CVD risk and statins Flashcards
what is primary CVD risk prevention
CV risk reduction in patients with the aim of preventing cardiovascular disease in those at risk of getting it
what is secondary CVD risk prevention
Risk reduction in those with established CVD to reduce the risk of further cardiovascular events
what are the three tools that can be used to assess CVD risk
framingham equations ASSIGN QRISK
what are the framingham equations and how are they used to assess CVD risk
graphs based on results from the framingham study (1948, 1971 and 2002) in america - age, gender, bp, smoking status and cholesterol
what are the limitations of the framingham equations for assessing CVD risk
does not take other risk factors into account reflective of CVD in america in 60s/80s
what is ASSIGN and how is it used to calculate CVD risk
based on a study from dundee university - scores people 1-99 based on risk factors - >20 = high risk
what is QRISK and how is it used to establish CVD risk
online - assesses based on lots of factors and updated every year - based on 2.3 mill english/welsh people
how does smoking affect CVD risk assessments
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
what is a pack year
20 cigarettes a day for 1 year
what is the NICE guidance for assessing CVD risk
- identify and assess everyone >40y/o- full formal assessment is frisk >10%- QRISK
which patient groups should not be assessed using QRISK
T1 DM eGFR <60/albuminuria risk of familial hypercholesterolaemia >85 HIGH RISK GROUPS
what are the NICE guidelines for management of high CVD risk
- communication on lifestyle advice before statins - then atorvastatin 20mg OD
what lifestyle factors should be discussed when evaluating reducing CVD risk
□ Healthy eating, cardioprotective diet, physical activity, weight, alcohol and smoking
what monitoring parameters need to be checked before statins are started
full lipidsLFTs
what needs to be monitored after 3 months of statins
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
what are the drug recommendations for primary prevention of CVD with/out T2DM
if 10yr risk >10% - atorvastatin 20mg
what are the drug recommendations for primary prevention of CVD with T1DM
if >40 y/oDM >10 years nephropathy other risk factors - atorvastatin 20mg
what are the drug recommendations for secondary prevention of CVD with/out T2DM
atorvastatin 80mg - lower if interactions, ADR risk, pt preference
what are the drug recommendations for primary and secondary prevention of CVD in CKD patients
atorvastatin 20mg if target not achieved and eGFR >30 increase dose if eGFR <30 - renal specialist
what intensity is atorvastatin
high
what other statin is high intensity and can be used as an alternative
rosuvastatin
what are patients targets after starting statins
> 40% reduction in non-HDLHDL >1mmol
what are some side effects of statins
muscle toxicity GI disturbance hepatoxicity T2 DM dementia - non conclusive nightmares
what are the symptoms of statin related muscle toxicity
symmetrical pain/weakness in large proximal muscles worsened on exercise elevated CKresolves on discontinuation
what to do if a patient suffers from statin intolerance
- stop/assess- restart at same dose - change statin (hydrophilic rosuvastatin/lipophilic atorvastatin) - alternate day/twice weekly dosing - alternatives , ezetimibe etc
