Cardiovascular risk

Question 1

Patients considered at high-risk of CVD? (5)

Answer 1

Patients over 85
Patients with familial dyslipidaemia
Patients with CKD
People aged >40 with Type 1 diabetes, or with diabetes for greater than 10 years
People with Qrisk > 10%

Question 2

Elements of blood lipid profile which are associated with CVD risk? (2)

Answer 2

Increased non-HDL to HDL cholesterol ratio

Increased total triglycerides

Question 3

When should familial dyslipidaemia be considered? (4)

Answer 3

Total cholesterol >9
Non HDL cholesterol > 7.5
Fasting triglycerides >10
Total cholesterol >7.5 + FHx of premature CVD

Question 4

Statin contraindications?

Answer 4

Breastfeeding, pregnancy, active liver disease (transaminases >3x upper limit normal)

Question 5

Important drug interactions? (4)

Answer 5

Warfarin ( statins increase effect)
Macrolide antibiotics e.g. clarithromycin
Antifungals
Calcium channel blockers

Question 6

Target for statin therapy?

Answer 6

Aim to reduce non-HDL by >40% from baseline

Question 7

When should blood lipids be rechecked again?

Answer 7

3 months and 1 year after starting/dose change

Question 8

Risk factors for statin-associated myositis? (2)

Answer 8

Increasing age and alcohol excess

Question 9

When does statin-associated myositis usually start?

Answer 9

<6 months after initiating, consider other cause if >6 months

Question 10

Alternative to statin for people unable to tolerate statins?

Answer 10

Ezetimibe

Question 11

BMI classifications (4)

Answer 11

healthy weight- 18.5 to 24.9
overweight- 25 to 29
obesity- 30-40
morbid obesity > 40

Question 12

Weight loss target/strategy?

Answer 12

Aim for a calorie deficit around 600/day (gives a weight loss around 1-2lb/0.5kg per week)

Question 13

Only drug licensed for weight loss in UK

Answer 13

Orlistat

Question 14

Guidelines for physical exercise? (2)

Answer 14

> 30 mins moderate intensity exercise on >= 5 days/week (e.g. brisk walking)
Muscle strengthening activities 2x/week

Question 15

Dietary recommendations for CVD prevention

a) Unsalted nuts, seeds and legumes
b) Fish
c) Fruit and vegetables
d) Fibre
e) Fat
f) Salt

Answer 15

a) 4 or 5 portions a week
b) Two portions a week, including a portion of oily fish
c) 5 portions per day
d) 30-45g/day (ideally wholegrain)
e) Total fat should be less than 30% total energy intake, and saturated fat <7%
f) less than 6g/day

Question 16

Important secondary causes of hypertriglyceridaemia to exclude? (2)

Answer 16

T2DM

Alcohol excess

Question 17

Most effective drug treatments for reducing nicotine withdrawal symptoms? (2)

Answer 17

Varenicline (champix)

or combination NRT (patch + short acting option)

Question 18

What % weight loss at 3 months is needed for Orlistat to be continued?

Answer 18

5% or 3% if diabetic

Question 19

When should orlistat prescription be considered?

Answer 19

BMI > 30

or BMI > 27 with associated risk factors e.g. T2DM, HTN, dyslipidaemia

Question 20

When would bariatric surgery be considered as a first-line option?

Answer 20

BMI greater than 50

Question 21

NICE bariatric referral (after lifestyle/medication) cut-offs:

a) with risk factors
b) with no risk factors

Answer 21

a) 35

b) 40