SAC320

1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 11
The Biomedical
Basis of Chronic
Diseases

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Chronic Diseases
 Now leading causes of death and disability
 Not deadly in the short run but have severe impacts on the quality of life
 Multiple causes, risk factors less recognizable
 Long period of onset
 Possibility of secondary prevention
 Importance of animal models
 Ethical concerns limiting experiments on humans

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Cardiovascular Disease
 Cardiovascular disease encompasses two leading causes of death in the U.S.
– Heart disease and stroke
 Causes have been relatively well established through epidemiologic studies.
 Atherosclerosis is part of the development of cardiovascular disease.
 Plaque begins at an early age in the U.S.
 American diet raises risk.
 Diet, high blood pressure, diabetes, and smoking interact, causing injury of
artery walls.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Cardiovascular Disease (cont.)
 Total cholesterol level—low is better.
– Low density lipoprotein (LDL)—low is better.
– High density lipoprotein (HDL)—high is better.
 Genetics are a major factor.
 Exercise lowers total cholesterol, increases HDL.
 Smoking lowers HDL.
 Moderate alcohol consumption raises HDL.
 Use of statins for secondary prevention is widespread.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Hypertension: High Blood Pressure
 Hypertension is an important risk factor for cardiovascular disease.
 “Primary hypertension” has no known cause.
 Obesity, smoking, and stress may be risk factors.
 Salt plays a role.
 Borderline high blood pressure is 140/90; “normal” blood pressure is below
120/80.
 Secondary prevention is effective.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Cancer
 Cancer is much more difficult to understand than cardiovascular disease.
 It is not one disease but many, each with different risk factors, treatments, etc.
 Cancer arises from mutations in DNA.
– Mutations are caused by chemicals, viruses, radiation.
 Diet and hormones play a role.
 Tobacco use causes one-third of cancer deaths.
 Testing chemicals for carcinogenicity is complex.
 Hepatitis B vaccination prevents liver cancer.
 Human papilloma virus vaccine is recent.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Diabetes
 Diabetes is deficiency in ability to metabolize sugar.
 Diabetes is a major cause of disability.
 Type 1, “childhood onset,” is insulin production failure.
 Type 2, “adult onset,” is insulin resistance.
– It is closely correlated with obesity.
– Prevalence is rising in the U.S. along with obesity.
 Both are usually treatable but need long-term monitoring and good access to
medical care.
– Lack of access to routine medical care contributes to the seriousness of diabetes as
a public health problem.

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2021
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Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Complications of Diabetes
 Blindness
 Kidney failure
 Poor wound healing
 Amputations of the extremities

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Other Chronic Disease of Public Health Importance
 Alzheimer’s disease and other dementias
 Arthritis
 Mental Illness

10. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 How do epidemiology and biomedical science complement each other in
improving people’s understanding of chronic diseases?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 Why are animal models important for understanding human diseases?

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Compare the medical approach with the public health approach to saving lives
from cardiovascular disease.
 What are the advantages and disadvantages of each approach?

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Compare the medical approach with the public health approach to saving lives
from cancer.
 What are the advantages and disadvantages of each approach?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 5
 Visit the website of the National Heart, Lung, and Blood Institute,
www.nhlbi.nih.gov/index.htm.
 Under “News & Resources,” review press releases over the past year.
 What new findings has the institute publicized?

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©
2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 6
 Visit the National Cancer Institute’s website, www.nci.nih.gov.
 Under “News and Events,” review press releases over the past year.
 What new findings has the institute publicized?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 8
 Find these websites:
– American Cancer Society
– American Heart Association
– American Lung Association
– American Diabetes Association
 How do these websites differ from those of the NIH institutes for the same
diseases?