CVD Flashcards
What are the non-modifiable risk factors of CVD? Name as many as you can
pp 215
1. Age— increase with age
- Sex—♂ > ♀ in those < 65y
- Ethnic origin—in
the UK people who originate from the Indian subcontinent have increased risk, Afro- Caribbeans have decreased risk - Socioeconomic position*
- Personal history of CVD
- Family history of CVD—<55y ♂; <65y ♀
- Low birth weight (IUGR)
What are the MODIFIABLE (proven benefit) risk factors of CVD?
- Smoking*—E p. 156
- Hyperlipidaemia—E p. 222
- Hypertension*—E p. 218
- DM*—E p. 326
- Diet*—E p. 148
- Obesity (particularly waist-hip ratio)*—E p. 152
- Physical inactivity*—E p. 154
- Alcohol consumption*—E p.158
- Left ventricular dysfunction/ heart failure (2° prevention)—E p. 234
- Coronary prone behaviour— competitiveness, aggression
and feeling under time pressure (2° prevention)—behaviour modification is associated with
d risk
What are the Modifiable (unproven benefit) risk factors of CVD?
- Haemostatic factors—increased plasma fibrinogen
- Apolipoproteins—increased lipoprotein(a)*
- Homocysteine— increased blood homocysteine
- Vitamin levels—decreased blood folate, vitamins B12 and B6 Depression
Which 9 CVD risk factors account for 90% of risk for acute MI?
- Socioeconomic position*
- Hypertension*—E p. 218
- Physical inactivity*—E p. 154
- Alcohol consumption*—E p. 158
- Smoking*—E p. 156
- DM*—E p. 326
- Diet*—E p. 148
- Obesity (particularly waist-hip ratio)*—E p. 152
- Apolipoproteins—
increased lipoprotein(a)*
What is primary prevention in CVD? Aim?
Intervening before health effects occur
Aim is to Stop CVD from developing
What is the current risk estimation tool to calculate 10 years CVD risk?
QRisk3
what are the 3 strategies of primary prevention?
- Population strategy - that Influences factors that increase CHD risk in an entire population, e.g. anti-smoking campaigns.
- Health checks - for the over 40s, e.g. national screening programme
- High-risk strategy - This strategy aims to identify individuals at high risk through opportunistic screening and health checks and decrease their risk through lifestyle modification ± medication.
–> Most CVD occurs in individuals of medium risk as that is the largest group. However, individuals at high risk have the most to gain from risk reduction.
What is secondary prevention in CVD? Aim?
Secondary prevention refers to preventing CHD and stroke through drug therapy and counseling for high risk individuals – such as those with previous events or known cardiovascular diseases (CVD).
Aims to stop progression of symptomatic CVD.
Explanation:
46% people who die from MI are already known to have CHD. There is strong evidence that targeting patients with CVD for risk-factor modification is effective in d risk of recurrent CVD.
Who are the high-risk groups for developing CVD?
- All people aged >85y
- All patients with a familial dyslipidaemia—E p. 225
- People with eGFR <60 mL/min/1.73m2 and/or albuminuria
- People with type 1 DM who are >40y or have had DM for >10y or have
established nephropathy or other CVD risk factors - People with 10y CVD risk of ≥10% using the QRisk3 calculator
What are the causes of hypertension?
Causes of HTN:
* Unknown (‘essential’)—95%; alcohol (10%) or obesity may be contributory factors
- Endocrine disease—Cushing’s (both syndrome and 2° to steroids); Conn’s syndrome; phaeochromocytoma; acromegaly; hyperparathyroidism; DM
- Renal disease
- Pregnancy
- Coarctation of the aorta—E p. 252
__% of all adults have HTN
20%
More than __% of people aged >60y have hypertension
50%
How might someone with HTN present at the GP clinic?
- Usually asymptomatic and found during routine BP screening or incidentally. Occasionally headache or visual disturbance
- May be symptoms of end-organ damage—LVH, TIAs, previous CVA/ MI, angina, renal impairment, PVD
BP criteria for Stage 1 HTN?
Stage 1 hypertension:
Clinic BP ≥140/90mmHg and subsequent daytime
average ABPM/HBPM ≥135/85mmHg
BP criteria for Stage 2 HTN?
Stage 2 hypertension:
Clinic BP ≥160/100mmHg and subsequent
daytime average ABPM/HBPM ≥150/95mmHg
