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10.3A: Predisposing Factors - Biology

10.3A: Predisposing Factors - Biology


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The spread and severity of infectious disease is influenced by many predisposing factors.

Learning Objectives

  • Recognize factors that are classified as predisposing to infectious disease

Key Points

  • Some predisposing factors of contracting infectious diseases can be anatomical, genetic, general and disease specific.
  • Climate and weather, and other environmental factors that are affected by them, can also predispose people to infectious agents.
  • Other factors such as overall health, age and diet are important considerations in the prevention of spreading infectious diseases.

Key Terms

  • cystic fibrosis: Cystic fibrosis (also known as CF or mucoviscidosis) is an autosomal recessive genetic disorder that affects most critically the lungs, and also the pancreas, liver and intestine. It is characterized by abnormal transport of chloride and sodium across an epithelium, leading to thick, viscous secretions.
  • Chronic granulomatous disease: Also known as CGD, is a diverse group of genetic diseases in which certain cells of the immune system have difficulty forming the reactive oxygen compounds (most importantly, the superoxide radical) used to kill certain ingested pathogens. This leads to the formation of granulomata (a special type of inflammation) in many organs.

The spread and severity of infectious disease is influenced by many predisposing factors. Some of these are more general and apply to many infectious agents, while others are disease specific. Others can be anatomical. For example, women suffer more frequently from urinary tract infections which can be attributed to their shorter urethra.

Genetics is another contributing factor. Cystic fibrosis is a genetic disease that causes alteration of the mucus in the lungs. This predisposes patients to chronic infections with bacteria which form biofilms in the lungs. The most common infectious agent is Pseudomonas aeruginosa. Another example is chronic granulomatous disease which directly affects the ability of the host immune system to fight invaders.

Climate and weather, and other environmental factors that are affected by them, can also predispose people to infectious agents. A long-standing puzzle has been why flu outbreaks occur seasonally. One possible explanation is that, because people are indoors more often during the winter, they are in close contact more often, and this promotes transmission from person to person. Another factor is that cold temperatures lead to drier air, which may dehydrate mucus, preventing the body from effectively expelling virus particles. The virus also survives longer on surfaces at colder temperatures and aerosol transmission of the virus is highest in cold environments (less than 5°C) with low relative humidity. Indeed, the lower air humidity in winter seems to be the main cause of seasonal influenza transmission in temperate regions. Some scientists speculate that the seasonal fluctuations of vitamin D levels can be a factor in the spread of influenza too.

Overall health is a very important factor in preventing disease. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions. In general, deliberately-induced immunosuppression is performed to prevent the body from rejecting an organ transplant, treating graft-versus-host disease after a bone marrow transplant, or for the treatment of autoimmune diseases such as rheumatoid arthritis and Crohn’s disease. Of course, the immune system can be weak due to other reasons such as chemotherapy and HIV.

Age is another critical factor. Newborns and infants are more susceptible to infections as are the elderly.

Inadequate diet can raise the risks too. For example, globally, the severe malnutrition common in parts of the developing world causes a large increase in the risk of developing active tuberculosis and other opportunistic infections, due to its damaging effects on the immune system. Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty.


La biologie de la schizophrénie

Schizophrenia is an illness where the clinical signs and symptoms, course, and cognitive characteristics are well described. Successful pharmacological treatments do exist, even though they are likely palliative. However, this broad knowledge base has not yet led to the identification of its pathophysiology or etiology The risk factors for schizophrenia are most prominently genetic and scientists anticipate that contributions from the new genetic information in the human genome will help progress towards discovering a disease mechanism. Brain-imaging techniques have opened up the schizophrenic brain for direct inquiries, in terms of structure, neurochemisiry, and function. New proposals for diagnosis include grouping schizophrenia together with schizophrenia-related personality disorders into the same disease entity, and calling this schizophrenia spectrum disorder. New hypotheses of pathophysiology do not overlook dopamine as playing a major role, but do emphasize the participation of integrative neural systems in the expression of the illness and of the limbic system in generating symptoms. Critical observations for future discovery are likely to arise from molecular genetics, combined with hypothesis-generating experiments using brain imaging and human postmortem tissue.


Introduction

With a growing body of knowledge regarding their pathogenesis, pulmonary transfusion reactions are drawing attention as potentially preventable medical complications. Systematic data collection has played an important role in understanding the incidence and epidemiology of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO). 1-6 These often severe hazards of transfusion have been independently associated with morbidity and mortality and account for the majority of all transfusion-related deaths since 2011. 7-10 This report summarizes the current definitions, pathophysiology, and risk factors for TRALI and TACO, with additional focus on patients with hematological malignancies. In addition, we will review the impact of mitigation strategies and patient blood management (PBM) on reducing their incidence and role for further prevention. 11


Other Biological Factors of Addiction

Though alcohol and drug addiction are typically considered more social diseases, genetics and epigenetics—gene expressions triggered by environmental conditions, such as the effects of stress—make up anywhere between 40-60% of a person’s risk of addiction.

Besides genetic traits that may pass down in families with addiction issues, a host of less specific biological factors can also play a role.

Gender

Gender is one of the leading indicators of addiction potential, drawing a few interesting lines in the sand regarding the different risk factors facing men and women.

On a very general level, men are more likely to use drugs and alcohol than women and are also more likely to overdose. Women, on the other hand, have been found more susceptible to experience cravings or relapse.

But gender can impact almost every way alcohol and drug addiction manifests in a person, with everything from different body chemical compositions to different general body weights playing a role.

Ethnicity

Ethnicity is another factor that seems to impact the risk of drug or alcohol addiction—even from a purely biological level—thanks to factors like different drug metabolism rates, which may affect drug sensitivity and the overall potential for addiction or overdose.

The age when one begins drinking or using a drug is another biological condition that can play a massive part in developing addictive behaviors. That’s because the human brain is still growing in critical ways throughout puberty. Introducing it to a mind-altering substance during this time could affect neurological pathways, making a person that much more susceptible to the possibility of long-term drug and alcohol abuse.

Mental Health

And even mental health disorders can create different biological conditions that may affect one’s tendency to pick up addictive behaviors. Depression, anxiety, and attention deficit hyperactive disorder (ADHD) are just a few mental health conditions that have shown links to drug and alcohol addiction.


Diabetes Risk Factors

Know the risk factors for different types of diabetes.

Type 1 Diabetes

Type 1 diabetes is thought to be caused by an immune reaction (the body attacks itself by mistake). Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. Known risk factors include:

  • Family history: Having a parent, brother, or sister with type 1 diabetes.
  • Age: You can get type 1 diabetes at any age, but it&rsquos more likely to develop when you&rsquore a child, teen, or young adult.

In the United States, whites are more likely to develop type 1 diabetes than African Americans and Hispanic/Latino Americans.

Currently, no one knows how to prevent type 1 diabetes.

Type 2 Diabetes

You&rsquore at risk for developing type 2 diabetes if you:

  • Have prediabetes
  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister with type 2 diabetes
  • Are physically active less than 3 times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

If you have non-alcoholic fatty liver disease you may also be at risk for type 2 diabetes.

You can prevent or delay type 2 diabetes with simple, proven lifestyle changes such as losing weight if you&rsquore overweight, eating healthier, and getting regular physical activity.

Prediabetes

You&rsquore at risk for developing prediabetes if you:

  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister with type 2 diabetes
  • Are physically active less than 3 times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

You can prevent or reverse prediabetes with simple, proven lifestyle changes such as losing weight if you&rsquore overweight, eating healthier, and getting regular physical activity. The CDC-led National Diabetes Prevention Program can help you make healthy changes that have lasting results.

Gestational Diabetes

You&rsquore at risk for developing gestational diabetes (diabetes while pregnant) if you:

  • Had gestational diabetes during a previous pregnancy
  • Have given birth to a baby who weighed more than 9 pounds
  • Are overweight
  • Are more than 25 years old
  • Have a family history of type 2 diabetes
  • Have a hormone disorder called polycystic ovary syndrome (PCOS)
  • Are African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander

Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen, and is more likely to develop type 2 diabetes later in life too.

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you&rsquore overweight, eating healthier, and getting regular physical activity.


What Is Meant By Biological Factors?

As defined by the Psychology Dictionary, a biological factor is that which affects the behavior and function of an organism and includes any condition that has a psychological effect on a living being.

Types of Biological Factors Biological factors are considered the primary determinants of the way a human behaves and may play a significant role in the development of mental illnesses. As opposed to environmental factors, which exist outside of the organism in question, biological factors are all entirely internal. In humans, a biological factor can take the form of a physical, physiological, neurological, chemical or genetic condition and impacts the way an individual thinks or acts. The term is very broad and covers any biological condition that affects an organism's physiology.

Examples of Biological Factors A biological factor can determine how an individual behaves under different situations. Certain character traits can indicate a predisposition for issues with physical or mental health, such as aggression or impulsiveness leading to criminal tendencies. Although a person isn't defined by biological factors, these conditions can have a major impact on his or her behavior.

There are hundreds of different biological factors influencing the way an individual behaves. Other examples include chemical conditions, such as the levels of serotonin in the brain genetic conditions, including the passing down of personality disorders like schizophrenia and physiological factors, such as irregularities in the function of the hypothalamic-pituitary-adrenal axis, which helps living organisms adapt to different types of stress.

Link Between Biological Factors and Health Because biological factors can play such a large part in human behavior, doctors, scientists and other specialists often study them when trying to understand human health. Even with physical health issues, biological factors may be involved. Obesity, for example, may be influenced in part by how efficient an individual's body is at converting extra dietary energy to fat. The argument of nature versus nurture often arises when considering these conditions. However, evidence shows that an organism's ability to efficiently store fat and therefore increase the risk of obesity is an inherited factor.

Perhaps more commonly, biological factors come up in studies on mental illness. Environmental factors, such as trauma and stress, may contribute to the development of mental health issues, but biological factors often form the foundation. Neurological studies of individuals diagnosed with certain mental illnesses show a correlation between genetics and the expression of those illnesses. Brain abnormalities have been identified in people with schizotypal personality disorder while impulsive aggression as appears in borderline personality and other disorders seem to be linked to the workings of a complex neurochemical system.

By studying biological factors and finding the relationship between genetics, brain chemistry and anatomy and the development of mental illnesses, doctors and scientists are able not only to better understand the condition but to find more effective interventions. For example, doctors may be able to decrease a suicidal individual's risk by desensitizing the serotonin receptors in the brain with medication. A clearer understanding of the link between biological factors and human health may lead to better and more successful treatment of both physical and mental health issues.


Contents

The narrowing of coronary arteries reduces the supply of oxygen-rich blood flowing to the heart, which becomes more pronounced during strenuous activities during which the heart beats faster. [25] For some, this causes severe symptoms while others experience no symptoms at all. [4]

The most common symptom is chest pain or discomfort that occurs regularly with activity, after eating, or at other predictable times this phenomenon is termed stable angina and is associated with narrowing of the arteries of the heart. Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing. [26] Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease. [27] Angina, shortness of breath, sweating, nausea or vomiting, and lightheadedness are signs of a heart attack, or myocardial infarction, and immediate emergency medical services are crucial. [26]

Symptoms in women Edit

Symptoms in women can differ from those in men, and the most common symptom reported by women of all races is shortness of breath. [28] Other symptoms more commonly reported by women than men are extreme fatigue, sleep disturbances, indigestion, and anxiety. [29] However, some women do experience irregular heartbeat, dizziness, sweating, and nausea. [26] Burning, pain, or pressure in the chest or upper abdomen that can travel to the arm or jaw can also be experienced in women, but it is less commonly reported by women than men. [29] On average, women experience symptoms 10 years later than men. [30] Women are less likely to recognize symptoms and seek treatment. [26]

Coronary artery disease has a number of well determined risk factors. These include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, family history, and excessive alcohol. [6] [7] [17] About half of cases are linked to genetics. [31] Smoking and obesity are associated with about 36% and 20% of cases, respectively. [32] Smoking just one cigarette per day about doubles the risk of CAD. [33] Lack of exercise has been linked to 7–12% of cases. [32] [34] Exposure to the herbicide Agent Orange may increase risk. [35] Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, psoriasis, and psoriatic arthritis are independent risk factors as well. [36] [37] [38] [39]

Job stress appears to play a minor role accounting for about 3% of cases. [32] In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis. [40] In contrast, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression. [40] Having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness, hostility, and impatience, [41] is linked to an increased risk of coronary disease. [42]

Blood fats Edit

    (specifically, serum LDL concentrations). HDL (high density lipoprotein) has a protective effect over development of coronary artery disease. [43] may play a role. [44]
  • High levels of lipoprotein(a), [45][46][47] a compound formed when LDL cholesterol combines with a protein known as apolipoprotein(a).

Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. [48] Saturated fat is still a concern. [48]

Genetics Edit

The heritability of coronary artery disease has been estimated between 40% and 60%. [49] Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease. [50]

Other Edit

    in women under the age of 40. [51]
  • Depression and hostility appear to be risks. [52]
  • The number of categories of adverse childhood experiences (psychological, physical, or sexual abuse violence against mother or living with household members who used substances, mentally ill, suicidal, or incarcerated) showed a graded correlation with the presence of adult diseases including coronary artery (ischemic heart) disease. [53]
  • Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. [54]
  • Low hemoglobin. [55]
  • In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CAD. [56]

Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the heart's muscle cells. The heart's muscle cells may die from lack of oxygen and this is called a myocardial infarction (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arteries can induce transient ischemia which leads to the induction of a ventricular arrhythmia, which may terminate into a dangerous heart rhythm known as ventricular fibrillation, which often leads to death. [57]

Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory cells – to form a plaque. Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play a significant role in stiffening the arteries and inducing the early phase of coronary arteriosclerosis. This can be seen in a so-called metastatic mechanism of calciphylaxis as it occurs in chronic kidney disease and hemodialysis. [ citation needed ] Although these people suffer from kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into the channel of an artery, causing partial obstruction to blood flow. People with coronary artery disease might have just one or two plaques, or might have dozens distributed throughout their coronary arteries. A more severe form is chronic total occlusion (CTO) when a coronary artery is completely obstructed for more than 3 months. [58]

Cardiac syndrome X is chest pain (angina pectoris) and chest discomfort in people who do not show signs of blockages in the larger coronary arteries of their hearts when an angiogram (coronary angiogram) is being performed. [59] The exact cause of cardiac syndrome X is unknown. Explanations include microvascular dysfunction or epicardial atherosclerosis. [60] [61] For reasons that are not well understood, women are more likely than men to have it however, hormones and other risk factors unique to women may play a role. [62]

For symptomatic people, stress echocardiography can be used to make a diagnosis for obstructive coronary artery disease. [63] The use of echocardiography, stress cardiac imaging, and/or advanced non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease. [63] [64]

The diagnosis of "Cardiac Syndrome X" – the rare coronary artery disease that is more common in women, as mentioned, is a diagnosis of exclusion. Therefore, usually, the same tests are used as in any person with the suspected of having coronary artery disease: [65]

    electrocardiography (ECG)
  • Exercise ECG – Stress test
  • Exercise radioisotope test (nuclear stress test, myocardial scintigraphy) (including stress echocardiography) (MRI)

The diagnosis of coronary disease underlying particular symptoms depends largely on the nature of the symptoms. The first investigation is an electrocardiogram (ECG/EKG), both for "stable" angina and acute coronary syndrome. An X-ray of the chest and blood tests may be performed. [ citation needed ]

Stable angina Edit

In "stable" angina, chest pain with typical features occurring at predictable levels of exertion, various forms of cardiac stress tests may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), echocardiography (using ultrasound of the heart) or scintigraphy (using uptake of radionuclide by the heart muscle). If part of the heart seems to receive an insufficient blood supply, coronary angiography may be used to identify stenosis of the coronary arteries and suitability for angioplasty or bypass surgery. [66]

Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD). [67] A 2015 monograph explains that "Regardless of the nomenclature, stable angina is the chief manifestation of SIHD or SCAD." [67] There are U.S. and European clinical practice guidelines for SIHD/SCAD. [68] [69]

Acute coronary syndrome Edit

Diagnosis of acute coronary syndrome generally takes place in the emergency department, where ECGs may be performed sequentially to identify "evolving changes" (indicating ongoing damage to the heart muscle). Diagnosis is clear-cut if ECGs show elevation of the "ST segment", which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI) this is termed a STEMI (ST-elevation MI) and is treated as an emergency with either urgent coronary angiography and percutaneous coronary intervention (angioplasty with or without stent insertion) or with thrombolysis ("clot buster" medication), whichever is available. In the absence of ST-segment elevation, heart damage is detected by cardiac markers (blood tests that identify heart muscle damage). If there is evidence of damage (infarction), the chest pain is attributed to a "non-ST elevation MI" (NSTEMI). If there is no evidence of damage, the term "unstable angina" is used. This process usually necessitates hospital admission and close observation on a coronary care unit for possible complications (such as cardiac arrhythmias – irregularities in the heart rate). Depending on the risk assessment, stress testing or angiography may be used to identify and treat coronary artery disease in patients who have had an NSTEMI or unstable angina. [ citation needed ]

Risk assessment Edit

There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on different variables above. A notable example is Framingham Score, used in the Framingham Heart Study. It is mainly based on age, gender, diabetes, total cholesterol, HDL cholesterol, tobacco smoking, and systolic blood pressure. When it comes to predicting risk in younger adults (18–39 years old), Framingham Risk Score remains below 10-12% for all deciles of baseline-predicted risk. [70]

Polygenic score is another way of risk assessment. In one study the relative risk of incident coronary events was 91% higher among participants at high genetic risk than among those at low genetic risk. [71]

Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. [72] [73] Prevention involves adequate physical exercise, decreasing obesity, treating high blood pressure, eating a healthy diet, decreasing cholesterol levels, and stopping smoking. Medications and exercise are roughly equally effective. [74] High levels of physical activity reduce the risk of coronary artery disease by about 25%. [75]

Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counseling and education to bring about behavioral change might help in high-risk groups. However, there was insufficient evidence to show an effect on mortality or actual cardiovascular events. [76]

In diabetes mellitus, there is little evidence that very tight blood sugar control improves cardiac risk although improved sugar control appears to decrease other problems such as kidney failure and blindness. [ citation needed ] The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary artery disease while high intake increases the risk. [77]

Diet Edit

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death. [78] Vegetarians have a lower risk of heart disease, [79] [80] possibly due to their greater consumption of fruits and vegetables. [81] Evidence also suggests that the Mediterranean diet [82] and a high fiber diet lower the risk. [83] [84]

The consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause a precursor to atherosclerosis [85] and increase the risk of coronary artery disease. [86]

Evidence does not support a beneficial role for omega-3 fatty acid supplementation in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death). [87] [88] There is tentative evidence that intake of menaquinone (Vitamin K2), but not phylloquinone (Vitamin K1), may reduce the risk of CAD mortality. [89]

Secondary prevention Edit

Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include:

Aerobic exercise, like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease. [92] Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol which is considered "good cholesterol". [93] [94]

Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force found "insufficient evidence" to recommend that doctors counsel patients on exercise but "it did not review the evidence for the effectiveness of physical activity to reduce chronic disease, morbidity, and mortality", only the effectiveness of counseling itself. [95] The American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise. [96]

Psychological symptoms are common in people with CHD, and while many psychological treatments may be offered following cardiac events, there is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction. [91]

Neuropsychological Assessment Edit

A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females/women. [97] Consequently, since research is showing that cardiovascular diseases, like CHD, can play a role as a precursor for dementia, like Alzheimer's disease, individuals with CHD should have a neuropsychological assessment.

There are a number of treatment options for coronary artery disease: [98]

  • Lifestyle changes
  • Medical treatment – drugs (e.g., cholesterol lowering medications, beta-blockers, nitroglycerin, calcium channel blockers, etc.)
  • Coronary interventions as angioplasty and coronary stent (CABG)

Medications Edit

    , which reduce cholesterol, reduce the risk of coronary artery disease [99][100]
  • Calcium channel blockers and/or beta-blockers [101] such as aspirin[101][102]

It is recommended that blood pressure typically be reduced to less than 140/90 mmHg. [103] The diastolic blood pressure however should not be lower than 60 mmHg. [ vague ] Beta blockers are recommended first line for this use. [103]

Aspirin Edit

In those with no previous history of heart disease, aspirin decreases the risk of a myocardial infarction but does not change the overall risk of death. [104] It is thus only recommended in adults who are at increased risk for coronary artery disease [105] where increased risk is defined as "men older than 90 years of age, postmenopausal women, and younger persons with risk factors for coronary artery disease (for example, hypertension, diabetes, or smoking) who are at increased risk for heart disease and may wish to consider aspirin therapy". More specifically, high-risk persons are "those with a 5-year risk ≥ 3%". [ citation needed ]

Anti-platelet therapy Edit

Clopidogrel plus aspirin (dual anti-platelet therapy) reduces cardiovascular events more than aspirin alone in those with a STEMI. In others at high risk but not having an acute event, the evidence is weak. [106] Specifically, its use does not change the risk of death in this group. [107] In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death. [108]

Surgery Edit

Revascularization for acute coronary syndrome has a mortality benefit. [109] Percutaneous revascularization for stable ischaemic heart disease does not appear to have benefits over medical therapy alone. [110] In those with disease in more than one artery, coronary artery bypass grafts appear better than percutaneous coronary interventions. [111] [112] Newer "anaortic" or no-touch off-pump coronary artery revascularization techniques have shown reduced postoperative stroke rates comparable to percutaneous coronary intervention. [113] Hybrid coronary revascularization has also been shown to be a safe and feasible procedure that may offer some advantages over conventional CABG though it is more expensive. [114]

As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. [116] This increased from 5.2 million deaths from CAD worldwide in 1990. [116] It may affect individuals at any age but becomes dramatically more common at progressively older ages, with approximately a tripling with each decade of life. [117] Males are affected more often than females. [117]

It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue. [118]

Coronary artery disease is the leading cause of death for both men and women and accounts for approximately 600,000 deaths in the United States every year. [119] According to present trends in the United States, half of healthy 40-year-old men will develop CAD in the future, and one in three healthy 40-year-old women. [120] It is the most common reason for death of men and women over 20 years of age in the United States. [121]

Names Edit

Other terms sometimes used for this condition are "hardening of the arteries" and "narrowing of the arteries". [122] In Latin it is known as morbus ischaemicus cordis (MIC).

Support groups Edit

The Infarct Combat Project (ICP) is an international nonprofit organization founded in 1998 which tries to decrease ischemic heart diseases through education and research. [123]

Industry influence on research Edit

In 2016 research into the archives of the [ failed verification ] Sugar Association, the trade association for the sugar industry in the US, had sponsored an influential literature review published in 1965 in the New England Journal of Medicine that downplayed early findings about the role of a diet heavy in sugar in the development of CAD and emphasized the role of fat that review influenced decades of research funding and guidance on healthy eating. [124] [125] [126] [127] [128]

Research efforts are focused on new angiogenic treatment modalities and various (adult) stem-cell therapies. A region on chromosome 17 was confined to families with multiple cases of myocardial infarction. [129] Other genome-wide studies have identified a firm risk variant on chromosome 9 (9p21.3). [130] However, these and other loci are found in intergenic segments and need further research in understanding how the phenotype is affected. [131]

A more controversial link is that between Chlamydophila pneumoniae infection and atherosclerosis. [132] While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. [133] Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases. [134]

Since the 1990s the search for new treatment options for coronary artery disease patients, particularly for so called "no-option" coronary patients, focused on usage of angiogenesis [135] and (adult) stem cell therapies. Numerous clinical trials were performed, either applying protein (angiogenic growth factor) therapies, such as FGF-1 or VEGF, or cell therapies using different kinds of adult stem cell populations. Research is still going on – with first promising results particularly for FGF-1 [136] [137] and utilization of endothelial progenitor cells.

Plant-based nutrition has been suggested as a way to reverse coronary artery disease, [139] but strong evidence is still lacking for claims of potential benefits. [140]


Social Determinants of Health

Social determinants of health are economic and social conditions that influence the health of people and communities. These conditions are shaped by the amount of money, power, and resources that people have, all of which are influenced by policy choices. Social determinants of health affect factors that are related to health outcomes. Factors related to health outcomes include:

  • How a person develops during the first few years of life (early childhood development)
  • How much education a persons obtains
  • Being able to get and keep a job
  • What kind of work a person does
  • Having food or being able to get food (food security)
  • Having access to health services and the quality of those services
  • Housing status
  • How much money a person earns
  • Discrimination and social support

What are determinants of health and how are they related to social determinants of health?

Determinants of health are factors that contribute to a person’s current state of health. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population:

  • Genes and biology: for example, sex and age
  • Health behaviors: for example, alcohol use, injection drug use (needles), unprotected sex, and smoking
  • Social environment or social characteristics: for example, discrimination, income, and gender
  • Physical environment or total ecology: for example, where a person lives and crowding conditions
  • Health services or medical care: for example, access to quality health care and having or not having insurance

Other factors that could be included are culture, social status, and healthy child development. Scientists do not know the precise contributions of each determinant at this time.

In theory, genes, biology, and health behaviors together account for about 25% of population health. Social determinants of health represent the remaining three categories of social environment, physical environment/total ecology, and health services/medical care. These social determinants of health also interact with and influence individual behaviors as well. More specifically, social determinants of health refer to the set of factors that contribute to the social patterning of health, disease, and illness.

Why is addressing the role of social determinants of health important?

Addressing social determinants of health is a primary approach to achieving health equity. Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance.” Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy.” Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities.

Learning Activity

Go to the Your Health Profile webpage and answer the questions.

  • What conditions do people with your health profile most frequently experience?
  • Are you under- or overweight?

Does dopamine play a role in depression?

The neurotransmitter dopamine, which mediates motivation and desire, is one of several brain signaling chemicals that are implicated in depression. It is associated with two of the most prominent features of depression—anhedonia, or the inability to experience pleasure, and appetite alterations.

Many neurons that use dopamine to relay signals are sensitive to the effects of stress, which can alter their excitability and activity. Studies have also shown that reward-generating areas of the brain—such as the nucleus accumbens, where dopamine signals originate—may be underactive in depression.


Disease Risk Factors Slides and Worksheet (GCSE Biology AQA)

Secondary science resources for GCSE and A-level. Mostly free: the paid resources contribute toward the graphics software and hardware used to produce them. Covering Biology, Chemistry and Physics. All resources are exam board specific.

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pdf, 1.48 MB pptx, 14.9 MB pdf, 232.2 KB docx, 2.83 MB

Suitable for remote online distance learning.

Discussion exercise and worksheet on risk factors and non-communicable diseases for teaching and revision. This resource follows the AQA Biology GCSE syllabus. Leads on to Cardiovascular Disease: https://www.tes.com/teaching-resource/cardiovascular-disease-slides-and-worksheet-gcse-biology-aqa-12344623

  • Types of risk factor
  • Asbestos
  • Global, national and local risk factors
  • Direct and indirect causes of disease
  • Identifying risk factors by correlation

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A bundle is a package of resources grouped together to teach a particular topic, or a series of lessons, in one place.

GCSE Biology Health and Organisation Slides and Worksheets Bundle (AQA)

Suitable for remote online distance learning. Slides are written to be self-explanatory so can also be used for home study. Powerpoint presentations and accompanying worksheets covering organisation (AQA GCSE Biology Grade 9-1) for teaching and revision. Ten of the resources in this package are free for content preview. Suggested Order - Cell organisation - Enzymes - Digestive enzymes - Respiratory system - Circulatory system - Health and disease - Disease risk factors - Cardiovascular Disease - Cancer - Plant cell organisation - Transpiration and translocation - Communicable Disease - Immunity - Drugs - Monoclonal Antibodies - Plant Diseases


ANBL1232: Utilizing Response and Biology Based Risk Factors to Guide Therapy in Patients with Non-High Risk Neuroblastoma

PRIMARY OBJECTIVES: I. To eliminate therapy as the initial approach for infants < 12 months of age with small International Neuroblastoma Risk Group (INRG) stage L1 neuroblastoma while maintaining an overall survival (OS) of 99%. II. To eliminate therapy as the initial approach for non-high-risk patients < 18 months of age with localized neuroblastoma and favorable biology (histologic and genomic features) while maintaining an OS of 99%. III. To achieve a 3-year OS of > 81% for infants < 18 months of age with INRG stage Ms neuroblastoma using objective criteria for early initiation of a response-based treatment algorithm. EXPLORATORY OBJECTIVES: I. To describe the time to intervention or tumor progression, type of intervention and site of progression for patients with localized neuroblastoma who experience progression after an initial period of observation. II. To characterize the pharmacokinetic profile of the chemotherapeutic agents carboplatin and etoposide in patients with stage Ms disease. III. To define the genomic profile of tumors from patients with non-high-risk neuroblastoma both at initial biopsy and at the time of subsequent biopsy or surgical resection. IV. To describe the histology of tumor specimens obtained at the time of subsequent biopsy or surgical resection. V. To determine the salvage rate (OS) of patients with tumor relapse or disease progression. VI. To determine the procedural complication rate (initial biopsy, resection [intraoperative and postoperative], subsequent biopsy) and correlate with the degree of surgical resection. VII. To determine the rate of reduction in image defined risk factors (IDRF) in L2 tumors following observation or chemotherapy. OUTLINE: Patients are assigned to 1 of 3 treatment groups. GROUP A: Patients undergo clinical observation for 96 weeks in the absence disease progression. GROUP B: Patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients undergo surgery or receive first-line chemotherapy comprising carboplatin intravenously (IV) over 1 hour on day 1 (courses 1, 2, 4, 6, and 7), etoposide IV over 1 hour on days 1-3 (courses 1, 3, 4, 5, and 7), cyclophosphamide IV over 1 hour on day 1 (courses 2, 3, 5, 6, and 8), and doxorubicin hydrochloride IV over 15 minutes on day 1 (courses 2, 4, 6 and 8). Treatment with chemotherapy repeats every 21 days for 2-8 courses in the absence of disease progression or unacceptable toxicity. Once a partial response (PR) or better is achieved, patients undergo clinical observation for 3 years. GROUP C: Patients at high risk for deterioration and a poor outcome immediately receive first-line chemotherapy as in Group B. All other patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients receive first-line chemotherapy as in Group B. Once a PR or better is achieved, patients undergo clinical observation for 3 years. After completion of study treatment, patients are followed up annually for up to 10 years post-enrollment.