Chronic - Prevention of CVD

Question 1

Name 3:

• Non-modifiable risk factors
• Modifiable risk factors
• Medical co-morbidities

for cardiovascular disease.

Answer 1

• Non-modifiable risk factors
  
  • Older age
  • Family history
  • Male
• Modifiable risk factors
  
  • Smoking
  • Alcohol consumption
  • Poor diet (high sugar and trans-fat and reduced fruit and vegetables/omega 3 consumption)
  • Lack of exercise
  • Obesity
  • Poor sleep
• Stress
  
  • Medical co-morbidities:
  • Diabetes
  • Hypertension
  • CKD
  • Inflammatory conditions such as rheumatoid arthritis
  • Atypical antipsychotics medications

Question 2

How can you work out which patients need medical intervention for primary prevention of CVD?

Answer 2

• QRISK 3 score – calculates risk of stroke/MI in the next 10 years. If >10% risk over the next 10 years (QRISK 3 score above 10%), start statin – atorvastatin 20mg
• All patients with CKD or Type 1 diabetes>10 years, start statin – atorvastatin 20mg

Question 3

What should be done when starting a statin?

Answer 3

• Check lipids at 3 months, increase dose to aim for >40% reduction in non-HDL cholesterol
• Checking LFTs within 3 months of starting a statin and again at 12 months – can cause a transient and mild rise in ALT and AST in the first few weeks – they do not need stopping if the rise is <3 times upper limit of normal

Question 4

Who is offered secondary prevention for CVD?

Answer 4

For patients with established cardiovascular disease: angina, previous MI, stroke, TIA, peripheral arterial disease

Question 5

What should all patients with established CVD be offered?

Answer 5

4 As

Atorvastatin

Aspirin (if they have had an MI, dual anti-platelet therapy)

Atenolol (or any other beta blocker)

ACE inhibitor

Question 6

What lifestyle advice should be offered to all patients for the prevention of CVD?

Answer 6

Avoid all applicable modifiable risk factors:

• Smoking
• Alcohol consumption
• Poor diet (high sugar and trans-fat and reduced fruit and vegetables/omega 3 consumption)
• Lack of exercise
• Obesity
• Poor sleep
• Stress