CVD risk and statins

Question 1

what is primary CVD risk prevention

Answer 1

CV risk reduction in patients with the aim of preventing cardiovascular disease in those at risk of getting it

Question 2

what is secondary CVD risk prevention

Answer 2

Risk reduction in those with established CVD to reduce the risk of further cardiovascular events

Question 3

what are the three tools that can be used to assess CVD risk

Answer 3

framingham equations ASSIGN QRISK

Question 4

what are the framingham equations and how are they used to assess CVD risk

Answer 4

graphs based on results from the framingham study (1948, 1971 and 2002) in america - age, gender, bp, smoking status and cholesterol

Question 5

what are the limitations of the framingham equations for assessing CVD risk

Answer 5

does not take other risk factors into account reflective of CVD in america in 60s/80s

Question 6

what is ASSIGN and how is it used to calculate CVD risk

Answer 6

based on a study from dundee university - scores people 1-99 based on risk factors - >20 = high risk

Question 7

what is QRISK and how is it used to establish CVD risk

Answer 7

online - assesses based on lots of factors and updated every year - based on 2.3 mill english/welsh people

Question 8

how does smoking affect CVD risk assessments

Answer 8

Patients who have stopped in the last 5 years should be considered a smoker when assessing more than 5 years ago depends on lifetime exposure - use clinical judgement

Question 9

what is a pack year

Answer 9

20 cigarettes a day for 1 year

Question 10

what is the NICE guidance for assessing CVD risk

Answer 10

• identify and assess everyone >40y/o- full formal assessment is frisk >10%- QRISK

Question 11

which patient groups should not be assessed using QRISK

Answer 11

T1 DM eGFR <60/albuminuria risk of familial hypercholesterolaemia >85 HIGH RISK GROUPS

Question 12

what are the NICE guidelines for management of high CVD risk

Answer 12

• communication on lifestyle advice before statins - then atorvastatin 20mg OD

Question 13

what lifestyle factors should be discussed when evaluating reducing CVD risk

Answer 13

□ Healthy eating, cardioprotective diet, physical activity, weight, alcohol and smoking

Question 14

what monitoring parameters need to be checked before statins are started

Answer 14

full lipidsLFTs

Question 15

what needs to be monitored after 3 months of statins

Answer 15

full lipidsLFTs - if >3x upper limit - discont and recheck in one monthCK - if symptoms of statin related muscle toxicity- again at 12 months, then annually

Question 16

what are the drug recommendations for primary prevention of CVD with/out T2DM

Answer 16

if 10yr risk >10% - atorvastatin 20mg

Question 17

what are the drug recommendations for primary prevention of CVD with T1DM

Answer 17

if >40 y/oDM >10 years nephropathy other risk factors - atorvastatin 20mg

Question 18

what are the drug recommendations for secondary prevention of CVD with/out T2DM

Answer 18

atorvastatin 80mg - lower if interactions, ADR risk, pt preference

Question 19

what are the drug recommendations for primary and secondary prevention of CVD in CKD patients

Answer 19

atorvastatin 20mg if target not achieved and eGFR >30 increase dose if eGFR <30 - renal specialist

Question 20

what intensity is atorvastatin

Answer 20

high

Question 21

what other statin is high intensity and can be used as an alternative

Answer 21

rosuvastatin

Question 22

what are patients targets after starting statins

Answer 22

> 40% reduction in non-HDLHDL >1mmol

Question 23

what are some side effects of statins

Answer 23

muscle toxicity GI disturbance hepatoxicity T2 DM dementia - non conclusive nightmares

Question 24

what are the symptoms of statin related muscle toxicity

Answer 24

symmetrical pain/weakness in large proximal muscles worsened on exercise elevated CKresolves on discontinuation

Question 25

what to do if a patient suffers from statin intolerance

Answer 25

• stop/assess- restart at same dose - change statin (hydrophilic rosuvastatin/lipophilic atorvastatin) - alternate day/twice weekly dosing - alternatives , ezetimibe etc