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Cardiology > CAD risk factors > Flashcards

CAD risk factors Flashcards

1
Q

Stats on coronary stenosis severity prior to MI?

A

68% - have less than 50% stenosis
18% - have 50-70%
14% - have more than 70%
- so more stenosis doesnt mean that there is an increased likelihood of having an MI. Not all about the plaque occlusion

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2
Q

Progression of coronary remodeling?

A
  • minimal CAD: lumen starts to expand - plaque build up (this is where we want to tx aggressively)
  • moderate: more occlusion
  • SEvere: expansion overcomes, and lumen narrows
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3
Q

Amount of women that die of CHD?

A
  • 1 in 2-3 women die of CHD, but only 4% fear dying of this
  • 1 in 27 women die of breast cancer, 40% fear of dying of breast cancer
  • 2/3 of women have at least 1 CHD risk.. 52% over age 45 have HTN, 40% over 55 have high cholesterol
  • hormone replacement is not cardioprotective, could actually be harmful
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4
Q

Major CAD risk factors?

A
  • cigarette smoking (19% of women smoke and 23% of men), after 1 year of quitting, decrease risk of developing CAD by 50%
  • elev total or LDL cholesterol
  • HTN
  • low HDL (less than 40 in men and 50 in women)
  • family hx of premature CAD: CHD in male first degree less than 55, CHD in female first degree less than 65
  • age (men 45 and over, and women 55 and over)
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5
Q

Other risk factors?

A
  • obesity: greater than 30 and overweight 25-30
  • abdominal obesity waist circumference greater or equal to 40 in men and greater or equal to 35 in women (5-10 lb wt loss makes a huge difference)
  • physical inactivity: recommend at least 30 min moderate activity at least 4-5 days/week
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6
Q

BMI and increased risk of CHD in nurses study?

A
  • CHD risk increases for BMI greater than 23 and diabetes increases for BMI greater than 22
  • risk also is sig increased for wt gain after 18 of 5 kg or more
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7
Q

How is diabetes a CHD risk equivalent?

A
  • 10 yr risk for CHD: 20%
  • high mortality with est CHD:
    high mortality with acute MI and high mortality post acute MI
  • high sugars: more strain, increased O2 demand, HDLs drop, and LDLs increase
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8
Q

What are the general features of the metabolic syndrome?

A
  • abd obesity
  • atherogenic dyslipidemia: elev TGs (greater than 150), high LDL, low HDL (lower than 40 in men, and 50 in women)
  • raised BP
  • insulin resistance
  • prothrombotic state
  • proinflammatory state
  • combo of high BP, low HDL, and high LDL significantly increases risk of CHD
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9
Q

Pulse pressure relationship with CHD mortality?

A
  • higher the systolic the more increased risk of CHD mortality (diastolic isn’t a huge factor)
  • pulse pressure widens -more likely to have tear in vessel and have plaque rupture
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10
Q

Lifestyle modifications and effect on SBP?

A
  • wt reduction: 5- 10 mm Hg/ 10 kg wt loss
  • DASH: 8 -14 mmHg
  • Na+ reduction: 2-8 mm Hg
  • physical activity: 4-9 mmHg
  • mod of alcohol consumption: 2-4 mmHg
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11
Q

What drugs should be used for stage 1 HTN (140-159/90-99)? stage 2 (systolic over 160, or diastolic over 100)

A

stage 1:
- lifestyle modification
- thiazide diuretic, consider ACEI, ARB, BB, CCB, or combo
stage 2:
- lifestyle modification
- 2 drug combo: thiazide + ACEI or ARB or BB or CCB, add on other drugs if needed

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12
Q

TC level correlation with CHD (framingham study)

A
  • 35% OF CHD occurs in people with TC less than 200

- need to decrease LDLs

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13
Q

Difference in major risk factors and emerging risk factors?

A
  • major risk factors: account for only half of variability in CHD risk in US pop
  • emerging risk factors could enhance predictive power in individuals: lipids and nonlipids
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14
Q

What does Hs-CRP correlate with?

A
  • correlates well with LDL levels (inflammatory response from LDL)
  • use in younger pts that are high risk to motivate them to lower LDL
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15
Q

CHD risk equivalents?

A
  • greater than 20% 10 yr risk of CHD (framingham)
  • diabetes
  • other forms of clinical atherosclerotic disease: AAA, PAD, CAD
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16
Q

How much of the adult pop are at intermediate risk for total CHD?

A
  • 40%
  • they have at least 1 major risk CHD factor and have 6-20% 10 yr risk of a hard CHD event, possible warranting further risk stratification by noninvasive tests to assess atherosclerotic likeliness
  • get baseline EKG
    tx RFs: with statin
17
Q

Diet changes?

A

DASH

  • more fruits, veggies
  • less saturated fat, and carbs (low fat dairy products)
  • more fiber and protein
  • less Na+
18
Q

Guidelines for primary prevention of CVD and stroke?

A
  • beginning at 20:
    regularly assess family hx, smoking status, diet, alcohol intake, and physical activity
  • BP, BMI, waist cirumference, pulse assessed at least every 2 years, fasting lipid profile, glucose measured every 5 years (2yrs if risk factors present)
  • beginning age 40:
    assess 10 yr risk of CHD using mult risk factor score (start younger if 2+ risk factors present), those at greater than 20% risk considered CHD risk equivalent
19
Q

Management of primary prevention of CVD?

A
  • smoking: complete cessation, no ETS
  • BP below 140/90, belwo 130/85 if renal infuse or CHF, below 130/80 if diabetic
  • dietary intake: in moderation, cut down
  • aspirin: consider 81 mg for those at 10 year risk of 10% or greater
  • lipids
  • physical activity: at least 30 min/day on most days of the week
  • wt management: desireable BMI: 18.5- 25
  • diabetes: fasting glucose less than 110 and HgbA1C less than 7%
20
Q

Secondary prevention of CVD?

A
  • CVD rates in those with pre-existing disease are 5-7x greater than healthy individuals
  • diabetics run a similar event rate as those with previous MI
  • RF modification is the cornerstone of secondary prevention efforts
  • categories of pts for secondary prevention efforts: 1) stable CHD, 2) unstable angina 3) prior MI 4) prior CABG 5) prior PTCA 6) known vascular disease
21
Q

AHA guidelines?

A
  • cessation of smoking
  • lipid management goals
  • physical activity
  • wt management
  • antiplatelet/anticoag
  • ACEIs
  • BBs
    BP control
  • early aspirin
  • early BBs
  • reperfusion for AMI
  • stroke: a fib and alcohol use
22
Q

Risk reduction for pts with CHD or other atherosclerotic disease?

A
  • ASA: 20-30%
  • BBs: 20-35%
  • ACEIs: 22-25%
  • statins: LDL less than 100 25-42%
  • smoking cessation: 50%
  • providers are aware of guidelines and risk reduction yet majority not tx their patients

Cardiology (20 decks)

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