Cardiovascular Disease

Question 1

What is atherosclerosis a combination of?

Answer 1

Atheromas (fatty deposits in the artery walls) and sclerosis (the process of hardening or stiffening of the blood vessel walls).

Question 2

What causes atherosclerosis?

Answer 2

Chronic inflammation and activation of the immune system in the artery wall.

This causes deposition of lipids in the artery wall, followed by the development of fibrous atheromatous plaques

Question 3

What does atherosclerotic plaque cause?

Answer 3

Stiffening of the artery walls leading to hypertension
Stenosis leading to reduced blood flow (e.g. in angina)

Plaque rupture giving off a thrombus that blocks a distal vessel leading to ischaemia, for example in acute coronary syndrome)

Question 4

What are non-modifiable risk factors for atherosclerosis?

Answer 4

Older age
Family history
Male

Question 5

What are modifiable risk factors for atherosclerosis?

Answer 5

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 6

What co-morbidities can increase the risk of atherosclerosis and should be monitored carefully?

Answer 6

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

Question 7

What can atherosclerosis cause?

Answer 7

Angina
Myocardial Infarction
Transient Ischaemic Attacks
Stroke
Peripheral Vascular Disease
Mesenteric Ischaemia

Question 8

What are the two types of prevention in CVD?

Answer 8

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 9

How can modifiable risk factors be modified to reduce the risk of CVD?

Answer 9

Advice on diet, exercise and weight loss
Stop smoking
Stop drinking alcohol
Tightly treat co-morbidities (such as diabetes)

Question 10

What does QRISK 3 score tell us?

Answer 10

Risk that a patient will have a stroke or MI in the next 10 years

If patient’s risk is >10%, statin should be offered (atorvastatin 20mg at night)

Question 11

Who should be offered atorvastatin regardless of QRISK 3 score?

Answer 11

All patients with chronic kidney disease (CKD) or type 1 diabetes for more than 10 years should be offered atorvastatin 20mg.

Question 12

What does secondary prevention of CVD involve?

Answer 12

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