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Roomies Collab Deck 1: Infectious Disease and CV > Cardiovascular disease risk assessment and prevention > Flashcards

Cardiovascular disease risk assessment and prevention Flashcards

1
Q

What are potentially modifiable risk factors for cardiovascular disease? (9)

A
  1. Hypertension
  2. Abnormal lipids
  3. Obesity
  4. Diabetes mellitus
  5. Psychosocial factors - depression, anxiety, social isolation
  6. Low physical activity
  7. Poor diet
  8. Smoking
  9. Excessive alcohol intake
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2
Q

According to NICE, which patients should have a full formal risk assessment for cardiovascular disease?

A

Patients with an estimated 10-year risk of 10% or more

Patients aged over 40 years should have their estimate of CVD risk reviewed on an ongoing basis

SIGN recommend that CVD risk assessments are offered at least every 5 years to all patients aged 40 years and over

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3
Q

Which patients should you NOT use a risk calculator to estimate their CVD risk?

A
  1. Established CVD
  2. Chronic kidney disease stage 3 or higher
  3. Albuminuria
  4. Familial hypercholesterolaemia
  5. Hereditary disorders of lipid metabolism
  6. Type 1 diabetes mellitus
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4
Q

In which patients do cardiovascular disease risk calculators underestimate the cardiovascular risk?

A
  1. Patients with existing conditions or medications than can cause dyslipidaemia (e.g. antipsychotics, corticosteroids, or immunosuppressants)
  2. Patients taking antihypertensives
  3. Patients taking lipid-regulating drugs
  4. Patients who have recently stopped smoking

Interpretation of risk scores as well as the need for further management of risk factors in those who fall below the CVD risk threshold, should always reflect informed clinical judgement.

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5
Q

Which two cardiovascular risk calculators are used to assess CVD risk for patients in England and Wales?

A

QRISK2
JBS3

QRISK2 is in the current NICE guidelines but there is an updated QRISK3

ASSIGN is used for the Scottish population

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6
Q

Which cardiovascular disease risk calculator (used in England and Wales) gives both a 10-year risk and a lifetime risk?

A

JBS3

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7
Q

What lifestyle modifications should all patients at any risk of CVD be advised?

A
  1. Changes to diet (increase fruit and vegetable consumption, reduce saturated fat and dietary salt intake)
  2. Increase physical exercise
  3. Weight management
  4. Reduce alcohol consumption
  5. Smoking cessation
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8
Q

Is aspirin used in the primary prevention of cardiovascular disease?

A

NO

Limited benefit gained versus risk of side-effects such as bleeding

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9
Q

When should antihypertensive therapy be offered to patients for primary prevention of cardiovascular disease?

A

At high risk of CVD
AND
Have a sustained elevated systolic BP over 140 mmHg and/or diastolic BP over 90 mmHg

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10
Q

Which lipid-lowering therapy does NICE recommend for patients who have a 10% or greater 10-year risk of developing cardiovascular disease?

A

low dose atorvastatin

- Oral: 20 mg once daily (can be increased to 80 mg if necessary)

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11
Q

Which lipid-lowering therapy does NICE recommend for patients who have chronic kidney disease?

A

low dose atorvastatin

- Oral: 20 mg once daily (can be increased to 80 mg if necessary)

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12
Q

Which patients with type 1 diabetes should be offered low-dose atorvastatin for primary prevention of cardiovascular disease?

A
  1. Aged over 40 years
  2. Diabetes for > 10 years
  3. Established nephropathy
  4. other CVD risk factors
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13
Q

Patients aged (?) years and over may benefit from low-dose atorvastatin to reduce their risk of non-fatal myocardial infarction

A

85 years

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14
Q

What needs to be discussed in an annual medication review for all patients taking statins?

A
  1. Medication adherence
  2. Lifestyle modification
  3. CVD risk factors
  4. Non-fasting, non-HDL cholesterol concentration
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15
Q

What needs to be checked 3 months after starting treatment with a high-intensity statin?

A
  1. Total cholesterol
  2. HDL-cholesterol
  3. Non-HDL cholesterol

High-intensity statin = the dose at which a reduction in LDL-cholesterol of greater than 40% is achieved

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16
Q

In primary prevention of cardiovascular disease, what is the recommended aim for reduction in non-HDL cholesterol concentration using a statin?

A

Greater than 40% decrease in non-HDL-cholesterol

17
Q

If cholesterol remains above the target concentration despite lipid-lowering therapy (statins) in patients at high risk of vascular events, what class of drug should be considered?

A

PCSK9 inhibitors (alirocumab, evolocumab)

18
Q

Which drug does NICE recommend using as an adjunct to a statin in patients with primary hypercholesterolemia?

A

Ezetimibe

- 10 mg daily

19
Q

How does ezetimibe decrease cholesterol levels?

A

Inhibits intestinal absorption of cholesterol

If used alone, it has a modest effect on lowering LDL-cholesterol, with little effect on other lipoproteins.

20
Q

How do PCSK9 inhibitors (alirocumab, evolocumab) work to decrease cholesterol levels?

A

Bind to a pro-protein involved in the regulation of LDL receptors on liver cells.
Receptor number are increased, which results in increased uptake of LDL_cholesterol from the blood

21
Q

Is antiplatelet therapy recommended for secondary prevention of cardiovascular disease?

A

YES

Low-dose daily aspirin (75 mg daily) should be offered to patients with established atherosclerotic disease.

If aspirin is not tolerated or contraindicated, the alternative is clopidogrel

22
Q

For the secondary prevention of cardiovascular disease, what is the alternative antiplatelet therapy for a patient intolerant to aspirin or in whom aspirin is contraindicated?

A

Clopidogrel

- Oral: 75 mg once daily

23
Q

What are the two options for antiplatelet therapy to prevent recurrence of stroke and other vascular events in all patients with a history of stroke or TIA who are in sinus rhythm?

A
  1. Clopidogrel
    - Oral: 75 mg once daily
  2. Dipyridamole with aspirin
    - Oral using modified-release medicines: 25/200 mg twice daily
24
Q

What lipid-lowering therapy should be offered to patients for secondary prevention of cardiovascular disease in patients with established atherosclerotic CVD?

A

high-dose atorvastatin
- Oral: 80 mg once daily

A lower dose can be used if the patient is at an increased risk of side-effects or drug interactions

25
Q

What lipid-lowering therapy is offered for secondary prevention of cardiovascular disease in patients with established CVD and chronic kidney disease?

A

Low-dose atorvastatin

- Oral: 20 mg once daily (can be increased to 80 mg if necessary)

26
Q

Why do we avoid a high-dose simvastatin for secondary prevention of cardiovascular disease?

A

Risk of myopathy

27
Q

In which patients should we consider a high-dose simvastatin for secondary prevention of cardiovascular disease?

A

Those who have not achieved their treatment goals with lower doses AND have severe hypercholesterolaemia AND high risk of cardiovascular complications

Benefits should outweigh risks

28
Q

What drug class should be considered for treatment in patients with depression and coronary heart disease?

A

SSRIs

Psychological treatment should be considered in patients with mood and anxiety disorders and comorbid CVD; complex patients may require referral to mental health services for assessment and delivery of high-intensity or specialist treatments

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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