Atherosclerosis

Question 1

What is atherosclerosis?

Answer 1

A combination of atheromas (fatty deposits) and sclerosis (hardening of walls)

Question 2

What is atherosclerosis caused by and how does it progress?

Answer 2

• Chronic inflammation and activation of the immune system in the artery wall.
• Causes deposition of lipids in the artery wall

-Followed by development of atheromatous plaques

Question 3

What can atheromatous plaques cause ?

Answer 3

Stiffening-> hypertension
Stenosis-> reduced blood flow e.g angina
Rupture-> thrombus leading to ischaemia

Question 4

What are the non-modifiable risk factors for atherosclerosis?

Answer 4

• older age
• family history
• male

Question 5

What are the modifiable risk factors for atherosclerosis?

Answer 5

• smoking
• alcohol consumption
• poor diet
• low exercise
• obesity
• poor sleep
• stress

Question 6

What co-morbidities increase the risk of atherosclerosis?

Answer 6

• diabetes
• hypertension
• CKD
• inflammatory conditions e.g rheumatoid
  arthritis
• atypical antipsychotic medications

Question 7

What does atherosclerosis eventually lead to?

Answer 7

-angina
- MI
-Transient ischaemic attacks
-Stroke
-Peripheral vascular disease
-Mesenteric ischeamia

Question 8

Describe primary prevention of cardiovascular disease

Answer 8

• QRISK 3 score if > 10% atorvastatin 20 mg at night
• CKD or T1DM patients for >10 years atorvastatin 20 mg

Question 9

What is secondary prevention of cardiovascular disease?

Answer 9

A – Aspirin (plus a second antiplatelet such as clopidogrel for 12 months)
A – Atorvastatin 80mg
A – Atenolol (or other beta-blocker – commonly bisoprolol) titrated to maximum tolerated dose
A – ACE inhibitor (commonly ramipril) titrated to maximum tolerated dose

Question 10

What are the notable side effects of statins

Answer 10

Myopathy (check creatine kinase in patients with muscle pain or weakness)
Type 2 diabetes