Cardiometabolic risk
12 important questions on Cardiometabolic risk
What are the 5 stages in the process of Cardiometabolic disease
- Healthy
- able to adapt
- Early changes
- small abnormalities; do not yet affect the functioning of the body
- Preclinical phase
- elevated risk factors; insulin resistance, low-grade inflammation and changes to arterial wall, high blood pressure and cholesterol, loss of kidney function
- Screening
- e.g. Oral glucose tolerance test or heart scan can for calcification in coronary arteries
- clinical phase
- disease event; with hospitalisations and specialist care
You can have exogenous risk factors and endogenous risk factors for Cardiometabolic diseases. Name a few
- smoking
- diet
- physical activity
- alcohol use
- stress
- other lifestyle and environmental factors
Endogenous factors (biological/intrinsic factors): (non-modifiable risk factors)
- age
- sex
- genetic factors
- blood lipids
- blood pressure
- body composition
- diabetes mellitus
- chronic inflammation
CV risk factors not only affect heart and blood vessel, but also kidney, brain and eye
What are the 'new' pathways in Cardiometabolic disease?
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Which CVD risk factor is the largest contributor to morality worldwide?
Blood pressure and risk of IHD and stroke. How does this looks like in a graph. And when do you reach the hypertension gut of point
Risk increases already at SBP > 115 mmHg!
What are the cholesterol target values?
- <5 mmol/l normaal
- >5 mmol/l slightly elevated
- >6,5 mmol/l elevated
- >8.0 mmol/l highly elevated
HDL
- >1.5 is healthy
Triglycerides
- <1.7 is healthy
Cholesterol Ratio (TC/HDL)
- <4 is healthy
LDL
- <3 is healthy
What is the influence of total blood cholesterol on CHD mortality and stroke mortality
Three important pathways for CMD
- Saturated fat intake
- Raised serum (LDL) cholesterol
- Atherosclerosis
- Myocardial infarction (CHD)
- High salt intake
- Raised blood pressure
- Kidney function decline & stroke
- Low fibre intake
- Obesity
- Type 2 diabetes & CHD
Rothman's pie model for causality
A risk factor that all three have in common might be a necessary cause, that always needs to be present before the disease can develop
N.B. A necessary cause does not have to be a sufficient cause!
Who does the SCORE system works?
based on gender, age, total cholesterol, systolic blood pressure and smoking status
based on individual's risk to die from CVD within next 10 year
In the USA they have the Framingham risk score
How does the prevention of the guidelines European society of cardiology look like?
- Quit smoking
- Physical activity >= 5x per week (30 min)
- alcohol: max. 2 glasses (women) or 3 glasses (men) per day (Dutch health council: 0-1 glasses per day
- Optional body weight (BMI < 25kg/m2)
- dietary advice
- <10% saturated fat, <1% trans fat
- fish: 1-2 times per week
- 200 grams vegetables and 2 pieces of fruit
- salt: max. 6 grams per day
If 10-years risk >10%
- all of the above PLUS
- statins and antihypertensive medication
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