CVD Flashcards
What is atherosclerosis?
Atherosclerosis is a condition where fatty deposits (atheromas) and stiffening (sclerosis) occur in the walls of medium and large arteries, causing them to harden and narrow.
What are the primary causes of atherosclerosis?
Atherosclerosis is caused by chronic inflammation and immune system activation in the artery walls, leading to lipid deposition and fibrous atheromatous plaque formation.
What are the potential consequences of atherosclerosis?
Atherosclerosis can lead to artery stiffening, stenosis (narrowing), and plaque rupture, resulting in conditions like hypertension, reduced blood flow (angina), or blockage leading to ischemia (e.g., acute coronary syndrome).
What are non-modifiable risk factors for atherosclerosis?
Non-modifiable risk factors include:
* Older age
* Family history
* Being male
What are modifiable risk factors for atherosclerosis?
Modifiable risk factors include:
* Raised cholesterol
* Smoking
* Alcohol consumption
* Poor diet
* Lack of exercise
* Obesity
* Poor sleep
* Stress
What medical co-morbidities increase the risk of atherosclerosis?
Medical co-morbidities that increase risk include:
* Diabetes
* Hypertension
* Chronic kidney disease
* Inflammatory conditions (e.g., rheumatoid arthritis)
* Certain medications (e.g., atypical antipsychotics)
What are the end results of atherosclerosis?
The end results can include:
* Angina
* Myocardial infarction
* Transient ischemic attacks (TIA)
* Strokes
* Peripheral arterial disease
* Chronic mesenteric ischemia
What is the difference between primary and secondary prevention of cardiovascular disease?
Primary prevention applies to patients without cardiovascular disease, while secondary prevention is for patients with conditions like angina, myocardial infarction, TIA, or stroke.
What strategies are recommended to optimise modifiable risk factors?
Strategies include:
* Addressing diet
* Exercise
* Obesity
* Stopping smoking
* Reducing alcohol consumption
* Optimising treatment for co-morbidities like diabetes
What dietary changes are recommended in NICE guidelines for cardiovascular disease prevention?
Recommended changes include:
* Reducing total fat to less than 30% of calories
* Less than 7% saturated fat
* Reduced sugar intake
* Whole grains
* At least 5 servings of fruit and vegetables daily
* 2 servings of fish per week (one oily)
* 4 servings of legumes, seeds, and nuts weekly
What exercise guidelines does NICE recommend for cardiovascular disease prevention?
NICE recommends:
* At least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week
* Strength training at least twice a week
How is primary prevention of cardiovascular disease managed using the QRISK3 score?
If the QRISK3 score is above 10%, patients should be offered atorvastatin 20mg as primary prevention, especially in patients with chronic kidney disease or type 1 diabetes.
What is the role of statins in managing atherosclerosis?
Statins reduce cholesterol production by inhibiting HMG CoA reductase. They are recommended for reducing cholesterol levels in patients at risk for cardiovascular disease, with regular monitoring of lipid levels and liver function.
What are the potential side effects of statins?
Statins may cause:
* Myopathy
* Rhabdomyolysis
* Type 2 diabetes
* Rare haemorrhagic strokes
Monitoring for muscle pain and checking creatine kinase levels is important.
What other cholesterol-lowering drugs are used in atherosclerosis management?
Other drugs include:
* Ezetimibe (reduces cholesterol absorption)
* PCSK9 inhibitors (lower cholesterol)
* Bempedoic acid (reduces cholesterol production)
These may be used in combination with statins or as alternatives when statins are not tolerated.
What is secondary prevention in cardiovascular disease?
Secondary prevention includes using:
* Antiplatelet medications
* Statins
* Beta-blockers
* ACE inhibitors
The “4 As” are used: Antiplatelet, Atorvastatin, Atenolol (or other beta blockers), and ACE inhibitors.
How are patients treated after myocardial infarction?
Patients receive dual antiplatelet treatment (aspirin and clopidogrel or ticagrelor), with aspirin continued indefinitely and clopidogrel or ticagrelor for about 12 months.
What is familial hypercholesterolemia?
Familial hypercholesterolemia is a genetic condition leading to very high cholesterol levels. It can be heterozygous (1 gene abnormal) or homozygous (both genes abnormal), with the latter causing extremely high cholesterol and early cardiovascular disease.
How is familial hypercholesterolemia diagnosed?
Diagnosis is based on:
* Family history of premature cardiovascular disease
* Very high cholesterol levels
* Tendon xanthomas
The Simon Broome and Dutch Lipid Clinic Network Criteria are used for clinical diagnosis.
What is the management of familial hypercholesterolemia?
Management includes:
* Specialist referral
* Genetic testing
* Testing family members
* Statins for cholesterol control
