CVD Flashcards
Which arteries does atherosclerosis affect?
Medium and large
What are the 3 results of plaques in arteries?
○ Stiffening - leads to hypertension and strain on the heart as it tries to pump blood against extra resistance.
○ Stenosis - leads to reduced blood flow (e.g. in angina).
Plaque rupture - creates a thrombus that can block a distal vessel and cause ischaemia.
What are the non-modifiable risk factors of atherosclerosis?
• Older age
• Family history
• Male
What are the modifiable risk factors of atherosclerosis?
• Raised cholesterol
• Smoking
• Alcohol consumption
• Poor diet
• Lack of exercise
• Obesity
• Poor sleep
• Stress
What medical comorbidities put you at risk of atherosclerosis? (5)
• Diabetes
• Hypertension
• Chronic kidney disease (CKD)
• Inflammatory conditions, such as rheumatoid arthritis
• Atypical antipsychotic medications
What can atherosclerosis lead to? (6)
• Angina
• Myocardial infarction
• Transient ischaemic attacks
• Strokes
• Peripheral arterial disease
• Chronic mesenteric ischaemia
What type of mutation is familial hypercholesterolaemia?
Autosomal dominant
If person is homozygous for familial hypercholesterolaemia what levels of cholesterol does it cause?
Over 13 mmol/L
What are 3 important features of The Simon Broome criteria or the Dutch Lipid Clinic Network Criteria?
Familial history of premature CVD
Very high cholesterol >7.5
Tendon Xanthomata
What are The Simon Broome criteria or the Dutch Lipid Clinic Network Criteria used for?
Diagnosing familial hypercholesterolaemia?
What is the management of familial hypercholesterolaemia?
• Specialist referral for genetic testing and testing of family members
• Statins
What diet advise is given in prevention of CVD? (7)
• Total fat is less than 30% of total calories (primarily monounsaturated and polyunsaturated fats)
• Saturated fat is less than 7% of total calories
• Reduced sugar intake
• Wholegrain options
• At least 5 a day of fruit and vegetables
• At least 2 a week of fish (one being oily)
• At least 4 a week of legumes, seeds and nuts
What exercise advise is given to prevent CVD? (2)
• Aerobic activity for a total of at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity per week
• Strength training activities at least 2 days a week
What is the QRISK score?
estimates the percentage risk that a patient will have a stroke or myocardial infarction in the next 10 years.
What is the primary prevention of CVD?
What criteria must be met for this to be given? (3)
Atorvastatin 20mg at night
- QRISK over 10%
- Chronic kidney disease
- Type 1 diabetes for more than 10 years or are over 40years
How do statins work?
reduce cholesterol production in the liver by inhibiting HMG CoA reductase.
What checks need to be done when taking statins?
• Check lipids 3 months after starting statins and before increasing the dose to aim for a greater than 40% reduction in non-HDL cholesterol.
• Check LFTs within 3 months of starting a statin and again at 12 months.
What are the side effects of statins?
Myopathy
Rhabdomyolisis
Type 2 diabetes
Haemorrhagic stroke (very rare)
What medication is a serious interaction with statins?
Macrolide antibiotics e.g. Clarithromycin or erythromycin
What are 2 other types of cholesterol lowering drugs aside from statins?
Ezetimibe
PCSK9 inhibitors
What is the action of ezetimibe?
Inhibits absorption of cholesterol in the intestine
What is the secondary prevention of CVD?
Antiplatet (aspirin)
Atorvostatin 80mg
Atenolol
ACEi
What initial dual antiplatelet therapy is given after an MI?
Aspirin 75mg daily (continued indefinitely)
Clopidogrel or ticagrelor (generally for 12 months before stopping)
After an Ischaemic stroke what would make you chose Clopidogrel over ticagrelor?
If patient has peripheral artery disease
