Atherosclerosis and CVD

Question 1

what is atherosclerosis?

Answer 1

atheroma (fatty deposits) building up in large vessel walls. Caused by chronic inflammation and immune system activation in wall.

Lipids in artery wall forming plaques = stiffening, stenosis and plaque rupture

Question 2

Dangers of a plaque in arterial wall rupturing?

Answer 2

plaque breaks off and causes thrombus = can lodge in distal vessel eg coronary artery

Question 3

What can stiffening of the arterial walls lead to?

Answer 3

Hypertension

Question 4

What can stenosis of the arterial walls lead to?

Answer 4

reduced blood flow - angina

Question 5

what are non-modifiable risk factors for cardiovascular disease?

Answer 5

Older age
Family history
Male

Question 6

what are modifiable risk factors for cardiovascular disease?

Answer 6

Raised cholesterol
Smoking
Alcohol consumption
Poor diet
Lack of exercise
Obesity
Poor sleep
Stress

Question 7

What are medical co-morbidities for increased atherosclerosis risk?

Answer 7

Diabetes
Hypertension
Chronic kidney disease (CKD)
Inflammatory conditions, such as rheumatoid arthritis
Atypical antipsychotic medications

Question 8

what can be the end result of atherosclerosis?

Answer 8

Angina
Myocardial infarction
Transient ischaemic attacks
Strokes
Peripheral arterial disease
Chronic mesenteric ischaemia

Question 9

What are the two prevention types of cardiovascular disease?

Answer 9

primary - never had CVD diagnosis
secondary - after CVD diagnosis

Question 10

Examples to optimise modifiable risk factors?

Answer 10

Address diet, exercise and obesity
Stop smoking
Reducing alcohol consumption
Optimise treatment of co-morbidities (such as diabetes)

Question 11

What are recommened dietary changes for CVD?

Answer 11

Total fat is less than 30% of total calories (primarily monounsaturated and polyunsaturated fats)
Saturated fat is less than 7% of total calories
Reduced sugar intake
Wholegrain options
At least 5 a day of fruit and vegetables
At least 2 a week of fish (one being oily)
At least 4 a week of legumes, seeds and nuts

Question 12

Recommended exercise guidlines for CVD?

Answer 12

Aerobic activity for a total of at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity per week
Strength training activities at least 2 days a week

Question 13

What is the medical primary prevention for CVD?

Answer 13

atorvastatin 20mg at night

Question 14

How to know who to give primary medical prevention for CVD to?

Answer 14

QRISK3 score - chance of stroke or MI in 10 yrs
If over 10% = statin

Question 15

As well as QRISK3 score - who else is given a statin for primary CVD prevention?

Answer 15

pts with CKD (egfr less than 60)
and type 1 diabetes (10 plus years and over 40)

Question 16

What is the secondary prevention for cardiovascular disease?

Answer 16

4As

A – Antiplatelet medications (e.g., aspirin, clopidogrel and ticagrelor)
A – Atorvastatin 80mg
A – Atenolol (or an alternative beta blocker – commonly bisoprolol) titrated to the maximum tolerated dose
A – ACE inhibitor (commonly ramipril) titrated to the maximum tolerated dose

(after MI remember to add aspirin 75mg daily and clopidogrel/ticagrelor for 12 motnhs)