CVD 2 Flashcards
traditional ASCVD risk factors
Diabetes
Smoking
Obesity and overweight
Physical inactivity
Hypertension
Dyslipidemia
non-traditional ASCVD risk factors (no good validation)
Preterm delivery
Hypertensive disorders of pregnancy
Gestational diabetes
Autoimmune disease
Breast cancer treatment
Depression
ASCVD risk in women
__ 10 year risk, but __ lifetime risk
higher rates of __
ASCVD risk in women
lower 10 year risk, but higher lifetime risk
higher rates of subclinical coronary artery disease (CAD)
signs of stable angina
pain with exertion only
unstable angina signa
pain at rest
symptoms new or escalated from baseline
non-ST segement elevation MI (NSTEMI) signs
same as unstable angina + troponin and CKMB
ST segment elevation MI (STEMI)
same as NSTEMI but with ST segment elevation
hyperlipidemia is
an excess of lipids or fats in blood
symptoms of high cholesterol
often no symptoms
strongest risk factor for CAD/CHD
hypercholesterolemia
people with high cholesterol have about __x the risk of heart disease
people with high cholesterol have about 2x the risk of heart disease
__% of American adults have high LDL cholesterol
33.5% of American adults have high LDL cholesterol
__% of adults with high LDL get treatment
< 50% of adults with high LDL get treatment
consequence of hyperlipidemia
atherosclerosis
5 types of people to screen for hyperlipidemia
- Men at higher risk at 25 y.o.
- Men at lower risk at 35 y.o.
- Women at higher risk at 35 y.o.
- Women at lower risk at 45 y.o.
- People with diabetes
risk enhancers for hyperlipidemia
- Family Hx
- Persistently elevated LDL >= 160 mg/dL
- Persistently elevated TGs >= 175 mg/mL
- Chronic kidney disease
- Preeclampsia, gestational HTN, early menopause
- Metabolic syndrome
- Inflammatory disease: RA, SLE, psoriasis, HIV
- Ethnicity: South Asian ancestry
elevated LDL as a risk enhancer is
> = 160 mg/dL
elevated TGs as a risk enhancer is
> = 175 mg/dL
what ethnicity is a risk enhancer for hyperlipidemia
South Asian
if measured in select individuals, these values are risk enhancers
Hs-CRP > = 2.0 mg/L
Lp(a) > 50 mg/dL or > 125 nmol/L
apoB > = 130 mg/dL
ABI < 0.9
Lp(a) should be checked in adults and youth with (primary prevention)
- first-degree relatives with premature ASCVD or elevated Lp(a)
- personal history of premature ASCVD or ischemic stroke
- primary of familial high cholesterol
Lp(a) should be checked in adults with (secondary prevention)
- premature ASCVD
- recurrent or progressive ASCVD (despite lipid-lowering)
- aortic stenosis
- less LDL-C lowering than expected with statins
total cholesterol goal
< 200: normal*
200-239: Borderline
> 240: High
bad LDL cholesterol goals
< 140: normal*
< 70 for CHD or DM (Diabetes Mellitus)
> 160: probably too high
good HDL cholesterol goals
> 60 for women
40 for men
triglycerides goals
< 150: normal
150-199: borderline
200-499: high
> 500: very high
statins are used for
primary and secondary prevention of CVD
statins in primary prevention of CVD
prevent or delay ONSET of CVD
statins in secondary prevention of CVD
treat CVD and prevent or delay disease manifestations
statins effects
reduce LDL by 30-60%
mild increase in HDL
decrease TGs by 14-33%
side effects of statins
rare hepatotoxicity
proteinuria
renal failure
cognitive impairment
diabetes
statins decrease __
no other lipid lowering drug besides __ does this
statins decrease mortality
no other lipid lowering drug besides PCSK9 does this
PCSK9 is a serine protease made in the liver that degrades __ and increases __ levels
PCSK9 is a serine protease made in the liver that degrades LDL receptors and increases LDL levels
PCSK9 inhibitors mechanism
monoclonal antibody inhibits PCSK9, prevents endocytosis of LDL-receptor
PCSK9 inhibitors decrease
mortality
2 lipid lowering drugs that decrease mortality
statins and PCSK9 inhibitors
PCSK9 inhibitor side effects
flu-like symptoms
back and joint pain
muscle pain
Statin + __ had greater LDL reduction that statin alone
Statin + Evolocumab had greater LDL reduction that statin alone
Statin + Evolocumab also reduced __, __, and __
BUT, not __
Statin + Evolocumab also reduced cardiovascular death, stroke, and hospitalization
BUT, not mortality
statin + alirocumab showed reduced __ and __
statin + alirocumab showed reduced MI and all cause mortality
Vascepa helps fix blood __ levels but doesn’t prevent __
Vascepa helps fix blood TG levels but doesn’t prevent CVD
3 lifestyle modifications for CVD and hypertension
exercise
diet
smoking cessation
exercise recommendations
150 mins MVPA per week
decreased sedentary time
diet recommendations: reduce
reduce sodium, potassium, alcohol
how should we reduce sodium
increase urine
hydrate!
ideal diet
fruits, veggies, whole grains, lean protein
ideal diet: avoid
tropical oils
SSB
