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MI: Risk Factors and Primary Prevention

MI: Risk Factors and Primary Prevention. Risk Factors. Factors that appear to increase the general population’s chances of experiencing a health problem Not a guarantee that any one individual will have the problem, but useful when applied to entire patient population.

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MI: Risk Factors and Primary Prevention

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  1. MI: Risk Factors and Primary Prevention

  2. Risk Factors • Factors that appear to increase the general population’s chances of experiencing a health problem • Not a guarantee that any one individual will have the problem, but useful when applied to entire patient population

  3. How are Risk Factors Determined? • Show a causal relationship between the risk factor and the disease through careful study • Association studied should have, if possible: • Strength • Consistency • Specificity • Proper Time Sequence • A Potential Biological Explanation and/or Analogy • A Dose-Response Relationship • A large Testable Population

  4. MI Risk Factors Many can be reduced or avoided through Primary Prevention

  5. Preventable Risk Factors and MI • Up to 90% of myocardial infarction risk comes from factors that can be changed long before MI occurs (Lancet, Sept. 2004) • Primary prevention: actions that stop the development of a disease before it even starts

  6. Risk Factor: Smoking • Dose-response relationship without plateau • Every additional cigarette smoked increases MI risk further • Reduces body’s ability to signal for production of tPA, a natural clot-busting protein • Women smokers at further elevated risk

  7. Primary Prevention: Smoking • Don’t start • However much you smoke, smoke less.

  8. Risk Factor: Hi LDL/ Lo HDL • Cholesterol: • Vital component of cell walls • Vital precursor to many hormones • HOWEVER, also major component of atherosclerotic plaques • Made in the liver • Lipoproteins • Make fat and cholesterol soluble in the blood

  9. Risk Factor: Hi LDL/ Lo HDL • Low Density Lipoprotein • Carries cholesterol from liver to body for use • “Bad” cholesterol • High plasma LDL (>70-100 mg/dL) = more atherosclerosis, MI • High Density Lipoprotein • Carries cholesterol from body to the liver for elimination • “Good” cholesterol • Low plasma HDL (<40mg/dL) = more atherosclerosis, MI

  10. Primary Prevention: Hi LDL/ Lo HDL • Dietary Changes: • Decrease saturated fat consumption (<7%) • Eliminate trans fat consumption • Cholesterol in food NOT strong link to increased LDL • Lifestyle Changes: • Increase activity • Not always possible

  11. Risk Factor: Chronic Hypertension • Continuously High Blood Pressure • Systolic > 140 mmHg • Linked to ¼ of MI cases • Strongly linked to arteriosclerosis and CVD

  12. Primary Prevention: Hypertension • Dietary Changes: • Reduce sodium intake • Reduce simple sugar intake • Get daily doses of Potassium and Calcium • Lifestyle changes • Get more exercise, keep HR elevated for longer • Decrease body fat • Avoid stress • Again, not always possible

  13. Abdominal Obesity and Diet • Obesity from excessive fat around the abdomen is a strong predictor of many other risk factors • High LDL • Hypertension • Diabetes • Waist:Hip ratio • 0.9 for men • 0.85 for women

  14. Abdominal Obesity and Diet • However, poor diet can lead to all of those even without obesity • Eat fruits and vegetables • Avoid saturated fats and trans fats • Get >25g dietary fiber per day

  15. Unavoidable MI Risk Factors

  16. Genetics and MI risk factors • All previously mentioned risk factors can also be influenced by genes • Family history increases risk of • Hypercholesterolemia (High LDL) • Hypertension • Atherosclerosis • As genetics advances, we can separate “nature” from “nurture” • Specific genes and mutations shown to increase clotting risk, LDL, etc.

  17. Gender • Estrogen linked to lower risk of MI • Pre-menopause: women at lower risk • Post-menopause: women at same risk as men • MI leading cause of death for both men and women

  18. Aging • Some degree of atherosclerosis inevitable with age • Even with perfect health, risk of MI increases in old age

  19. Diabetes • Failure of normal insulin function • Type I: genetic, no insulin produced • Type II: acquired with some genetic predisposition, insulin resistance • Increases risk of high LDL and high blood pressure • Further increases the risk of MI, possibly due to damage caused by poorly controlled blood sugar

  20. Recap • If a patient doesn’t think they can quit smoking, is there any use to trying to get them to smoke less? • True or false: only overweight patients have high blood pressure. • Which item should you leave out of your breakfast if you want to improve your LDL:HDL ratio the most: eggs, bacon, or milk?

  21. Sources • Yusuf, et al, “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study,” The Lancet, Volume 364, Issue 9438, Pages 937 - 952, 11 September 2004 • Chobanian , et al, “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,” Hypertension. 2003;42:1206 • Ulrich, et al, “A comprehensive linkage analysis for myocardial infarction and its related risk factors,” Nature Genetics, 2002, vol. 30, no2, pp. 210-214 • Ardissino, et al, “Prothrombotic Genetic Risk Factors in Young Survivors of Myocardial Infarction,” Blood, 1999 94: 46-51

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