Cardiovascuar Health Flashcards by Jasmine Watts

What is cardiovascular disease?

Can refer to a number of conditions
CHD
Stroke
Peripheral artery disease
Heart failure
MI

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What is atherosclerotic cardiovascular disease? (ASCVD)

Acute coronary syndromes
History of MI
Stable or unstable angina
Etc
Presumed to be of atheroscleortic origin

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What is the leading cause of death for men and women?

Heart disease

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How many people die from heart disease/

One person dies every 34 seconds
697,000 Americans die (1 in every 5 deaths)

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What are the important risk factors for heart disease/

HTN
Hyperlipidemia
Smoking

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What is the #1 for primary prevention of heart disease?

Promote a healthy lifestyle throughout life

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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

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What is the #3 for primary prevention of heart disease?

Adults 40 to 75 yoa evaluate
-10 year atherosclerotic cardiovascular disease (ASCVD)

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What does the ASCVD risk calculator over estimate for?

Hispanic and Asians

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What does the ASCVD under estimate for ?

American Indian population

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What is borderline and intermediate for the 10 year ASCVD risk calculator?

Borderline: 5-7.5%
Intermediate: 7.5-20%

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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

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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

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What is the #6 for primary prevention of heart disease?

Adults with T2DM
-improve diet
-exercise
-metformin is first-line therapy

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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

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What is the #7 for primary prevention of heart disease?

Assess tobacco use with every healthcare visit

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What is the leading preventable cause of death?

Tobacco

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What is the #8 for primary prevention of heart disease?

Aspirin
-used infrequently for primary prevention of ASCVD bc of no net benefit

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Should adults with a >10% CVD risk use aspirin?

No, no net benefit
-those with low bleeding risk are more likely to benefit

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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

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What is the #10 for primary prevention of heart disease?

Non pharmacological interventions are recommended for all adults with elevated blood pressure or HTN

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What is the target BP when using pharmacological interventions?

<130/80mm Hg

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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

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What does the AHA recommend for screening for cholesterol levels?

screen all adults >20 yoa
>40 calculate 10 year risk assessment

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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