OET PART B READING

PART B READING : Targeting two important risk factors for cardiovascular disease
and other major risk factors that can be lowered by modification, treatment or
control

(ARA) - It's well known that the prevalence of diabetes is on the rise. According to the
Centers for Disease Control and Prevention (CDC), about 23.6 million, or nearly 8
percent of people in the United States, have diabetes, and 1.6 million new cases are
diagnosed each year in people aged 20 and older. Type 2 diabetes is the most
common form, accounting for about 90 to 95 percent of those diagnosed, and occurs
when the body either does not produce enough insulin or does not respond to
insulin.

But something that many people may not know is that in addition to having diabetes,
70 percent of adults with type 2 diabetes also have high LDL cholesterol (LDL-C), the
"bad" cholesterol that can cause build-up in the arteries, greatly increasing their risk
for cardiovascular disease. Cholesterol is needed for the body to function normally,
but when there is too much LDL-C in the bloodstream, it is deposited in arteries,
including those of the heart, which can limit blood flow and lead to heart disease.

The American Diabetes Association (ADA) and the American College of Cardiology
(ACC) emphasize that it is critical to control both cholesterol and blood sugar levels.
The ADA recommends that patients with type 2 diabetes aim for an A1C level, which
reflects your average blood sugar level for the past two to three months, of less than
7 percent. The National Cholesterol Education Program (NCEP) ATP III recommends
that patients with type 2 diabetes target an LDL-C goal of less than 100 mg/dL.

Treating these two diseases can take a combination of efforts, including a healthy
diet and increased exercise. Medications are also sometimes needed. While there are
many drugs approved by the U.S. Food and Drug Administration (FDA) to treat type 2
diabetes and others available to lower LDL-C, a drug called Welchol (colesevelam HCl)
is the first and only medication approved as an adjunct to diet and exercise to reduce
both A1C in adults with type 2 diabetes and LDL-C in adults with elevated
cholesterol. Welchol addresses both of these chronic health conditions with one
medication and offers the convenience of two formulations, Welchol tablets and
Welchol for Oral Suspension. Welchol can be taken alone or with other cholesterol
lowering medications known as statins and can be added to other anti-diabetic
medications (metformin, sulfonylureas, or insulin).

"For patients with type 2 diabetes and high LDL cholesterol, it is important to manage
both conditions," said Yehuda Handelsman, MD, FACP, FACE, Medical Director of the
Metabolic Institute of America in Tarzana, Calif. "Welchol reduces these two risk
factors for cardiovascular disease in adults with type 2 diabetes by significantly
lowering A1C and LDL-C or 'bad' cholesterol, providing a unique therapeutic option."
It is important to note that the affect of Welchol on cardiovascular morbidity and
mortality has not been determined.

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What are the major uncontrollable risk factors for coronary heart disease? The
American Heart Association has identified several risk factors for coronary heart
disease. Some of them can be modified, treated or controlled, and some can’t. The
more risk factors a person has, the greater the chance that he or she will develop
heart disease. Also, the greater the level of each risk factor, the greater the risk. For
example, a person with a total cholesterol of 300 mg/dL has a greater risk than
someone with a total cholesterol of 240 mg/dL, even though all people with a total
cholesterol of 240 or higher are considered high risk.

Increasing age — About 82% of people who die of coronary heart disease are 65 or
older.

Male sex (gender) — The lifetime risk of developing CHD after age 40 is 49% for men
and 32% for women. The incidence of CHD in women lags behind men by 10 years
for total CHD and by 20 years for more serious clinical events such as MI and sudden
death.

Heredity (including Race) — Children of parents with heart disease are more likely to
develop it themselves. African Americans have more severe high blood pressure
than Caucasians and a higher risk of heart disease. Heart disease is also higher
among Mexican Americans, American Indians, native Hawaiians and some Asian
Americans. This is partly due to higher rates of obesity and diabetes. Most people
with a strong family history of heart disease have one or more other risk factors. Just
as you can't control your age, sex and race, you can't control your family
history. Therefore, it's even more important to treat and control any other risk
factors you have.

Other major risk factors that can be lowered by modification, treatment or control.

Tobacco smoke — Smokers’ risk of developing CHD is two to four times that of
nonsmokers'. Smokers who have a heart attack are more likely to die and die
suddenly (within an hour) than nonsmokers. Cigarette smoking also acts with other
risk factors to greatly increase the risk for coronary heart disease. People who smoke
cigars or pipes seem to have a higher risk of death from coronary heart disease (and
possibly stroke), but their risk isn't as great as cigarette smokers'. Constant exposure
to other people's smoke — called environmental tobacco smoke, secondhand smoke
or passive smoking — increases the risk of heart disease even for nonsmokers.

High blood cholesterol levels — The risk of coronary heart disease rises as blood
cholesterol levels increase. When other risk factors (such as high blood pressure and
tobacco smoke) are present, this risk increases even more. A person's cholesterol
level is also affected by age, sex, heredity and diet.

High blood pressure — High blood pressure increases the heart’s workload, causing
the heart to enlarge and weaken over time. It also increases the risk of stroke, heart
attack, kidney failure and heart failure. When high blood pressure exists with

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OET PART B READING
obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or
stroke increases several times.

Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease.
Regular, moderate-to-vigorous physical activity is important in preventing heart and
blood vessel disease.

Obesity and overweight — People who have excess body fat — especially if a lot of it
is in the waist area — are more likely to develop heart disease and stroke even if they
have no other risk factors. Excess weight increases the strain on the heart, raises
blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (good)
cholesterol levels. It can also make diabetes more likely to develop. Many obese and
overweight people have difficulty losing weight. If you can lose as little as 10 to 20
pounds, you can help lower your heart disease risk.

Diabetes mellitus — Diabetes seriously increases the risk of developing

cardiovascular disease. Even when glucose levels are under control, diabetes greatly
increases the risk of heart disease and stroke. From two-thirds to three-quarters of
people with diabetes die of some form of heart or blood vessel disease.

What other factors contribute to heart disease risk?

Stress — Individual response to stress may be a contributing factor. Some scientists

have noted a relationship between coronary heart disease risk and stress in a
person’s life, their health behaviors and socioeconomic status. These factors may
affect established risk factors. For example, people under stress may overeat, start
smoking or smoke more than they otherwise would.

Excessive alcohol intake — Drinking too much alcohol can raise blood pressure,
cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer
and other diseases, and produce irregular heartbeats. It also contributes to obesity,
alcoholism, suicide and accidents. The risk of heart disease in people who drink
moderate amounts of alcohol (an average of one drink for women or two drinks for
men per day) is lower than in nondrinkers. One drink is defined as 1–1/2 fluid ounces
(fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-
proof spirits, 4 fl oz of wine, or 12 fl oz of beer. It’s not recommended that
nondrinkers start using alcohol or that drinkers increase their intake.

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Part B reading – QUESTIONS – Note: some questions have more than one option
which could be correct.

Targeting two important risk factors for cardiovascular disease and other major risk
factors that can be lowered by modification, treatment or control

Q1 According to paragraph 1 of the article: (Circle the correct option)

a. Diabetes has stabilised

b. 1.6 million people aged 20 and older have diabetes
c. Type 2 diabetes is the most common
d. Type 2 diabetes occurs when there is an over-production of insulin

Q2 In addition to having diabetes: (Circle the correct options)

a. 30% of adult with Type 2 diabetes do not have high counts of low density lipids
b. 70% of adults with Type 2 diabetes do have high counts of low density lipids
c. Too many LDLs in the bloodstream go straight to the heart
d. LDLs in the bloodstream can hinder blood flow

Q3 According to the ADA and the ACC (Circle the correct options)

a. Both blood sugar levels and cholesterol levels need to be controlled if diabetes is to be
avoided
b. Blood sugar levels need to be controlled if diabetes is to be avoided
c. ACA believes less than 7% average blood sugar level over a one month period indicates no
diabetes risk
d. The NCEP recommends Type 2 diabetics aim for less than 100 mg/dL of low density lipids

Q4 Welchol, a drug to lower the level of LDLs in the blood: (circle the correct options)

a. has been approved by the U.S. FDA

b. Welchol must be taken with other statins
c. Welchol should not be added to medications such as metformin, sulfonylureas or insulin.
d. Welchol needs to be taken together with a healthy diet and an exercise program to reduce
A1C in Type 2 diabetics and LDL-C in adults with elevated cholesterol levels.

Q5 Welchol’s affect on cv mobidity and mortality

a. is supported by the evidence

b. has not been positively established
c. has been positively established
d. none of the above

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Q6 Some risk factors can be controlled, or lowered; some cannot be controlled: such as
advancing age, one’s gender, and one’s genetic inheritance. However, there are some major
risk factors that can be lowered – by modifying one’s lifestyle - or by medical intervention.

Risk factors such as : (circle correct options)

a. high blood pressure
b. high cholesterol levels
c. obesity
d. all of the above

Q7 The article states that stress : (circle correct options)

a. causes overeating and/or habitual smoking

b. interacts with lifestyle and socioeconomic status
c. depends on how one reacts to it
d. may depend on how one reacts to it

Q8 Alcohol contributes to heart failure and strokes : (circle correct options)

a. if you drink too much

b. moderate alcohol intake leads to less risk of heart disease
c. might contribute to high triglycerides
d. is not a factor in developing cancer

Q9 To have just “one drink” of alcohol, means : (circle correct options)

a. to consume no more than 1½ fluid ounces

b. to consume 4 fluid ounces
c. to consume 12 fluid ounces
d. depends on the type of alcohol

Q10 High blood pressure and physical inactivity: (circle the correct options)

a. are contributing factors for coronary heart disease

b. people with high blood pressure should not do physical activities
c. people with high blood pressure have increased risk of renal failure
d. to prevent heart disease, one should have regular mild physical activity

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Part B reading – ANSWERS

Targeting two important risk factors for cardiovascular disease and other major risk
factors that can be lowered by modification, treatment or control

1–c Para 1, line 4

2 – b, d Para 2
3 – a, d Para 3
4 - a, d Para 4
5- b Last sentence, p1
6- d
7 - b, d Page 3, para 4
8 - a, b, c Page 3, last para
9 - d Page 3, last para, line 6
10 – a, c Page 2 High Blood Pressure and page 3 – Physical Inactivity -

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