Cardiovascular Risk Assessment & Statins (Clinical) Flashcards

1
Q

What is classed as Primary CV risk reduction?

A

Pt is at risk of CVD
-Aim to prevent CVD in those at a risk of developing it.
Example is Diabetic patients

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2
Q

What is classed as secondary CV risk reduction?

A

Those who have CVD
-Have had a MI so now we need to reduce the risk of it happening again.

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3
Q

What are the Framingham Equations based on?

A

CVD risk is estimated on:
-Age
-Gender
-BP
-Smoking status
-Cholesterol (TC:HDL ratio)

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4
Q

Why isn’t the Framingham equation used?

A

It does not take into account other risk factors, such as;
Ethnicity, Family history, BMI, Socioeconomic status
-Tends to overestimate UK population risk

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5
Q

What is the ASSIGN score?

A

-Score of risk factors 1-99
High risk = score of 20+

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6
Q

What does NICE recommend to calculator CVD risk?

A

QRISK

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7
Q

What does QRISK include?

A

Ethnicity, treated HTN, Social deprivation, BMI, Family history,
Other medication conditions - AF, DM, CKD, RA, Migraines, Steroids, Lupus (SLE), Antipsychotics, Mental illness, ED, Variable systolic bp readings

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8
Q

Who do we use QRISK for and when do we do something about it?

A

*Pt is 25-84 primary prevention
*Pt has T2DM 25-84
*10 year risk of CVD greater than 10%
–> Do a full formal risk assessment

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9
Q

Who don’t you use QRISK for?

A

All these patients are already considered high risk
-T1DM
-eGFR <60ml/min &/or albuminuria
-Risk of familiar hypercholesterolaemia / other inherited lipid abnormality
-Above 85, especially if smoke/HTN

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9
Q

What must be discussed before offering statins?

A

Lifestyle changes and optimise management of other modifiable risk factors (Blood glucose/Bp)

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10
Q

When would a patient who has stopped smoking stop being a CV risk due to that?

A

5 years still considered a CV risk, anymore than that use clinical judgement

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10
Q

Define what it means by pack years?

A

A pack year is smoking 20 cigarettes a day for one year:
Number of pack years = packs smoked per day x years as a smoker
OR
Number of cigarettes smoked per day x no of years smoked /20

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11
Q

What percent do statins reduce your relative risk by?

A

30%

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12
Q

What does relative risk reduction mean?

A

How much the treatment reduces the risk of bad outcomes relative to the control group who did not have the treatment

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13
Q

What does absolute risk reduction (ARR) mean?

A

Risk of developing over time from and about the patient.
Percent over 10 years - Percent reduced by.

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13
Q

What does number needed to treat mean?

A

How many people needed to treat to prevent one adverse event occurring.
Worked out by:
100/ARR

14
Q

What is NOT routinely offered for primary prevention? CVD

A

Aspirin 75mg OD - as risk of bleeding outweighs the benefit

14
Q

What baseline assessments should be done before starting statin therapy?

A

-Smoking status
-Alcohol consumption
-BP
-BMI
-Lipid profile
-Diabetes status
-Renal function
-LFTs
-TSH

14
Q

IF you have a patient with T1DM, what should be considered?

A

Starting Atorvastatin 20mg OD
WHEN:
Pt is 40+
Been diagnosed for more than 10 years or has established nephropathy or other CVD risk factors

15
Q

If a patient has a 10-year QRISK3 score of >10%, what should they be offered?

A

Atorvastatin 20mg OD

16
Q

Pt X has previously had a stroke and has got T2DM, What statin should be offered?

A

Atorvastatin 80mg OD
*Secondary prevention

16
Q

Pt J Has previously had a cardiac event occur, and hasn’t got diabetes, what statin should be offered?

A

Atorvastatin 80mg OD
*Secondary prevention

17
Q

What should the primary prevention dose of Atorvastatin be for people with CKD?

A

Atorvastatin 20mg OD

17
Q

When should the dose of statin be increased?

A

If target reduction not achieved &
-If renal function 30 or above then increase the dose,
-If eGFR is lower than 30 agree a higher dose with a renal specialised

17
Q

What statins are classed as being HIGH intensity?

A

Atorvastatin 20mg-80mg
Simvastatin 80mg
Rosuvastatin 10-40mg

18
Q

What statins are classed as Medium intensity?

A

Fluvastatin 80mg
Simvastatin 10mg
Atorvastatin 10mg
Rosuvastatin 5mg

18
Q

What statins are classed as low intensity?

A

Fluvastatin 20-40mg
Pravastatin 10mg-40mg
Simvastatin 10mg

19
Q

What percentage reduction do you aim for when starting statins for hypercholesterinaemia?

A

> 40% reduction in NON-HDL cholesterol

20
Q

What tests do you do when the patient has been on statins for 3 months?

A

-Total cholesterol
-LFTs (if 3x higher than before - discontinue and recheck in 1 month)

20
Q

What would you do if a patients, 40% reduction is not achieved?

A

-Discuss adherence
-Optimise adherence to diet and lifestyle measures
-Consider statin dose increase, if dose is less than 80mg an the person is judged to be at a higher risk - use clinical judgement

21
Q

When would you check a patients Creatine kinase levels?

A

If they develop symptoms of statin related muscle toxicity - as the enzyme is released upon muscle damage

22
Q

Once a patient is stable on statins, when and what should be tested?

A

12 monthly
-Lipid profile and LFTs
- If up-titration required recheck after 3 months

23
Q

What is the main side effect to keep an eye out for when a patient is on statins?

A

-Statin associated muscle symptoms ‘myothy’ - very specific
-Symmetrical pain or weakness
-Large proximal muscles
-Worsened on exercise
-Elevated Creatine Kinase CK
-Resolve with discontinuation

24
Q

What are the general side effects associated with statins?

A

-GI disturbance
-Hepatotoxicity
-New onset T2DM
-Neurocognitive and neurological impairment
-Intracranial haemorrhage
-Sleep disturbance

25
Q

What should you do if a patient appears to be intolerant to statins?

A

-Try a lower dose statin
-Rechallenge at a lower dose of the same high intensity statin
-Change the statin (Hydrophilic (rosuvastatin instead of lipophilic atorvastatin)
-Consider alternate day/twice weekly dosage

26
Q

If you was considering alternate day/twice weekly dosage of statins, what statin would be preferable?

A

Pravastatin or Rosuvastatin

27
Q

If a patient is intolerant to statins what is an alternative drug to use?

A

Ezetimibe, PCSK9i, Bempedoic acid, Inclisiran