Cardiovascuar Health Flashcards
What is cardiovascular disease?
Can refer to a number of conditions
CHD
Stroke
Peripheral artery disease
Heart failure
MI
What is atherosclerotic cardiovascular disease? (ASCVD)
Acute coronary syndromes
History of MI
Stable or unstable angina
Etc
Presumed to be of atheroscleortic origin
What is the leading cause of death for men and women?
Heart disease
How many people die from heart disease/
One person dies every 34 seconds
697,000 Americans die (1 in every 5 deaths)
What are the important risk factors for heart disease/
HTN
Hyperlipidemia
Smoking
What is the #1 for primary prevention of heart disease?
Promote a healthy lifestyle throughout life
What is the #2 for primary prevention of heart disease?
A team-based care approach is an effective strategy for prevention of cardiovascular disease
-evaluate the social determinants
What is the #3 for primary prevention of heart disease?
Adults 40 to 75 yoa evaluate
-10 year atherosclerotic cardiovascular disease (ASCVD)
What does the ASCVD risk calculator over estimate for?
Hispanic and Asians
What does the ASCVD under estimate for ?
American Indian population
What is borderline and intermediate for the 10 year ASCVD risk calculator?
Borderline: 5-7.5%
Intermediate: 7.5-20%
What is the #4 for primary prevention of heart disease?
All adults should consume a healthy life-style
-emphasizes vegetables, fruits, nuts
-minimizes trans fats
-overweight and obesity
What is the #5 for primary prevention of heart disease?
At least 150 minutes per week of moderate- intensity PA OR
75 minutes per week of vigorous intensity
What is the #6 for primary prevention of heart disease?
Adults with T2DM
-improve diet
-exercise
-metformin is first-line therapy
When should a diabetic be considered for SGLT-2 inhibitor or GLP-1R agonist?
If their HbA1C is not less than 7% after lifestyle changes and metformin
-and they have CVD risks
What is the #7 for primary prevention of heart disease?
Assess tobacco use with every healthcare visit
What is the leading preventable cause of death?
Tobacco
What is the #8 for primary prevention of heart disease?
Aspirin
-used infrequently for primary prevention of ASCVD bc of no net benefit
Should adults with a >10% CVD risk use aspirin?
No, no net benefit
-those with low bleeding risk are more likely to benefit
What is the #9 for primary prevention of heart disease?
Statin therapy is the first-line treatment for primary prevention of ASCVD
-low-density lipoprotein cholesterol >190mg/dL
-diabetes
-40 to 75 yoa
What is the #10 for primary prevention of heart disease?
Non pharmacological interventions are recommended for all adults with elevated blood pressure or HTN
What is the target BP when using pharmacological interventions?
<130/80mm Hg
What does the AAP recommended for screening for cholesterol levels?
Begin 9-11 then again 17-21
May start at age 2 if FHx of hyperlipidemia
What does the AHA recommend for screening for cholesterol levels?
screen all adults >20 yoa
>40 calculate 10 year risk assessment
What is the UPToDate screening recommendations for cholesterol
Adults with high CVD risk
-males between 25 to 30
-females between 30 to 35
Adults with low CVD risk
-males at 35
-females at 45
When should lipoprotein levels be obtained?
9 to 12 hour fast
What are the levels of desirable, borderline high, and high total cholesterol?
Desirable: <200mg/dL
Borderline high: 200-239mg/dL
High: >240mg/dL
What are the levels for low and high HDL cholesterol
Low: <40mg/dL (dangerous)
High: >60mg/dL
What are the optimal and high levels of LDL cholesterol?
Optimal: <100mg/dL
High: 160-189mg/dL
What are the levels for normal, borderline high, high, and very high serum triglycerides?
normal: <150mg/dL
borderline high: 150-199mg/dL
High: 200-499mg/dL
Very high: >500mg/dL
What tests should be used for lipoprotein levels if the patient was not fasting?
Total cholesterol and HDL
*fasting is required is TC>250 or HDL<40
If someone has a LDL level of >190mg/dL what medication should they be on?
High intensity statin
10 year ASCVD risk of <5% low risk, what is the risk discussion?
Empathize lifestyle to reduce risk factors
10 year ASCVD risk of <5% to 7.5% borderline risk, what is the risk discussion?
Moderate intensity statin therapy
10 year ASCVD risk of 7.5% to <20%% intermediate risk, what is the risk discussion?
Moderate intensity statin to reduce LDL-C
-by at least 30%-49%
10 year ASCVD risk of >20% high risk, what is the risk discussion?
Statin to reduce LDL-C by
>50%
What is the #1 take home message for cholesterol?
Empathizes a heart-healthy lifestyle in all individuals
What is the #2 take home message for cholesterol?
Patients with clinical ASCVD, reduce low-density lipoprotein cholesterol LDL-C
-with high intensity statin
-lower LDL-C by >50%
What is the #3 take home message for cholesterol?
Very high-risk of ASCVD, use a LDL threshold of 70mg/dL to consider addition of non statins to stain therapy
-Add ezetimibe
-Add PCSK9 inhibitor
What is the #4 take home message for cholesterol?
Patients with severe primary hypercholesterolemia (LDL-C levels >190mg/dL)
-begin high-intensity statin therapy
-without calculating 10 year ASCVD risk
What happens if the LDL-C levels remains >100mg/DL?
Add ezetimibe
-if patient with multiple risk factors add PCSK( inhibitor
What is the #5 take home message for cholesterol?
Patients 40 to 75 years with DM and LDL-C >70mg/dL
-start a moderate-intensity statin therapy
-without calculating 10 year ASCVD risk
What is the #6 take home message for cholesterol?
Adults 40 to 75 yoa evaluated for primary ASCVD prevention
-have a clinician-patient risk discussion before starting statin therapy
What is the #7 take home message for cholesterol?
Adults 40 to 75 years without DM and LDL-C levels >70mg/dL
-WITH 10 year risk of >7.5%
-Starts a moderate-intensity statin
What should you do if the risk status of ASCVD is uncertain?
Use a coronary artery calcium (CAC) to improve specificity
What should the LDL-C levels be reduced by if statin are initiated?
> 30%
If 10 year risk>20%: reduce by >50%
What is a CAC? (Coronary artery calcium) score
A test that will measure the amount of calcium in the arteries of the heart
-estimates someones risk of developing heart disease
What is the #8 take home message for cholesterol?
Adults 40 to 75 years WITHOUT DM and a 10 year risk of 7.5% to 19.9%
-start statin therapy
What is the #9 take home message for cholesterol?
Adults 40 to 75 years without DM with LDL-C levels >70mg/dL to 189mg/dL at a
- 10 year ASCVD risk of
->7.5% to 19.9%
-consider CAC
What is the #10 take home message for cholesterol?
Re-test lipid measurement 4 to 12 weeks
-after statin initiation or dose adjustment
-repeated every 3 to 12 months as needed
What are the high-Intensity statins? (>50%)
Atorvastatin 40 to 80mg
Rosuvastatin 20-40mg
What are the moderate-intensity statins? (30-49%)
Atorvastatin 10 to 20mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg
What are the low-intensity lipids?
Simvastatin 10mg
What is the leading causes of death in the US?
Heart disease and stroke
What is normal blood pressure?
<120/80
What is elevated blood pressure?
120-129 (systolic)
<80 (diastolic)
What is HTN stage 1?
130-139 (systolic)
80-89 (diastolic)
What is HTN stage 2?
140 or higher (systolic)
90 or higher (diastolic)
What is hypertensive crisis?
Higher than 180 (systolic)
Higher than 120 (diastolic)
What is recommended to have to confirm the diagnosis of HTN?
Out-of-office BP measurements
What the different types of out-of-office self monitoring BP?
ABPM (ambulatory blood pressure monitoring ): best test
-set intervals, 24hrs
HBPM (home blood pressure monitoring)
-Patient takes
-more practical
what are the characteristics of ABPM?
Set intervals, 24 hrs
Obtain readings every 15-30 mins a day
What is masked hypertension?
Normal in office, but out-of-office consistently elevated
What is white coat hypertension?
Elevated office BP but normal readings when measured outside the office with either ABPM or HBPM
What is sustained hypertension?
Elevated both in and out of office
What is secondary hypertension?
HTN caused by another medical condition
What are common reasons for secondary hypertension?
Renovascular disease
Obstructive sleep apnea
What can you expect from every 1kg weight reduction
A decrease of 1mm Hg
Treatment options for elevated BP (120-129/<80mm Hg)
Nonpharmacoloical therapy
-reasses in 3-6 months
What is the treatment options for stage 1 hypertension (130-139/80-89mm Hg)
ASCVD >10%
YES= nonpharmacological therapy and BP-lowering medication
- reassess in 1 month
NO= nonpharmacological therapy
-reasses in 3-6 months
What is the treatment options for stage 2 hypertension? (BP >140/90mm Hg)
Non-pharmacological therapy and BP lowering medication
-reassess in 1 month
When would a 2 drug therapy for hypertension be used?
> 20/10 mmHg above goal
What do the ACE inhibitors end in?
Pril
What do the ARB’s end in?
Sartans
What do the CCB dihydropyridines end in/
Dipine
What is metabolic syndrome?
> 3 of the following
1. Fasting glucose >100mg/dL
2. Waist >40 men >35 women
3. HDL-C <40 men ,50 women
4. BP >130 systolic, >85 diastolic
5. TG >150 mg/dL
If you have metabolic syndrome what is the greater chance for?
Future CVD
