Risk Factors for Cardiovascular Disease PDF

Risk Factors for Cardiovascular Disease Objectives: Discuss non-modifiable and modifiable risk factors for Cardiovascular Disease Discuss emerging risk factors for Cardiovascular Disease Framingham Heart Study (FHS) FHS began in 1948, researchers recruited 5,209 men and women between the...

Risk Factors for Cardiovascular Disease Objectives: Discuss non-modifiable and modifiable risk factors for Cardiovascular Disease Discuss emerging risk factors for Cardiovascular Disease Framingham Heart Study (FHS) FHS began in 1948, researchers recruited 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts Researchers conducted physical exams and lifestyle interviews Later analyzed common pattern related to CVD development Framingham Heart Study (FHS) Ongoing study currently in its 3rd generation (including the original participants, their children, and their grandchildren) 1948 (1st generation) 1971 (2nd generation) 2002 (3rd generation) Study has been referenced in 6,000 articles in leading medical journals Framingham Heart Study (FHS) Through the FHS, we have learned the risk factors for heart disease and that many of the risks can be changed Implications on risk stratification/ treatments: during routine physical exams, doctors check BP, cholesterol, eating patterns, smoking status, physical activity status, assess body Framingham Heart Study (FHS) Risk factors can affect people differently depending on patient’s sex or race Findings from FHS paved the way to prevent and treat conditions more effectively Risk factors for CVD 2 groups of risk factors: Non-modifiable: age, male gender (men greater risk than premenopausal women, risk is similar after menopause), ethnicity, family history (genetics) Modifiable: health behaviour factors and traditional clinical risk factors Risk factors for CVD Health Behaviour Risk Factors: smoking, physical inactivity, diet (poor), excessive alcohol consumption, psychosocial factors, overweight and obesity Traditional Clinical Risk Factors: dyslipidemia, hypertension, diabetes mellitus Smoking Cigarette smoking and tobacco use dramatically increase risk of developing CVD Smoking responsible for ~25% of all CVD deaths in Canada Good news: prevalence of smoking has decreased substantially over the past 4 decades As a result of public health initiatives and clinical interventions Smoking Smoking Vaping? Cannabis? (smoking, eating, vaping) Increase risk of CVD Physical Inactivity Overall, 50% of Canadian adults are physically inactive (2005) Prevalence higher in women ↑ with advancing age tracked using self-reported questionnaires to measure Implications: rates likely overestimated In US, self-reported data suggest ~50% American adults are inactive whereas data based on objective measure of PA using accelerometers (device measures change in motion) indicate ~97% Physical Inactivity Diet (poor) Most relevant dietary markers: Excessive intake of saturated fats, cholesterol and sodium ~90% of adults do not meet the recommended target for saturated fats ~50% of men and 25% of women do not meet the recommended target for dietary cholesterol ~90% of men and 65% of women exceed the upper limit for sodium Negative effect on the risk of CVD Excessive Alcohol Consumption Patterns of drinking (moderate vs binge >6 drinks/session) Excessive alcohol intake, ↑ CVD risk New guidelines for alcohol consumption: 2023 Defining moderate alcohol consumption has changed CCSA-CGAH-Drinking-Less-is-Better-Alcohol-and-Youth-Poster-20 23-en (1).pdf Excessive Alcohol Consumption Psychosocial Factors Psychosocial factors such as depression, work stress, and low social support ↑ risk of CVD Overweight and Obesity Overweight and obesity- “refer to the elevation of body weight beyond normal range and are characterized by excessive accumulation of adipose tissue.” ↑ risk of CVD (linked to risk factors.. dyslipidemia, hypertension, diabetes, and several emerging risk factors) Overweight and Obesity BMI – body mass index Indicator of weight for height Does not distinguish between fat and lean tissue ↑ risk of CVD Body fat deposits and role of CVD risk Abdominal obesity → excess accumulation of visceral fat ↑ risk of CVD Overweight and Obesity Rates of overweight and obesity ↑ In 2004, 6 out of 10 Canadian adults were overweight or obese 1 out of 4 Canadian children and youth are overweight or obese Overweight and Obesity Dyslipidemia Abnormal blood lipid profile ↑ CVD risk High Total cholesterol (TC) High Low-density lipoprotein (LDL) * Low High-density lipoprotein (HDL) High TC/HDL ratio High Triglycerides The level at which dyslipidemia is deemed to be a major CVD risk factor is directly dependent on the individual global risk (ie., cumulative effect of all CV risk factors) Hypertension 17% of Canadians adults dx HTN Prevalence ↑ with age ↑ BP results in pathological changes in many organ systems – ↑CVD risk (↑ risk of stroke, retinopathy, PAD, CHF, renal failure) “silent killer” – frequently no symptoms until the disease in an advanced stage Hypertension Good news: improvements in the rate of hypertension control in the last decade Positive influence of the Canadian Hypertension Program (CHEP) on targeted management of HTN Diabetes DM ↑ risk of CVD DM is considered CVD risk equivalent (~same CVD event risk as patient with established disease… implication for treatment for HTN, dyslipidemia) T1DM and T2DM with majority of cases T2 DM origin Prevalence of DM highest in older adults Diabetes In 2005/06, 5.9% of the Canadian population dx with DM In 2017, 7.3% of Canadians aged 12 and older Summary – Risk Factors (health behaviour & traditional clinical) Trends: ↓ smoking rates ↑ prevalence of HTN, DM will likely continue to ↑ as population ages and rates of obesity/ inactivity ↑ Emerging Risk factors CACPR (2009)  Emerging Risk factors (↑CVD) ongoing research (not routinely screened) High C-Reactive Protein (CRP) levels CRP is a protein associated with inflammation found in the blood High Fibrinogen levels A protein involved in forming blood clots in the body High Lipoprotein(a), Lp(a) Is a type of LDL High Lp(a) increases clotting and inflammation )  References American College of Sports Medicine. (2018). ACSM’s guidelines for exercise testing and prescription (10th ed.). Lippincott Williams & Wilkins. Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention: Translating knowledge into action (3rd ed. ). (2009). Canadian Association of Cardiac Rehabilitation. Framingham Heart Study. https://www.framinghamheartstudy.org/