CARDIOVASCULAR DISEASE
     
     A.   Heart Disease, stroke, and related diseases account for
          almost as many death as everything else combined
          1.   Ea. yr. 1.5 million americans will get a HA
               a.   one third die
               b.   heart diseases the prin. cause of death
          2.   20 % of 1st MI die right then
          3.   50 % of second do
          4.   of the 236 mil. Amer, one quarter has some heart
               disease
               a.   MI, diabetes
          5.   Approx 3 mil. are disabled by heart disease
               a.   can't work, add cost to health insurance
          6.   hardening of the arteries is the single biggest
               cause of CHD
          7.   Bypass surgery is about $40,000 per operation


     B.   Ways we study cardiovascular disease
          1.   Epidemiological- study of cause
          2.   Clinical and Pathological
          3.   Animal and Brain Lab research
          4.   Invention Trials
          5.   Community research and demonstration

     C.   Multiple risk factors
          1.   Have a causal role
          2.   Have a predicted value
               a.   can give probability of a future MI
                    (1)  absolute risk and relative risk
                         (a)  absolute = chances of having a HA
                         (b)  relative = in comparison to another

     D.   Biological risk factors    ***     Not modifiable
          1.   Age
               a.   by 35, heart disease is top killer
               b.   men at 35 have a 1 in 4 chance of HA
               c.   progressively increases afterward
               d.   by age 60, one fifth will have had a HA
               e.   bet. ages of 55 & 64, 10 % of all mens deaths
                    will be by HA
          2.   Gender
               a.   females have lower incidence of HD before
                    menopause, accelerated after menop.
               b.   female rate lag behind males 10 years in
                    whites, 7 years in blacks
                    (1)  diabetes, oral contraceptives, cig.
                         smoking, will have effect
               c.   is still the leading cause of death in pre-
                    menopausal middle aged women
          3.   Genetic Factors
               a.   predispositions for hypertension
               b.   lipid or metabolic disfunction
               c.   inherited wrong anatomical patterns
               d.   family degree of HA in first degree relatives
                    is a very strong predictor.

     E.   Modifiable risk factors
          1.   lifestyles, socio-cultural
          2.   increased levels of total & LDL cholesterol levels
          3.   low levels of  HDL subfractions
          4.   cig smoking
          5.   hypertension
          6.   hyperglycemia/ glucose intolerance/ diabetes
          7.   obesity
          8.   dietary habits
               a.   excess calorie intake in relation to activity
                    level
               b.   high inhale of sat animal fat and choles.
               c.   low intake of complex carbos, dietary fiber,
                    and vegetable protein
               d.   excess salt
               e.   deficiency in amounts of potassium, magnesium,
                    calcium and selenium
               f.   more than a moderate amount of alcohol
          9.   physical inactivity and low level of fitness
          10.  psychosocial stress

     F.   Blood Cholesterol levels
          1.   choles. is predominant lipid part of the
               atherosclerotic lesion
          2.   total chol. of > 200 mg.dl. (mg %) and LDL > 130
               are the most potent factors
          3.   LDL is a major pathogen for atherosclerosis
          4.   for every 10 % increase over 200, there is a 2%
               increase in prob. of a HA
          5.   middle aged males over 300 are 3 times the risk of
               those same age over 200
          6.   Blood chol. is largely affected by diet, fat,
               fiber, and choles intake.
          7.   drug therapy
               a.   lovastatin  (reduce chol. by 30 %)
               b.   cholestyramine   ( red. by 15 - 20 %)
               c.   colestipol       (  "        "      )
     
                *** should be used only for non-responders to the
                    diet modification, weight control, and
                    exercise.