determinants drive the risk factors: The Dahlgren and Whitehead model (1991) of health
determinants provides insight into determinants that may affect health behaviours and health
outcomes, and gives us an appreciation for how their influence can relate to health effects
among different population groups.
Cardiovascular health is greatly influenced by social determinants. According to the World
Health Organisation, the social determinants of health are the conditions in which people are
born, grow, live, work and age. When working with your patient population, it is worth
considering some of the following social determinants which are key factors influencing health
throughout the life-course: gender, early child development, education, literacy, culture,
employment status and working conditions, income and social status, housing, local
environment, personal health practices, access to healthcare, and social support networks.
An individual’s social and economic position is directly linked to health. It has long been
recognised that a health inequalities gradient exists; with the least advantaged populations
experiencing the worst health. NICE public health guidance 6, ‘Behaviour change at population,
community and individual levels’ (2007) recognises the impact of this social and economic
, position and its direct link to health, with health inequalities being the result of a set of complex
interactions, including:
• The long-term effect of a disadvantaged social position
• Differences in access to information, services and resources
• Differences in exposure to risk
• Lack of control over one’s own life circumstances
• A health system that may reinforce social and economic inequalities.
BP
• Want to have as low of a BP without symptoms
• Target of 140 or less is a treatment threshold
• At middle age a 20 mmHg difference in SBP associated with twofold increase in CHD
mortality
Blood lipids/Cholesterol:
Think of HDL like scavenger that takes away LDL, LDL is main driver for CV health
In the UK, moving towards looking at Non-HDL, with TC-HDL
Measurement of Lipids- does not need fasting
Blood Glucose:
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