Cardiovascular Risk Factors

Question 1

Which types of lipoprotein are atherogenic?

Answer 1

the smaller ones: VLDL, IDL and LDL are atherogenic.

However, large VLDL and chylomicrons are not.

Question 2

Do statins always work?

Answer 2

Yes. They always reduce CHD end points. They reduce total cholesterol and LDL.
They also have other effects such as improvement of endothelial dysfunction, increased NO bioavailability, antioxidant properties, inhibition of inflammatory responses, stabilisation of atherosclerotic plaques

Question 3

list some diseases that hypertension can lead to?

Answer 3

LV hypertrophy
heart failure
MI
coronary heart disease
cerebral haemorrhage
chronic kidney failure
blindness
aortic aneurysm
gangrene of lower extremities 
hypertensive encephalopathy
stroke
pre-eclampsia/ eclampsia

Question 4

lifestyle modifications to reduce risk?

Answer 4

lose weight
limit alcohol intake
increase physical activity
reduce salt intake
stop smoking
limit intake of foods rich in fats and cholesterol

Question 5

for a Caucasian under 55years old, what drug steps should be used to manage their hypertension?

Answer 5

1. A (Ace-I)
2. A (Ace-I) + C (Ca blocker) / A (Ace-I) + D (thiazide-type diuretic)
3. A+C+D
4. Further diuretic therapy OR alpha blocker OR B-blocker

Question 6

For someone over 55 years old, or a black person of any age, what drug steps should be used to manage their hypertension?

Answer 6

1. C (Ca blocker)or D (thiazide-type diuretic)
2. A (Ace-I) + C (Ca blocker) OR A (Ace-I) + D (thiazide-type diuretic)
3. A+C+D
4. Add further diuretic therapy OR alpha blocker OR B-blocker

Question 7

What works better for hypertension management: single drug therapy / combination therapy?

Answer 7

combination
(This produces bigger reductions in BP, and also reduces side effects - so people are generally started on one or two tablets)

Question 8

what is the principal cause of death in type 2 diabetics?

Answer 8

cardiovascular disease (it is associated with abnormalities in lipoprotein metabolism , hypertension, increased propensity to oxidative stress and endothelial dysfunction. Hyperglycaemia itself may accelerate vascular damage. Also, type 2 diabetes is a hypercoagulable state)

Question 9

In type 2 diabetics, CVS events can be reduced by tight glycaemic control and aggressive management of BP and dyslipidaemia. What drugs can be used for this?

Answer 9

lipid lowering drugs
aspirin
clopidogrel (which is used with aspirin to prevent MI and stroke in people at risk)

Question 10

The more risk factors for CVS disease, the more likely it is that you will have an event. But out of hypertension, smoking, type 2 diabetes, and total cholesterol, which risk factor is the most powerful?

Answer 10

having type 2 diabetes

Question 11

what are features of the Mediterranean diet?

Answer 11

rich in fruit and veg, fish, grains, beans - protects against CHD
less meat (replace with poultry)
use canola oil (omega 3 fatty acids) instead of olive oil (omega 9 fatty acids)

Question 12

what socioeconomic factors increase CVS disease risk?

Answer 12

deprivation
being South Asian in the UK
being male

Question 13

what tool can be used to assess CVS risk?

Answer 13

ASSIGN score
(>20% means that you would benefit from interventions)