Atherosclerosis Flashcards
What is atherosclerosis?
Combination of atheromas = fatty deposits in artery walls
+
Sclerosis= process of hardening/stiffening blood vessel walls
Where does atherosclerosis affect?
Medium and large arteries
What causes atherosclerosis plaques?
Chronic inflammation and activation of immune system in artery wall which results in deposition of lipids in artery wall which is then followed by fibrous atheromatous plaques
What do fibrous atheromatous plaques cause?
Stiffened artery walls leading to hypertension
Stenosis leading to reduced blood flow = angina
Plaque rupture resulting in thrombus that can block distal vessel & cause ischaemia
Example of plaque rupture leading to ischemia?
Acute coronary syndrome
What does a plaque rupture result in?
Thrombus
Non-modifiable risks factors for atherosclerosis?
Family history
Older age
Male
Modifiable risks for atherosclerosis?
Poor diet Smoking Alcohol consumption Lack of exercise Obesity Poor sleep Stress
Medical co-morbidities?
Diabetes Hypertension Chronic kidney disease Inflammatory conditions Atypical antipsychotic medications
What does atherosclerosis result in?
Angina MI TIA Stroke Peripheral vascular disease Chronic mesenteric ischaemia
Who is primary prevention for?
Patients that have never had CV disease
How to assess a primary prevention patient?
QRISK3 score - calculates the likelihood of having a stroke/MI in next 10 years
If a QRISK score is — or above, you do what?
10%
Start a statin (atorvastatin 20mg @ night)
Who do you always offer 20mg of atorvastatin to?
Patients with CKD or type 1 diabetes
What should you check after prescribing patient a statin?
- Within 3 months check LFT’s as ALT/AST transiently rise in first few months of statin, however if it is less three times the upper limit of normal it is fine)
- At 3 months check lipids and increase dose to aim for greater than 40% reduction in non-HDL cholesterol
