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Adult/Ped Medicine 4 > Cardiovascular Risk Factors - Brown > Flashcards

Cardiovascular Risk Factors - Brown Flashcards

1
Q

define: risk factor

A

characterisitc or feature of an individual or population that is present in early life and is associated with an increased risk of developing future disease

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2
Q

non-modifiable cardiac risk factors

A
  • age
    • male > 45
    • female > 55
  • male gender
  • family history
    • male < 55
    • female < 65
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3
Q

modifiable cardiac risk factors

A
  • hyperlipidemia
  • smoking
  • hypertension
  • insulin resistance and diabetes
  • sedentary lifestyle
  • obesity
  • unhealthy diet
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4
Q

describe the modification of risk factors and thier role in prevention of heart disease

HYPERLIPIDEMIA

A
  • increased TC is a modifiable risk factor
  • early trials - decrease TC = decreased CHD events

ATP III Classification LDL

  • < 100 optimal
  • 100-129 near optimal
  • 130-159 borderline high
  • 160-189 high
  • > 190 very high

level of treatment is based on overall CV risk assessment

  • Clinical ASCVD: moderate to high-intensity statin
  • LDL > 190 - high intensity statin
  • Diabetic pts - moderate intensity statin
  • without ASCVD or DM; LDL 70-189 mg/dL estimated 10 year risk > 7.5% - moderate to high intensity statin
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5
Q

High-Intensity Statin Therapy

A

lowers LDL by > 50%

  • Atrovastatin
  • Rosuvastatin
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6
Q

Moderate-Intensity Statin Therapy

A

lowers LDL by 30-49%

  • Atrovastatin
  • Rosuvastatin
  • Simvastatin
  • Pravastatin
  • Lovastatin
  • Fluvastatin
  • Pitavastatin
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7
Q

describe the modification of risk factors and thier role in prevention of heart disease

DIABETES, INSULIN RESISTANCE AND HYPERTRIGLYCERIDEMIA

A
  • patients with diabetes tend to cluster other risk factors
  • insulin resistance increases risk
  • patients with type 1 and type 2 diabetes are at high risk
  • added sugars
    • should be less than <100 cal/day in women; <150 cald/day in men
    • > 21% of daily calories - double risk of CV
    • > 7 sugar-sweetened beverages increase risk of CV death by 29%
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8
Q

Metabolic Syndrome

A

waist circumfrence: > 40 men, > 35 women

insulin resistance: fasting glucose > 100

high blood pressure: BP > 130/85

dylipoproteinemia

  • elevated plasma triglycerides: TG > 150
  • reduced HDL levels: < 40 men, 50 women
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9
Q

describe the modification of risk factors and thier role in prevention of heart disease

HYPERTENSION

A

lowering diastolic BP (5-6 mmHg) reduces

  • risk of stroke
  • risk of vascular mortality
  • risk of coronary heart disease

slows the progression of

  • congestive heart failure
  • renal failure
  • ophthalmologic complications
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10
Q

describe the modification of risk factors and thier role in prevention of heart disease:

SMOKING

A

single most important modifiable risk factor for coronary artery disease

benefits of cessation

  • reduce cardiovascular risk of 50% in the first 1-2 years
  • risk approaches baseline in 5-15 years
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11
Q

Smoking: Mechanisms of Atherosclerosis

A
  • enhances oxidation of LDL
  • reduces levels of HDL
  • increases inflammatory markers (hs-CRP, fibrinogen)
  • spontaneous platelet aggregation
  • increases monocyte adhesion
  • increased prevalence of coronary spasm
  • reduces threshold for ventricular arrhythmias
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12
Q

describe the modification of risk factors and thier role in prevention of heart disease:

Sedentary Lifestyle

A

250,000 deaths annually can be attributed to physical activity

recommendation: 40 minutes of moderate intensity daily

activity can help reduce - non-fatal cardiovascular events and cardiovascular deaths

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13
Q

Physiologic Benefits of Regular Exercise

A
  • reduced myocardial oxygen demand
  • increased exercise performance
  • reduced blood pressure
  • weight control
  • reduced cholesterol, increased HDL
  • improved glucose tolerance
  • improved endothelial function
  • enhances fibrinolysis
  • reduces platelet reactivity
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14
Q

Inflammation Markers

A

present in every stage of atherothrombosis

  • hs-CRP
  • ICAM-1
  • IL-6
  • TNF-a
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15
Q

describe the modification of risk factors and thier role in prevention of heart disease

hs-CRP

A

inflammatory marker

strong predictive value in men, women, elderly, smokers, stable and unstable angina, prior MI

higher hsCRP - lower survival after MI; can predict recurrent events with CVA and PAD

modifiable risk factor?

  • Aspirin
  • Statins
  • Angiotensin converting enzyme inhibitors
  • thiazolidine derivatives
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Adult/Ped Medicine 4 (17 decks)

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