EPID 624 - Epidemiology of Chronic Diseases- Spring 2018

Cardiovascular Disease

Review CDC Heart Disease read the material and look at the interactive maps and WHO Atlas (Review just those items you think appropriate to this discussion, usually ther first item in each part/section), Use these maps for other cardiovascular diseases.

Latest Statistics on Heart Disease & Stroke from the AHA, Look at the paragraph on prevalence as well as incidence & mortality. Also, look at this latest report (Dec 2015) from the NCHS on cholesterol levels in children, Approximately one out of five children and adolescents (21%) had at least one abnormal cholesterol measure (high total cholesterol, low HDL cholesterol, or high non-HDL cholesterol!)..Look at thisnCDC app on heart disease death rates


Student PowerPoint Presentation

Reading from Textbook Chapter 13
As usual look at the first figure and compare with previous similar figures to compare causes and High Risk populations. focus first on coronary heart disease particularly the section on descriptive epidemiology and look at the Framingham project. Click on the link to the erpidemiologic background to get a feel for the effort that went into this continuing project. Consider what disease make up cardiovascular illness other than hypertension andstroke which wewill hear about next week.Think about that time trends what may have happened to cardiovascular diseases during the last 20 to 30 years to result in such a significant drop in heart disease deaths, then consider the modifiable risk factors with particular attention to tobacco, and obesity, also consider the file I sent you about cardiovascular disease deaths from JAMA this week.. Considering the attributable risk factors look at the prevention and control measures recommended and the example of evidence-based interventions. While in this course consider how many of the other chronic diseases we have evidence that is as good as that for cardiovascular diseases. . Then look at this JAMA 2011 Commentary on challenges for Cardiology. Also look at this 2011 commentary from the NIH on needed research for cardiovascular disease. Look at this from the Cleveland Clinic (review pages 1-9 of the main document.)Dr. buttery yes I can I borrow your car for a day again they they've had to keep my car because he couldn't make the headlight workw let me come over and pick up the keys okay if you come on over thank you

Scan Circulation pdf Facts (Do not attempt to read the whole publication but just the summary and pages 9 and 10 which relate to the incidence and prevalence. Then leaf through the rest quickly to get a feel for information available)


Visit the NCHS site and look for data on prevalence and incidence of heart disease (First section) Then go to Prevention at a glance (pdf file) 2010, and a commentary from JAMA. JAMA Review of progress.
Optimal strategies for prevention in the 21st Century and challenges for heart disease control from JAMA.

Read pages 4-8 from the paper on the Framingham Study History. Also look at this paper on angina in Women. You might want to use the Internet and search on the Framingham heart study, if you have time, and interest so prompts you. How about applying recommendations for secondary prevention of heart disease at community level (I have higlighted the essentials) from the AHA.
Consider the feasibility of a national surveillance system to support national policy.(Each state now has a cancer registry, should we have a Heart Disease Registry to give us more up-to-date information on the disease).

A current major controversy is which patients at risk should use statins,and is their use better then none, due to side effects?  The issue of how and when and on whom to use statins remains contentious. See the concern about More Pills, and this on use of statins., What about aspirin? What about a polypill (in particular look at the last highlight)? And an analyse of the readiness to impliment government enforcement of statins for all. At the end of 2015 The AHA News discussed the latest recommendations from the USPSTF on use of statins. the last few months many general medical publications around the worldhave issued different guidelines make it difficult for the medical professionals and the public to know what to do about statins, this article from the BMJ in November 2016 tries to sort out all these different competing recommendations.

Review the VDH Heart Disease web site
Is there a role for prevention in primary care? How about lifestyle?
What are the Healthy People 2020 Objectives? choose the two or three of those you believe to be the most important objectives, then consider whether are they likely to be met? What are the major elements of the 2020 plan? How does this relate to the million heart objectives?Another controversy in prevention of heart disease rolls around the use of fish oils or omega-3 fatty acids. There are many scams in healthcare associated industries particularly in the supplement industry. Take a look at this five-minute PBS video on "how good for you is fish oil really?"

Why do you think “Quality of Life” an important concept for chronic disease evaluation? What role may diet considerations oroviode?
Value of past research  Recommendatiss non future Research
What evidence do we have about the change in precursors to heart disease such as atherosclerosis?   

Review this article from science direct on obesity and cardiovascular disease control (Focus on the opening paragraph).
Scan this article in relation to tailored therapy for different diseases, mostly based on new findings linking genetic abnormalities to various diseases. An introduction of topic look at this commentary from JAMA.

Pragmatism - New Cholesterol Tx Guide
Study examines consumption of added sugar, death for cardiovascular disease

March 2017 Look at this editorial from JAMA for the week of March 7 as this article relates to the issues of obesity, diabetes, cardiovascular disease and hypertension and stroke. We can discusss this during our research session.

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