Deck 3: Epidemiology of Coronary Heart Disease

Question 1

Coronary heart disease causes more than 9 million deaths annually.

Answer 1

True

Question 2

CHD is nearly always a consequence of longstanding atherosclerosis and the development of atheromatous plaques that occlude the coronary arteries.

Answer 2

True

Question 3

Annual disability adjusted life years (DALY) due to ischemic heart disease are 2 to 3-fold higher in Russia, India, North Africa, and the Middle East than in the USA, Canada, Western Europe, and Japan.

Answer 3

True

Question 4

Atherosclerosis progresses in sequential stages of endothelial dysfunction over a period of several months.

Question 5

In the Seven Countries Study, populations consuming a Mediterranean diet had the lowest rates of CHD.

Question 6

Results of the Framingham Heart Study confirmed the multifactorial nature of CHD.

Question 7

The international MONICA Project has documented a disturbing increasing trend in obesity worldwide.

Question 8

The five major risk factors for CHD are cigarette smoking, hypertension, elevated cholesterol, type 2 diabetes mellitus, and inflammation.

Question 9

Most studies suggest that serum cholesterol level is a better predictor of impending CHD than C-reactive protein.

Question 10

Multiple CHD risk factors rarely cluster in the same individual.

Question 11

Name the famous German pathologist who first postulated that atherosclerosis was due to the deposition of lipid-laden plaques in the lining of arteries.

A) Nikolai Anitschkow
B) Rudolph Virchow
C) Louis Pasteur
D) Edward Jenner

Question 12

The "response to injury" hypothesis states that atherosclerosis is primarily a consequence of:

A) inflammation.
B) high cholesterol.
C) hypertension.
D) smoking.

Question 13

The "dual hypothesis" of atherogenesis primarily involves what two processes?

A) Smoking & Hypertension
B) Hypercholesterolemia & Inflammation
C) Hypercholesterolemia & Smoking
D) Inflammation & Smoking

Question 14

What cells are the progenitors of foam cells in atherogenesis?

A) Leukocytes
B) Lymphocytes
C) Macrophages
D) Endothelial cells

Question 15

Which of the following statements are true?

A) Results of the Framingham Study first demonstrated that high cholesterol increases the risk of CHD.
B) Results of the Seven Countries Study first demonstrated that high cholesterol increases the risk of CHD.
C) Results of the Framingham Study demonstrated significant cardioprotection from consuming a "Mediterranean diet."
D) Results of the Seven Countries Study demonstrated significant cardioprotection from consuming a "Mediterranean diet."
E) Both a and c are true.
F) Both b and d are true.

Question 16

Which of the following are risk factors for CHD?

A) High LDL cholesterol
B) Low LDL cholesterol
C) Low HDL cholesterol
D) High HDL cholesterol
E) Both a and c are true.

Question 17

Which of the following cholesterol levels characterizes an individual at high risk for developing CHD?

A) Total cholesterol of 240 mg per dl or higher
B) LDL cholesterol of 140 mg per dl or higher
C) HDL cholesterol less than 60 mg per dl
D) All of the above are correct.

Question 18

High blood pressure increases the risk of CHD by 2 to 3-fold in men and women of all ages.Based upon new guidelines established by the American Heart Association, what are the current threshold levels of blood pressure for high CHD risk?

A) Systolic Blood Pressure of 140 mm Hg or higher
B) Diastolic Blood Pressure of 90 mm Hg or higher
C) Systolic Blood Pressure above 130 mm Hg and Diastolic Blood Pressure above 85 mm Hg
D) Only a and b are correct.

Question 19

Which of the following statements are true?

A) Chronic tobacco smoking heightens the CHD mortality by 2 to 3-fold.
B) Chronic exposure to environmental tobacco smoke heightens the relative risk of CHD by about 25%.
C) Smoking cessation produces an approximate 50% reduction in CHD risk within two years.
D) All of the above statements are correct.

Question 20

Which of the following blood levels do not increase CHD risk?

A) Elevated Homocysteine
B) Elevated APO A1
C) Elevated APO B
D) Elevated C Reactive Protein
E) Elevated Glucose

Question 21

Define coronary heart disease (ischemic heart disease) and characterize its association with atherogenesis.

Question 22

Define and discuss the two theories of atherogenesis.

Question 23

Discuss current international patterns of CHD mortality and morbidity.

Question 24

Discuss key findings of the three major prospective studies of CHD: the Seven Countries Study, the Framingham Study, and MONICA.

Question 25

Document known risk factors for CHD and chemopreventive agents.

Question 26

Discuss the relative predictive values of serum cholesterol and C Reactive Protein.

Question 27

Discuss molecular mechanisms by which type 2 diabetes increases the risk of CHD development.

Question 28

What strategies would you propose for the primary prevention of CHD?