CVD

Question 1

Which arteries does atherosclerosis affect?

Answer 1

Medium and large

Question 2

What are the 3 results of plaques in arteries?

Answer 2

○ 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.

Question 3

What are the non-modifiable risk factors of atherosclerosis?

Answer 3

• Older age
• Family history
• Male

Question 4

What are the modifiable risk factors of atherosclerosis?

Answer 4

• Raised cholesterol
• Smoking
• Alcohol consumption
• Poor diet
• Lack of exercise
• Obesity
• Poor sleep
• Stress

Question 5

What medical comorbidities put you at risk of atherosclerosis? (5)

Answer 5

• Diabetes
• Hypertension
• Chronic kidney disease (CKD)
• Inflammatory conditions, such as rheumatoid arthritis
• Atypical antipsychotic medications

Question 6

What can atherosclerosis lead to? (6)

Answer 6

• Angina
• Myocardial infarction
• Transient ischaemic attacks
• Strokes
• Peripheral arterial disease
• Chronic mesenteric ischaemia

Question 7

What type of mutation is familial hypercholesterolaemia?

Answer 7

Autosomal dominant

Question 8

If person is homozygous for familial hypercholesterolaemia what levels of cholesterol does it cause?

Answer 8

Over 13 mmol/L

Question 9

What are 3 important features of The Simon Broome criteria or the Dutch Lipid Clinic Network Criteria?

Answer 9

Familial history of premature CVD
Very high cholesterol >7.5
Tendon Xanthomata

Question 10

What are The Simon Broome criteria or the Dutch Lipid Clinic Network Criteria used for?

Answer 10

Diagnosing familial hypercholesterolaemia?

Question 11

What is the management of familial hypercholesterolaemia?

Answer 11

• Specialist referral for genetic testing and testing of family members
• Statins

Question 12

What diet advise is given in prevention of CVD? (7)

Answer 12

• 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

Question 13

What exercise advise is given to prevent CVD? (2)

Answer 13

• 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

Question 14

What is the QRISK score?

Answer 14

estimates the percentage risk that a patient will have a stroke or myocardial infarction in the next 10 years.

Question 15

What is the primary prevention of CVD?
What criteria must be met for this to be given? (3)

Answer 15

Atorvastatin 20mg at night

1. QRISK over 10%
2. Chronic kidney disease
3. Type 1 diabetes for more than 10 years or are over 40years

Question 16

How do statins work?

Answer 16

reduce cholesterol production in the liver by inhibiting HMG CoA reductase.

Question 17

What checks need to be done when taking statins?

Answer 17

• 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.

Question 18

What are the side effects of statins?

Answer 18

Myopathy
Rhabdomyolisis
Type 2 diabetes
Haemorrhagic stroke (very rare)

Question 19

What medication is a serious interaction with statins?

Answer 19

Macrolide antibiotics e.g. Clarithromycin or erythromycin

Question 20

What are 2 other types of cholesterol lowering drugs aside from statins?

Answer 20

Ezetimibe
PCSK9 inhibitors

Question 21

What is the action of ezetimibe?

Answer 21

Inhibits absorption of cholesterol in the intestine

Question 22

What is the secondary prevention of CVD?

Answer 22

Antiplatet (aspirin)
Atorvostatin 80mg
Atenolol
ACEi

Question 23

What initial dual antiplatelet therapy is given after an MI?

Answer 23

Aspirin 75mg daily (continued indefinitely)
Clopidogrel or ticagrelor (generally for 12 months before stopping)

Question 24

After an Ischaemic stroke what would make you chose Clopidogrel over ticagrelor?

Answer 24

If patient has peripheral artery disease