Chapter 2. Guidelines for Primary and Secondary Prevention Flashcards
Asymptomatic carotid stenosis (60-99%) disease in primary prevention
CEA + Medical management reduces 5 year stroke risk from 11% to 5%
High intensity is has an LDL lowering effect of how many percent
> 50%
The following increases the risk of developing LV mural thrombi in 1-2 weeks
Large anterior wall MI
LVEF <40%
Apical wall motion abnormality
What is the result of Insulin Resistant Intervention after Stroke (IRIS STUDY)
Pioglitazone can be used in patient who do not have diabetes but with insulin resistance and is associated with lower risk of DM but high risk of edema, weight gain and fracture
Carotid Artery Disease accounts how many percent of all stroke
15-20%
What are the nutritional deficiency or excess that increases the risk for stroke
Elevated homocysteine levels
Deficient VIT B6 and B12
Elevated Na and Ca
Risk reduction of thromboembolic stroke
48%
In secondary prevention of stroke CEA + medical management in 70% stenosis without near occlusion the absolute risk reduction is
16% per 5 years
What is the age-adjusred prevalence of hypertension
20.6%
2nd generation valve INR requirement
Depends on poston
MR: 3-3.5
Aortic 2.5-3.0
Recommendation for Primary prevention with dyslipidemia
- 21 yo with >190 LDL should be treated with statin
- Low fat diet
- 40-75 without DM and ASCVD but with LDL 80-189 should received HIST
- < 70yo with ASCVD should received HIST
- 40-75 with DM but without ASCVD should be given with MIST or HIST if AIC is >7.15
- Patient with CSAD and low HDL: give niacin or fenofibrate
Gemfibrozil is associated with how many risk reduction for stroke
40%
How many percent VKA reduces risk for stroke with MI
19%
This study compare the outcome between CEA vs CAS
Carotid Revascularization Endarterectomy vs Stent Trial (CREST trial)
Fatal bleeding rate of ASA per year
0.17/year
Ideal waist circumference
35 in men 31 in women
Stroke risk for Carotid artery disease
13-15%
Recommendation for stroke prevention in patient with MVP and Aortic Valve Disease in the absence of AF
Use ASA
The incidence of stroke is greatly reduced by Metform by how many
31%
This is a study on Gemfibrozil on stroke
VA-HIT
What is the result of cochrane collaboration of CAS vs CEA trials
CAS - associated with increased with periprocedural stroke or death compared to CEQA
AHA/ASA indication fro statin
Clinical atherosclerosis cardiovascular disease LDL >190mg/dl LDL 70-189 (40-75 years old) History of DM Or consider other factors: ABI and CRP
Result of WASID
ASA is safer and effective as VKA for stroke prevention in 50-99% stenosis
Rate of ischemic events was high regardless of therapy (antiplatelet or anticoagulant)
What is the result of Extracranial-Intracranial Bypass trial
Failed to show clinical benefit in patient with CAD and MCA anastomosis
How many patient with ischemic stroke with overt DM
25-45%
Ideal antihypertensive in Primary prevention in patient with DM
ARB and ACEi
This study has proven that metformin as a first line therapy for overweight type 2 DM appears to decrease diabetes related end points such as stroke
United Kingdon Prospective Diabetes Study
What is the result of Asymptomatic Carotid Surgery Trial (ACST)
in patient with >60% stensosi
11.8% (medical) vs 6.4% (CEA+medical) stroke risk reduction
Gemfibrozil lowers cholesterol by what mechanism
PPar activation leads to increase synthesis of lipoprotein lipase increases clearance of TAG
What is the annual risk for stroke in asymptomatic intracranial artery disease
1.4%
First generation valves INR requirement
3-4.5
What type of obesity is the more positively associated with stroke
Abdominal obesity
How many percent VKA with ASA reduces risk for stroke with MI
29%
What is the criteria for diagnosis of Diabetes Mellitus
A1C 6.5%
CBG >126
Randome plasma glucose 200
2-hour PG of 200 during OGTT
What is the result of SPARCL trial
16% risk reduction with high dose statin
No significant ICG among control and statin groups
No clinical benefit to SAH
Risk of stroke that can reach the level of non-smoker
5 years
Recommendation for utilization of CDUS
- For asymptomatic patient at risk for significant disease
- To detect carotid stenosis in symptomatic patients
- Not routine for screening pf asymptomatic without vascular risk factors
- If CDUS is inconclusive do MRA or CTA
What additional medication is recommended to antiplatelet to ASA that shows to improve symptoms and increase walking distance
Cilostazol
What is the most important dose dependent risk factor for PAD
cigarette smoking
CEA is not considered in the following situation
- stenosis <50%
- Chronic total carotid occlusion
- Severe disabling stroke
Major independent risk factor for stroke and stroke-related mortality
Hypertension
Lowering the BP in this age group reduces how many risk of developing stroke: < 60yo, 60-69yo, >70 yo
< 60 yo: 40-50%
60-69 yo: 30-40%
> 70 yo: 20-30%
CEA is harmful in what situation
<30% stenosis
Risk for thromboembolism in valvular heart disease without AF Prothetic valve \_\_\_ Rheumatic MR \_\_\_ Rheumatic MS\_\_ MVP\_\_ Aortic valve\_\_
PV: 20% RMR: 7.7% RMS: 1.5-40% MVP: < 20% Aortic valve: not a risk
a 5% of decline of EF will have how many increase risk of risk in developing stroke
18%
CEA has no effect in what circumstances
30-49% stenosis
Risk of stroke for:
Obesity
Overweight
- 43% overweight
1. 7-2% Obese
This result to reduction of recurrent stroke by 12% and all stroke by 21%
Lowering of LDL by 1mmol/L with statin
K intake is associated with ____ lower risk of stroke
24%
What is the recommended risk factors modification in ICAD
SBP <140
HIST