CAD risk factors Flashcards
Stats on coronary stenosis severity prior to MI?
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
Progression of coronary remodeling?
- 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
Amount of women that die of CHD?
- 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
Major CAD risk factors?
- 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)
Other risk factors?
- 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
BMI and increased risk of CHD in nurses study?
- 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
How is diabetes a CHD risk equivalent?
- 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
What are the general features of the metabolic syndrome?
- 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
Pulse pressure relationship with CHD mortality?
- 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
Lifestyle modifications and effect on SBP?
- 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
What drugs should be used for stage 1 HTN (140-159/90-99)? stage 2 (systolic over 160, or diastolic over 100)
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
TC level correlation with CHD (framingham study)
- 35% OF CHD occurs in people with TC less than 200
- need to decrease LDLs
Difference in major risk factors and emerging risk factors?
- 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
What does Hs-CRP correlate with?
- correlates well with LDL levels (inflammatory response from LDL)
- use in younger pts that are high risk to motivate them to lower LDL
CHD risk equivalents?
- greater than 20% 10 yr risk of CHD (framingham)
- diabetes
- other forms of clinical atherosclerotic disease: AAA, PAD, CAD
How much of the adult pop are at intermediate risk for total CHD?
- 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
Diet changes?
DASH
- more fruits, veggies
- less saturated fat, and carbs (low fat dairy products)
- more fiber and protein
- less Na+
Guidelines for primary prevention of CVD and stroke?
- 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
Management of primary prevention of CVD?
- 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%
Secondary prevention of CVD?
- 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
AHA guidelines?
- 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
Risk reduction for pts with CHD or other atherosclerotic disease?
- 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
