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The decline in coronary heart disease mortality—the role of cholesterol chang
CME Test #IA The Decline in Coronary Heart Disease MortalityThe Role of Cholesterol Change The College of Physicians & Surgeons is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. As an organization accredited for continuing medical education, The College of Physicians & Surgeons of Columbia University designates these continuing education materials as meeting the criteria for 5 credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association, provided they are used and completed as designed. After reading this supplement, the physician may obtain CME credit by answering all of the following questions. P/ease compktely encircle the appropriate letter or letters for each question on the answer sheet provided at the end of the questions. Mail the completed answer sheet and a check in the amount of $25 payable to Columbia University to: Dr. Elizabeth C. Gerst, Director, Center for Continuing Education in the Health Sciences, College of Physicians & Surgeons, 630 West 168 Street, New York, New York 10032. You will receive your graded answer sheet, the correct answers, and documentation for 5 credit hours in Category I toward the American Medical Association’s Physician’s Recognition Award. No grades are kept; this test is for self-assessment only. Any questions or comments concerning this self-assessment examination may be directed to Dr. Elizabeth C. Gerst (telephone: 212694-3682).
6. Coronary heart disease (CHD) mortality rates a) have decreased in the U.S.A. only b) have decreased by more than 10% in the U.S.A. and a few other countries c) are decreasing worldwide d) are lower than cancer mrntality rates in the United States for persons younger than 55 years e) b&d f) a&d
1. Disorders of the heart and cardiovascular system have been the leading cause of death in the U.S.A. since a) 1910 b) 1920 c) 1930 d) 1940 e) 1950
2. Survival rates for the 3 years after acute myocardial farction have not changed over the last 20 years. a) true b) false
in7. Evidence linking risk factor modification and decrease of cardiovascular disease incidence and mortality rates a) is definitive; as risk-factor behaviors have improved, CHD incidence has decreased b) is, to date, circumstantial c) is stronger than the evidence linking improved medical care with decreased CHD incidence d) a&c
3. Coronary bypass surgery a) improves left ventricular function bj relieves angina c) has a positive effect on survival rates of all patients d) is usually more effective than medical treatment e) a&c f) a&b
4. The 3 major a) elevated b) male sex c) cigarette d) obesity e) elevated
risk factors for coronary cholesterol levels
8. According to a ranking of the states in the U.S.A., the CHD death rate a) has decreased the least in Louisiana and Illinois b) is highest in the area concentrated in the Appalachian region c) has decreased the most in the East Coast states d) a&b
heart disease are
smoking blood pressure
9. In people aged 35 to 45 years, the risk of coronary disease is considered extremely high when the low-density llpoprotein (LDL) cholesterol levels are at or above a) 100 mg/dl b) 150 mg/dl c) 175 mg/dl d) 200 mg/dl
5. Study results have shown that after 1 year of not smoking, the risk of heart disease from smoking is a) 30% eliminated b) 50% eliminated c) 90% eliminated d) not affected 42c
August
10. Based on your knowledge of dietary fat intake, which statement is correct? a) addition of polyunsaturated fats to the diet produces a reduction in LDL cholesterol that is about half that seen with the addition of rnonounsaturated fats b) addition of monounsaturated fats to the diet may produce a reduction in LDL cholesterol that approaches that seen with the addition of polyunsaturated fats cl the impact of removing saturated fats from the diet is about the same as that of adding polyunsaturated fats d) none of the above 11. Comparison of 2 major studies conducted in the early 1950s and 1970s indicates that the cholesterol level defining the upper quintile (80th percentile) of the U.S.A. population a) has not changed during that time b) seemed to change, but the difference is negated by adjustments for technical changes in cholesterol level measurement c) has decreased by approximately 10 % d) has decreased by approximately 5%
12. According to recent findings, of the 26% decrease in deaths from CHD what percentage is estimated to be due to changes in blood cholesterol levels? a) 10% b) 15% c) 3% d) 5%
13. The Lipid Research Clinlics Coronary Primary Prevention Trial (LRC CPPT) was made feasible because a) diet adjustment was not the main variable used b) the participants were at high risk for CHD c) a cholesterol-lowering1 drug for which a suitable placebo was available was used d) all of the above
14. In the LRC CPPT, men were excluded from the study if they a) did not show a substantial decrease in their cholesterol levels after following a prerandomization-phase diet b) had a substantial decrease in their cholesterol levels after following the prerandomization-phase diet c) had high blood pressure d) a&c e) b&c 15. At the end of the LRC CPPT, the average cholesterol reduction in the cholestyralmine-treatment group compared with the placebo group was a) 8.5% greater b) 3.4% greater c) 14% greater d) 20% greater 16. The LRC CPPT results showed that a) a 25% reduction in total plasma cholesterol in the cholestyramine group resulted in a halving of the CHD risk
27.1994
THE AMERICAN
JOURNAL
OF CARDIOLOGY
Volume
54
43c
b) a 15% reduction in LDL cholesterol levels in the ch+ lestyramine group resulted in a 49 % reduction in the risk of CHD c) in hypercholesterolemic persons, drug therapy should be offered simultaneously with dietary treatment d) b&c
17. The incidence of CHD in the cholestyramine pared with the placebo group was lower by a) 9% b) 15% c) 19% d) 24%
group com-
18. Examination of the incidence of side effects in the cholestyramine and placebo groups a) showed no differences that could not be attributed to chance b) showed an increased incidence of gallstones in the cholestyramine group c) showed more cases of gastrointestinal (GI) cancers in the cholestyramine group d) b&c
19. Cholestyramine resin is confined to the GI tract is not absorbed in the GI tract has been found to be a promoter of colon cancer in animal experiments when a cancer-inducing agent was also administered all of the above
a) W a 4
20. Which of the following probably are not atherogenic? a) chylomicrons b) very low-density lipoproteins c) intermediate-density lipoproteins d) low-density lipoproteins (LDL) e) high-density lipoproteins (HDL) f) a&e
21. Most forms of to a) a decrease b) a decrease LDL c) insufficient d) a decrease tosis
hypercholesterolemia
appear to be related
in receptor-mediated clearance of LDL in nonreceptor-mediated clearance supplies of lipoprotein lipase in clearance of LDL by nonspecific
of
pinocy-
22. In Westernized society, the characteristic atherogenic pattern is that a) lipid and lipoprotein levels remain about the same between childhood and adolescence b) HDL cholesterol values are higher in adult men than in adult women c) total and LDL cholesterol levels are higher in female than in male children d) HDL cholesterol levels are lower in female than in male children
44c
DECLINE
IN CORONARY
HEART
DISEASE
MORTALITY
SYMPOSIUM
23. Results from several studies have shown that black men, compared with white men, a) have a higher incidence of ischemic heart disease consistent with their higher prevalence of hypertension b) have a more atherogenic lipoprotein pattern c) have a lower incidence of ischemic heart disease, despite their higher prevalence of hypertension d) a&b
24. Comparisons of the LRC CPPT of middle-aged Soviet men with middle-aged men living in the U.S.A. indicated a) lower total cholesterol levels in the Soviets and a less atherogenic lipoprotein profile b) higher total cholesterol levels in the Soviets and a more atherogenic lipoprotein profile c) higher total cholesterol levels in the Soviets and a less atherogenic lipoprotein profile
25. In of a) b) c) d) e) f)
the LRC CPPT population studies, the major correlates HDL cholesterol were found to be obesity alcohol consumption carbohydrate intake cigarette smoking LDL cholesterol levels male sex
26. In the LRC CPPT program, the variation in the mean values of HDL levels measured among middle-aged participants chosen from different countries correlates highly with the
average incidence of or mortality from ischemic heart disease between countries as seen in other studies. a) true b) false
27. Although the findings are controversial, women participants of the LRC CPPT program reporting postmenopausal hormone use a) had higher CHD mortality rates than nonusers b) had higher LDL and HDL cholesterol levels than nonusers c) had lower total and LDL cholesterol levels and higher HDL cholesterol levels than nonusers d) had higher all-cause mortality rates than nonusers
28. Patients with high triglyceride creased risk for CHD. a) true b) false
levels are probably
at in-
29. Exercise a) mainly affects triglyceride and HDL cholesterol levels b) increases the amount of lipoprotein lipase present in muscle tissue c) serves to increase HDL cholesterol levels d) all of the above
30. The benefit of cholestyramine is that it does not have the potential to interfere with the absorption of other drugs. a) true b) false
6. Coronary heart disease (CHD) mortality rates a) have decreased in the U.S.A. only b) have decreased by more than 10% in the U.S.A. and a few other countries c) are decreasing worldwide d) are lower than cancer mrntality rates in the United States for persons younger than 55 years e) b&d f) a&d
1. Disorders of the heart and cardiovascular system have been the leading cause of death in the U.S.A. since a) 1910 b) 1920 c) 1930 d) 1940 e) 1950
2. Survival rates for the 3 years after acute myocardial farction have not changed over the last 20 years. a) true b) false
in7. Evidence linking risk factor modification and decrease of cardiovascular disease incidence and mortality rates a) is definitive; as risk-factor behaviors have improved, CHD incidence has decreased b) is, to date, circumstantial c) is stronger than the evidence linking improved medical care with decreased CHD incidence d) a&c
3. Coronary bypass surgery a) improves left ventricular function bj relieves angina c) has a positive effect on survival rates of all patients d) is usually more effective than medical treatment e) a&c f) a&b
4. The 3 major a) elevated b) male sex c) cigarette d) obesity e) elevated
risk factors for coronary cholesterol levels
8. According to a ranking of the states in the U.S.A., the CHD death rate a) has decreased the least in Louisiana and Illinois b) is highest in the area concentrated in the Appalachian region c) has decreased the most in the East Coast states d) a&b
heart disease are
smoking blood pressure
9. In people aged 35 to 45 years, the risk of coronary disease is considered extremely high when the low-density llpoprotein (LDL) cholesterol levels are at or above a) 100 mg/dl b) 150 mg/dl c) 175 mg/dl d) 200 mg/dl
5. Study results have shown that after 1 year of not smoking, the risk of heart disease from smoking is a) 30% eliminated b) 50% eliminated c) 90% eliminated d) not affected 42c
August
10. Based on your knowledge of dietary fat intake, which statement is correct? a) addition of polyunsaturated fats to the diet produces a reduction in LDL cholesterol that is about half that seen with the addition of rnonounsaturated fats b) addition of monounsaturated fats to the diet may produce a reduction in LDL cholesterol that approaches that seen with the addition of polyunsaturated fats cl the impact of removing saturated fats from the diet is about the same as that of adding polyunsaturated fats d) none of the above 11. Comparison of 2 major studies conducted in the early 1950s and 1970s indicates that the cholesterol level defining the upper quintile (80th percentile) of the U.S.A. population a) has not changed during that time b) seemed to change, but the difference is negated by adjustments for technical changes in cholesterol level measurement c) has decreased by approximately 10 % d) has decreased by approximately 5%
12. According to recent findings, of the 26% decrease in deaths from CHD what percentage is estimated to be due to changes in blood cholesterol levels? a) 10% b) 15% c) 3% d) 5%
13. The Lipid Research Clinlics Coronary Primary Prevention Trial (LRC CPPT) was made feasible because a) diet adjustment was not the main variable used b) the participants were at high risk for CHD c) a cholesterol-lowering1 drug for which a suitable placebo was available was used d) all of the above
14. In the LRC CPPT, men were excluded from the study if they a) did not show a substantial decrease in their cholesterol levels after following a prerandomization-phase diet b) had a substantial decrease in their cholesterol levels after following the prerandomization-phase diet c) had high blood pressure d) a&c e) b&c 15. At the end of the LRC CPPT, the average cholesterol reduction in the cholestyralmine-treatment group compared with the placebo group was a) 8.5% greater b) 3.4% greater c) 14% greater d) 20% greater 16. The LRC CPPT results showed that a) a 25% reduction in total plasma cholesterol in the cholestyramine group resulted in a halving of the CHD risk
27.1994
THE AMERICAN
JOURNAL
OF CARDIOLOGY
Volume
54
43c
b) a 15% reduction in LDL cholesterol levels in the ch+ lestyramine group resulted in a 49 % reduction in the risk of CHD c) in hypercholesterolemic persons, drug therapy should be offered simultaneously with dietary treatment d) b&c
17. The incidence of CHD in the cholestyramine pared with the placebo group was lower by a) 9% b) 15% c) 19% d) 24%
group com-
18. Examination of the incidence of side effects in the cholestyramine and placebo groups a) showed no differences that could not be attributed to chance b) showed an increased incidence of gallstones in the cholestyramine group c) showed more cases of gastrointestinal (GI) cancers in the cholestyramine group d) b&c
19. Cholestyramine resin is confined to the GI tract is not absorbed in the GI tract has been found to be a promoter of colon cancer in animal experiments when a cancer-inducing agent was also administered all of the above
a) W a 4
20. Which of the following probably are not atherogenic? a) chylomicrons b) very low-density lipoproteins c) intermediate-density lipoproteins d) low-density lipoproteins (LDL) e) high-density lipoproteins (HDL) f) a&e
21. Most forms of to a) a decrease b) a decrease LDL c) insufficient d) a decrease tosis
hypercholesterolemia
appear to be related
in receptor-mediated clearance of LDL in nonreceptor-mediated clearance supplies of lipoprotein lipase in clearance of LDL by nonspecific
of
pinocy-
22. In Westernized society, the characteristic atherogenic pattern is that a) lipid and lipoprotein levels remain about the same between childhood and adolescence b) HDL cholesterol values are higher in adult men than in adult women c) total and LDL cholesterol levels are higher in female than in male children d) HDL cholesterol levels are lower in female than in male children
44c
DECLINE
IN CORONARY
HEART
DISEASE
MORTALITY
SYMPOSIUM
23. Results from several studies have shown that black men, compared with white men, a) have a higher incidence of ischemic heart disease consistent with their higher prevalence of hypertension b) have a more atherogenic lipoprotein pattern c) have a lower incidence of ischemic heart disease, despite their higher prevalence of hypertension d) a&b
24. Comparisons of the LRC CPPT of middle-aged Soviet men with middle-aged men living in the U.S.A. indicated a) lower total cholesterol levels in the Soviets and a less atherogenic lipoprotein profile b) higher total cholesterol levels in the Soviets and a more atherogenic lipoprotein profile c) higher total cholesterol levels in the Soviets and a less atherogenic lipoprotein profile
25. In of a) b) c) d) e) f)
the LRC CPPT population studies, the major correlates HDL cholesterol were found to be obesity alcohol consumption carbohydrate intake cigarette smoking LDL cholesterol levels male sex
26. In the LRC CPPT program, the variation in the mean values of HDL levels measured among middle-aged participants chosen from different countries correlates highly with the
average incidence of or mortality from ischemic heart disease between countries as seen in other studies. a) true b) false
27. Although the findings are controversial, women participants of the LRC CPPT program reporting postmenopausal hormone use a) had higher CHD mortality rates than nonusers b) had higher LDL and HDL cholesterol levels than nonusers c) had lower total and LDL cholesterol levels and higher HDL cholesterol levels than nonusers d) had higher all-cause mortality rates than nonusers
28. Patients with high triglyceride creased risk for CHD. a) true b) false
levels are probably
at in-
29. Exercise a) mainly affects triglyceride and HDL cholesterol levels b) increases the amount of lipoprotein lipase present in muscle tissue c) serves to increase HDL cholesterol levels d) all of the above
30. The benefit of cholestyramine is that it does not have the potential to interfere with the absorption of other drugs. a) true b) false