CV Risk Factors & Lifestyle Changes Flashcards
what are the major independent risk factors for cardiovascular disease?
● Cigarette smoking
● Elevated blood pressure
● Elevated serum total cholesterol
● Elevated serum LDL cholesterol
● Diabetes mellitus
● Advancing age
some of these indepedent factors are modifiable, some are not modifiable.
what are the predisposing risk factors for cardiovascular disease?
● Obesity
- Abdominal obesity
- Physical inactivity
● Family history of premature coronary heart disease
● Ethnic characteristics
● Psychosocial factors
what are the non-modifiable cardiovascular risk factors?
● Increasing age
● Male gender
● Race
what are the modifiable risk factors?
● Tobacco smoking
● Dyslipidemia
● Hypertension
● Physical Inactivity
● Obesity/overweight
● Diabetes mellitus - though diabetes is not curable, it is considered modifiable because patients can improve their A1C (three month average glucose) levels with medication/insulin
● Stress
● Alcohol consumption
● Diet/nutrition
explain the correlation between age and cardiovascular risk
● Risk increased with
- Age ≥ 45 yrs in men
- Age ≥ 55 yrs in women
- estrogen loss contributes to this risk
● Each additional decade of life ~doubles risk of vascular disease
what is premature cardiovascular disease?
- in men: CV disease before age 45 yrs
- in women: CV disease before age 55 yrs
what is the relationship between cigarette smoking and cardiovascular dissease?
what is the goal of counseling and what are the steps to counseling?
-
per the surgeon general report:
- toxins from smoke contribute to atherosclerosis
- smoking has been associated with sudden cardiac death
-
counseling:
- goal: complete cessation of smoking
- steps:
- ask
- how long have they been smoking?
- does anyone around them smoke? (if you can get family/friend to quit, might make it easier for them)
- advise them to quit
- in a clear, strong, personalized way
- assess willingness to quit
- assist
- set up action plan -set a definitive “quit date” & have them tell their family/friends that quit date so they will be held accountable
- discuss obstacles
- offer support
- arrange - for a follow up
- ask
what is the relationship between family hx and cardiovascular disease?
- these are examples of family history that are independent risk factors (i believe)
- 1st male relative iwth CDH at < 55 years of age
- 1st female relative with CDH at <65 years of age
what are the pharmacological interventions for cigarrette smoking?
what is the treament goal when when using pharmaceuticals?
- pharmacologics:
- ● Varencicline (Chantix)
● Buproprion (Wellbutrin)
● Nortryptilline- tricyclic
● Cytisine- partial nicotinic agonist
- what is the role of electronic cigarettes in tobacco smoking?
- Originally lauded as a great cessation solution
- however, they have limited evidence of efficacy in cessation & limited evidence for safety.
what is considered
- normal BP?
- elevated BP?
- HTN stage 1?
- HTN stage 2?
- Normal: <120/80
- Elevated BP: systolic of 120-129 & diastolic <80
- Hypertension stage 1: systolic of 130-139 OR diastolic 80-89
- Hypertension stage 2 : systolic of 140+ OR diastolic of 90 +
hypertension as cardiovascular disease (CVD) risk factor
- what kind of risk factor?
- what has the ACC set as the therapuetic “goals” for treatment of HTN?
- HTN is a modifiable, independent risk factor for CVD
- is more common than other major RFs
- accounts for 47% of ischemic disease
- BP goals:
- ideal BP: <130/<80
- effect of decreasing BP: a 10 point SBP drop or a 5 point DBP drop leads to a significant reduction of risk
hyercholesterolemia in CVD risk
- is what kind of risk factor?
- what is the correlation (s) between cholesterol levels and CVD and how should pts be treated based on these levels?
- is an independent, modifiable risk factor
- recommendation is to treat with statins. level of statin intestinsity is based on pts LDLs levels & CVD history
- Patients 40-75, without known CVD and an LDL from 70-189 & 10 yr CV event of > 7.5%: give moderate-to-high intensity statin
- if 5-7.5% CV event risk: treat with moderate-intensity
- In patients with > 190 LDL: give high-intensity statins
- In patients with known CVD < 75 years old: give high-intensity statins
diabetes mellitus (DM) and CVD risk
- diabetes is what kind of CVD risk factor?
- what is the correlation between hyperglycemia/diabetes and CVD?
- what are the goals of treatment of diabetes with respect to CVD?
- DM is an independent, modifiable risk factor (considered modifiable HbA1c can be modified)
- diabetes are also more prone to additional risk factors - HTN, obesity, which further increase CVD risk
- hyperglycemia alone without overt DM can increase CVD risk
- Goals:
- goal HbA1c < 7%
- the closer to HbA1c to normal (<6%) - without hypoglycemia- the better
obsesity and CVD risk
- obesity is what kind of risk for CVD? describe the correlation.
- obesity is considered a pre-disposing risk factor, but certain studies have showed that is has independently predicted obesity
- linear relationship between BMI and CVD
what is the relationship between alcohol consumption and CVD?
- there is a J-shaped relationship between alcohol consumption and total mortality
- Lowest mortality - 1-2 drinks per day*
- alcohol can actually have protective effects at this level consumption. 1-2 drinks/day reduces CVD risk by 30-50%
- likely mediated through increased HDL levels
- alcohol can actually have protective effects at this level consumption. 1-2 drinks/day reduces CVD risk by 30-50%
- Higher mortality - occasional drinking
- Highest mortality - 3+ a day (5 worse than 4, etc.)
- Lowest mortality - 1-2 drinks per day*
why might alcohol have a protective effect against CVD?
- Most of the protective effect thought to be mediated through increased HDL
- Other proposed protective mechanisms
- Effects on coagulation factors and platelet
- Enhanced ability of blood to break up clots
- Antioxidant properties of red wine or dark beer
- Other proposed protective mechanisms
what statins to give for prevention/treatment of ASCVD based on
- age group
- LDL level
- whether or not they have diabetes
- ASCVD risk
in what situations do you always give high intensity statins?
- 0-19
- tx: lifestyle modifications
-
give statins if:
- they have familial hypercholesterolemia
- 20-39
- tx: lifestyle modifications
-
consider statins if:
- family hx of ASCVD
- LDL-C > 160 mg/dL
- 40-75:
- if they have diabetes –> moderate intensity statins
- if no diabetes & LDL-C between 70-190 mg/dl
- need to look at ASCVD risk:
- < 5% risk:
- lifetyle changes
- 5-7.5% risk:
- lifestyle changes
- consider moderate intensity statins
- 7.5- 20% risk:
- discuss moderate intensity statins to reduce LDL risk by 30-40%
- > 20% ris;:
- start statins to reduce LDL risk by > 50%
- < 5% risk:
- need to look at ASCVD risk:
give high intensity statins if they have LDL > 190
lifestyle modifications for management of hyperlipidemia & hypertension include what dietary recommendations
- both hyperlipedmia & HTN:
- Emphasizes: vegetables, fruits, and whole grains
- Includes: low-fat dairy, poultry, fish, legumes, nontropical oils, nuts
- Limits: sweets, sugar-sweetened beverages, red meats.
- Aim for 5-6% of calories from saturated fat.
- HTN specifically:
- add sodium restrictions:
- max of 2400 mg of sodium per day
- dropping to 1500 mg/d has even greater reduction of BP
- max of 2400 mg of sodium per day
- add sodium restrictions:
lifestyle modifications
lifestyle modifications for lowering CVD risk include what physical activity modifications?
- goal of aerobic physical activity to reduce LDL-C & non-HDL-C.
- 3 to 4x a week,
- 40 minutes per session
- “moderate- to vigorous-intensity”
- (walking probably not enough)
in summary, what key lifestyle changes can help prevent/manage ASCVD?
- Increase fruits and vegetables, decrease sugar and red meat.
- Limit your salt.
- Exercise at least 3 times a week.
- Lose weight.
- Alcohol in moderation
- Don’t smoke
