CVD risk background

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.n
hs.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 199826136-140
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 20032908917
• 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 2003290898904
• 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 199910(2)
Number Needed to Treat (NNT) for five years to
avoid one vascular death
Interventions for secondary prevention of MI
9
Mediterranean diet
19
Eating oily fish
21
Stopping smoking
26
Statins
30
Beta-blockers
37
Aspirin
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