5. Cardiovascular risk assessment and prevention

Question 1

Cardiovascular disease

Answer 1

conditions that affect the heart or blood vessels, commonly caused by atherosclerosis

Question 2

Types of atherosclerotic cardiovascular disease

Answer 2

1. Coronary artery disease - when blood vessels that supply the heart are affected (includes angina and heart attacks)
2. Cerebrovascular disease - when arteries that supply the brain are affected (includes strokes and transient ishcaemic attack)
3. Peripheral artery disease - when peripheral arteries in the limbs are affected
4. Aortic disease - affects the aorta
   Can split, can form a balloon (aneurysm) has a risk of rupturing

Question 3

Risk factors for cardiovascular disease - unmodifiable

Answer 3

• Men
• 50 years+
• Family history
• South-Asian, Afro-caribbean

Question 4

Risk factors for cardiovascular disease - modifiable

Answer 4

• Hypertension
• Dyslipidaemia
• Obesity
• Inactivity
• Smoking
• Excessive alcohol

Question 5

Healthy lifestyle

Answer 5

• Low saturated fat, salt
• Alcohol < 14 units
• 2.5h moderate intensity exercise
• 1h 15 min high intensity exercise

Question 6

Risk calculators

Answer 6

Determine the chance of someone having a heart attack or stroke in the next 10 years

e.g QRISK

Question 7

Cardiovascular risk assesment
typically offered to

Answer 7

Cardiovascular risk assessment offered to:
- 40+ years
- Estimated 10-year risk >10%

Some patients will already be deemed high risk, without the QRISK calculator

e.g patients over 85 years, patients with diabetic complications like nephropathy

Question 8

QRISK results

Answer 8

QRISK of 10% or more means the patient is high risk and will need primary preventon treatment with drugs

Question 9

Cardiovascular disease prevention treatment

Answer 9

Primary prevention:
* 20mg Atorvastatin (high-intensity statin)

Secondary prevention: for patients who already have a cardiovascular disease and to prevent a heart attack or stroke

• 80mg Atorvastatin
  AND
  Low-dose aspirin daily 75mg
• AND patients who have had a stroke/TIA and sinus rhythm: Clopidogrel OR dipyridamole

Question 10

Hyperlipidaemia

Answer 10

High levels of lipids or fat in the blood, i.e lipids or triglycerides

Question 11

Coronary artery disease

Answer 11

Where atherosclerosis affects the coronary arteries which supply the heart

Coronary artery disease includes angina and heart attacks

Angina, 2 types
* Stable
* Unstable

Heart attacks, 2 types
* STEMI
* Non-STEMI

Unstable angina, STEMI and Non-STEMI are types of acute coronary syndrome = MEDICAL EMERGENCY