cardiovascular disease

Question 1

Prevention of Cardiovascular Disease

Answer 1

Primary Prevention – for patients that have never had cardiovascular disease in the past.

Secondary Prevention – for patients that have had angina, myocardial infarction, TIA, stroke or peripheral vascular disease.

Question 2

Risk Factors

Answer 2

Non-Modifiable Risk Factors

Older age
Family history
Male

Modifiable Risk Factors

Smoking
Alcohol consumption
Poor diet (high sugar and trans-fat and reduced fruit and vegetables and omega 3 consumption)
Low exercise
Obesity
Poor sleep
Stress

Question 3

Medical co-morbidities increase the risk of atherosclerosis

Answer 3

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

Question 4

Primary Prevention of Cardiovascular Disease

Answer 4

Perform a QRISK 3 score
calculate the percentage risk that a patient will have a stroke or myocardial infarction in the next 10 years
QRISK 3 score is above 10%) then you should offer a statin

All patients with chronic kidney disease (CKD) or type 1 diabetes for more than 10 years should be offered atorvastatin 20mg.
checking lipids at 3 months and increasing the dose to aim for a greater than 40% reduction in non-HDL cholesterol.

LFTs within 3 months of starting a statin and again at 12 months

Question 5

Secondary Prevention of Cardiovascular Disease

Answer 5

Secondary prevention after developing cardiovascular disease can be remembered as the 4 As:

A – Aspirin (plus a second antiplatelet such as clopidogrel for 12 months)
A – Atorvastatin 80mg
A – Atenolol (or other beta-blocker – commonly bisoprolol) titrated to maximum tolerated dose
A – ACE inhibitor (commonly ramipril) titrated to maximum tolerated dose

Question 6

Side Effects of Statins

Answer 6

Myopathy (check creatine kinase in patients with muscle pain or weakness)
Type 2 diabetes
Haemorrhagic strokes (very rarely)