1.

Cocaine use increases the risk of a heart attack.

Cocaine also affects the levels of a number of blood components, including von Willebrand
factor and fibrinogen. These two components are involved in blood clotting.
(a)

The normal range for von Willebrand factor is 50 to 150 mg per cm and for fibrinogen is
3
150 to 300 mg per cm .
The graphs below show the effects of frequent and occasional cocaine use on the mean
concentration of von Willebrand factor and fibrinogen in the blood.

Al-NAjah Private School

(i)

Describe the effects of frequent and occasional cocaine use on the mean
concentrations of von Willebrand factor and fibrinogen in the blood.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

(ii)

Using the information given, explain why conclusions cannot be made about the
effect of occasional cocaine use on the concentrations of these blood components.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(1)

(b)

The diagram below shows two functions of von Willebrand factor.

Al-NAjah Private School

Using the information in this diagram and your own knowledge of the blood clotting
process, suggest why frequent cocaine use could increase the risk of a blood clot forming.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(4)

(c)

It has been suggested that there is a correlation between the change in the concentrations
of fibrinogen in the blood and the increased risk of heart disease due to cocaine use.
Explain why this suggestion is valid.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(2)
(Total 10 marks)

Al-NAjah Private School

2.

Obesity is a significant problem in western countries and an increasing problem in other parts of
the world. An obese person has a greater risk of developing heart disease.
Body Mass Index (BMI) is one measure used to help decide if a persons weight is reasonable
for their height. The BMI can be calculated by dividing mass in kilograms by height in metres
squared. A table is then used to judge if the BMI is reasonable or not. A copy of this table is
shown below.
BMI range

Less than 18.5

18.5 to 24.9

25.0 to 29.9

30.0 to 39.9

40.0 or above

Description

Underweight

Healthy
weight

Overweight

Obese

Morbidly
obese

(a)

A man was concerned that he was overweight and could be at risk from coronary heart
disease. He was 1.8 m tall and had a mass of 83.0 kg.
(i)

Calculate this mans body mass index (BMI) using the formula below.

mass in kilogrammes
2
BMI = (heights in meters)

Answer ...................................................
(2)

(ii)

Using the information in the table, interpret this mans BMI.

...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(2)

Al-NAjah Private School

(b)

The graph below shows one analysis of relative mortality compared with BMI, for men
and women.

Compare the effect of BMI on relative mortality for men and women.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(3)

Al-NAjah Private School

(c)

(i)
A relative mortality of 1.2 or less indicates a low risk of dying. Using
the information given, discuss whether or not a woman with a BMI of 32.5 should
be concerned about her risk of dying.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(2)

(ii)

Cardiovascular disease (CVD) is responsible for many deaths.

Describe two changes that this woman may be able to make to her lifestyle, to
reduce her risk of dying from CVD. Explain how each change would reduce the
risk.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(4)
(Total 13 marks)

Al-NAjah Private School

3.

Data on the cholesterol levels and blood pressure for different adult populations in America
were collected.
The mean cholesterol level and the percentage of each population with high blood pressure were
calculated. The results are shown in the table below.
Adult population
(ethnic groups)

Mean cholesterol level

3
/ mg dm

Percentage of
population with high
blood pressure (%)

Black and African American

204

40

White American

206

27

Mexican American

205

29

Statistically unreliable data

Statistically unreliable data

American Indian and Alaskan

Native

(a)

There could be a causal link or correlation between high blood pressure and the other
variables shown in the table.
Distinguish between the terms causation and correlation.
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
(2)

(b)

(i)
Using the information in the table above, describe the relationship
between ethnic group, cholesterol levels and the percentage of the population with
high blood pressure.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(2)

Al-NAjah Private School

(ii)

Suggest one reason why the data on the American Indian and Alaskan Native
population are described as statistically unreliable.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(1)

(c)

A student concluded from the results for gender, shown in the table below, that higher
cholesterol levels cause lower blood pressure.
Adult population
(gender)

Mean cholesterol level

/ mg dm3

Percentage of
population with high
blood pressure (%)

Female

207

26

Male

204

30

Using the information in both tables, explain why this is not a valid conclusion.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(3)
(Total 8 marks)

Al-NAjah Private School

4.

High blood cholesterol levels are associated with an increased risk of developing cardiovascular
disease (CVD). There are cholesterol-reducing drugs available to lower this risk.
(a)

Two groups of patients were treated with a different type of cholesterol-reducing drug,
Drug A or Drug B.
The graphs below show the percentage changes of total cholesterol (TC), lowdensity
lipoproteins (LDL) and high-density lipoproteins (HDL) in the blood of these patients,
after treatment.

(i)

Compare the effects of Drug A and Drug B on the percentage changes in total
cholesterol (TC), LDL and HDL in the blood of these two groups of patients.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

Al-NAjah Private School

(ii)

The enzyme HMG-CoA reductase catalyses the synthesis of cholesterol. When this
enzyme is active, there are fewer LDL receptors on liver cells. These receptors are
needed to remove LDL from the blood.
Statins are a group of cholesterol-reducing drugs that act by inhibiting this enzyme.
Suggest which of the two drugs, Drug A or Drug B, is more likely to be a statin.
Give reasons for your answer.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

(b)

State two risks of treatments using statins.

1 ..................................................................................................................................
.....................................................................................................................................
2 ..................................................................................................................................
.....................................................................................................................................
(2)

Al-NAjah Private School

10

(c)

Age and gender are two other factors that may influence the development of heart disease
in an individual.
The graph below shows the results of a survey in America, on the incidence of heart
disease in adults aged 18 and older.

(i)

Using the information in the graph, describe how the incidence of heart disease is
affected by age and gender.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

(ii)

Calculate the increased risk that a man who is 75 or older has of developing heart
disease, compared to a man aged between 18 and 44 years old.
Answer ..................................................................................................
(2)
(Total 13 marks)

Al-NAjah Private School

11

5.

Sunil has angina and has been recommended to control his diet to reduce his chance of a heart
attack.
(a)

Explain how atherosclerosis could cause the chest pain associated with an attack of
angina.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(3)

The table below shows some of the relevant dietary information for assessing the content
of three alternative breakfasts that Sunil normally eats.
Meal

Energy
/kJ

Carbohydrate / g

Saturated
fatty acids / g

Unsaturated
fatty acids / g

Cholesterol
/mg

2 slices
of whole
wheat
toast

580

26

0.5

1.5

margarine

180

0.1

3.8

baked
beans

1113

52

0.25

0.5

78.1

1.75

5.8

Food

Total

2 slices
of white
toast

662

29

0.3

1.7

margarine

180

0.1

3.8

2 fried
eggs

772

0.8

210

29.9

5.3

13.5

210

Total

2 slices
of white
toast

662

29

0.3

1.7

margarine

180

0.1

3.8

2 slices of
cheddar
cheese

948
0.8

5.8

58

29.9

7.3

11.3

58

Total

Al-NAjah Private School

12

(b)

(i)

Complete the table by calculating the total energy of each meal.

(1)

(ii)

Give the letter of the meal that contains the highest energy content.
Meal with highest energy content ...................
(1)

(iii)

Suggest which meal you would recommend to Sunil if he wishes to reduce his risk
of coronary heart disease. Explain the reasons for your choice.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)
(Total 8 marks)

6.

The table below shows population statistics and deaths from coronary heart disease (CHD) for
males and females in England during a two year period.
Number in the population

Number dying from CHD

Males

23 922 144

33 879

Females

25 216 687

9 016

(a)

(i)
For this two year period, calculate the percentage risk of a male dying
from CHD. Show your working.

(1)

Al-NAjah Private School

13

(ii)

Use the data in the table above to calculate how many times females are less likely
to die from CHD than males.

(1)

(b)

Body Mass Index (BMI) can be used to indicate whether a person is overweight. The
chart below shows the effect of having a high BMI on the risk of dying of CHD when
compared with a control group with a normal BMI of 20. A person with a BMI of 30 is
obese.
5

I n
r i s
d
C

4 0
c r e a s e
i n
k
o f 3d 0 e a t h
u e t o2 0
H D
/ %
1 0
0
2

0
B

(i)

o d

a s s

I n

e x

( B

I )

Describe the trend shown in the chart.

...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(2)

(ii)

Give the formula used to calculate BMI.

(1)

Al-NAjah Private School

14

(iii)

Explain why people who are overweight are more likely to die from CHD.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)
(Total 8 marks)

7.

The diagrams below show the left side of the heart at two stages of the cardiac cycle.

(a)

(i)

i a g

r a m

Name structure X shown on the diagram.

X .......................................................................................................................
(1)

(ii)

Name the part of the cardiac cycle illustrated by diagram B.

...........................................................................................................................
(1)

Al-NAjah Private School

15

(iii)

With reference to structures shown on diagram B, describe and explain what

happens during this phase of the cardiac cycle.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

(b)

Balloon angioplasty is regularly used to unblock coronary arteries that have been affected
by atherosclerosis. The procedure is shown in the diagram below.

i d

i n

c a t h

eN t ea rr r o

B a l l o o n
c a t h e t e r
u n i n f l a t e d
b a l l o o

B
p

a l l o o n
a r t i a l l y

B a l l o o n
i n f l a t e d

Al-NAjah Private School

l o

c k

e d

w
n

e d

w
b

i t h
a l l o

c a t h e t e r
a l l o o n

i t h

c o

r o

a r y

r o

a r y

a r t e r y

i t h

c a t h e t e r
i n f l a t e d

c o

a r t e r y

16

(i)

Suggest why the patient may experience chest pain as a result of this partial
blocking of one of the coronary arteries.
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
(3)

(ii)

Suggest why the walls of the artery return to their original position once the
balloon is removed.
...........................................................................................................................
...........................................................................................................................
(1)

(c)

Explain why doctors may advise a patient to try a balloon angioplasty in preference to an
operation such as a coronary bypass.
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
.....................................................................................................................................
(2)

(d)

Suggest why atherosclerosis usually affects coronary arteries but not coronary veins.
.....................................................................................................................................
.....................................................................................................................................
(1)
(Total 12 marks)

Al-NAjah Private School

17