1. CASE STUDY 2 DATENAME MARCH 2, 2011 SAMIA B. Epidemiology of Cardiovascular Disease/Coronary Artery Disease

2. What is the epidemiology of cardiovascular disease/coronary artery disease? What is coronary artery disease? What are the risk factors that contribute to a person’s likelihood of developing cardiovascular disease/coronary artery disease? How has the epidemiology of cardiovascular disease changed in recent years? Question

3. What is Coronary Artery Disease? (also called Coronary Heart Disease) A condition in which plaque, made up of fats, cholesterol, calcium and various other substances in the serum build up on arterial wall. Incidence of buildup is termed atherosclerosis Blocks the normal flow of oxygen- rich blood to the heart National Institute of Health http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html

4. Epidemiology of Cardiovascular Disease/Coronary Artery Disease Definition of Epidemiology, according to CDC The study of the distribution and determinants of disease or health status in a population; the study of the occurrence and causes of health effects in humans. Non-Geographical Based Background information: Prevalence of CVD/Coronary Artery Disease means the expression of certain risk factors. Ethnicity Risk Factors based on Lifestyle/Conditions Center For Disease Control and Prevention http://www.cdc.gov/heartdisease/about.htm

5. Geographical Prevalence Mississippi tends to have highest prevalence of cardiovascular disease Minnesota tends to have lowest. Center For Disease Control and Prevention http://www.cdc.gov/heartdisease/about.htm

7. NEJM Article: “Neighborhood of Residence and Incidence of Coronary Heart Disease” Overview A study that consisted of 15,792 people from the age of 45 to 64. All were residents of either Forsyth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. Conclusions Coronary Heart Disease was more likely to develop in disadvantaged neighborhoods than in advantaged. Affirmed that there is a lot of variation in geographic locations. "Neighborhood of Residence and Incidence of Coronary Heart Disease." New England Journal of Medicine. Web. 1 Mar. 2011.

8. NEJM Article: “Neighborhood of Residence and Incidence of Coronary Heart Disease” (cont.) Neighborhood trends could be attributed to the establishment of certain prevalent risk factors. Tobacco advertising Availability of healthy foods Physical environment: Availability of parks, public facilities, recreational services. Social norms Exposure to sources of chronic stress Noise Violence Availability or unavailability of support group, etc.

9. Epidemiology At the International Level Low- and middle-income countries are the ones that are greatest at risk. 82% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women. It is projected that by 2030 almost 23.6 million people will die from CVDs. The largest percentage increase is projected to occur in the Eastern Mediterranean Region. The largest increase in number of deaths is projected to occur in the South-East Asia Region. "WHO | Cardiovascular Diseases (CVDs)." Web. 01 Mar. 2011..

10. Risk Factors For Development of Cardiovascular/Coronary Artery Disease Major High LDL cholesterol levels Consistent blood pressure above 140/90 Smoking Insulin resistance Diabetes Obesity Metabolic syndrome Risk factors linked to obesity. Physical inactivity "Who Is At Risk for Coronary Artery Disease?" National Heart, Lung and Blood Institute. Web. 02 Mar. 2011..

11. Risk Factors For Development of Cardiovascular/Coronary Artery Disease (cont.) Age Men: Generally after 45 Women: Generally after 55 Family history Emerging Risk Factors High levels of C-Reactive Protein (CRP) Increases upon inflammation (body responds to injury or infection). Other Contributing factors Sleep Apnea Stress Alcohol

12. Changes in Epidemiology Over Recent Years The distribution of disease over social classes has changed. Initially, CVD/Coronary artery disease affected affluent, developed areas. Now it is mostly affecting people of low socioeconomic status. 1 The occurrence and decrease of CVD in certain countries has changed. Initially, the Pacific Island, United Kingdom and United States had an increase in mortality. Currently, however, incidence and risk in South Asian countries is increasing. 2 Reasons? Inadequate funding for fitness programs, public health initiatives, etc. Stressfulness from financial instability. "Coronary Heart Disease Risk Factors: New Priorities for The Developing World." The South Asian Journal of Preventive Cardiology. Web. 02 Mar. 2011. http://www.sajpc.org/vol8/vol8_3/coronaryheart.htm. http://www.sajpc.org/vol8/vol8_3/coronaryheart.htm 1.Marmot, M.G. (1992). Coronary heart disease: rise and fall of a modern epidemic. In: Marmot, M.G. and Elliott, P. (eds.) Coronary Heart Disease Epidemiology. Oxford. Oxford University Press. 3-19 2.Uemura, K. and Pisa, Z. (1988). Trends in cardiovascular disease mortality in industrialised countries since 1950. World Health Stat Q. 41:155-178