CVD risk factors & their management

Question 1

List the modifiable risk factors for development of CVD

Answer 1

• Smoking
• Dyslipidaemia
• Hypertension
• Diabetes mellitus
• Obesity
• Thrombogenic factors
• Physical activity
• Alcohol consumption
• ?Deprivation

Question 2

List the non-modifiable risk factors for development of CVD

Answer 2

• Personal history of CHD
• Family history of CHD
• Age
• Gender

Question 3

What is the main scoring system used to assess risk of CVD development

Answer 3

Assign score

Question 4

What are the recommended lifestyle modifications which can be made to reduce risk of CVD ?

Answer 4

• Lose weight, if overweight - aim of reducing weight by 3kg
• Limit alcohol intake < 14 units per week (if > deliver brief ABI)
• Increase physical activity
• Reduce salt intake
• Stop smoking
• Limit intake of foods rich in fats and cholesterol

Question 5

What is the recommended exericse per week for adults (19-64)?

Answer 5

They should do:

• At least 150 minutes of moderate aerobic activity such as cycling or fast walking every week, and
• Strength exercises on two or more days a week

Or

• 75 minutes of vigorous aerobic activity, such as running or a game of singles tennis every week, and
• Strength exercises on two or more days a week

Or

• A mix of moderate and vigorous aerobic activity every week. For example, two 30-minute runs plus 30 minutes of fast walking equates to 150 minutes of moderate aerobic activity, and
• Strength exercises on two or more days a week

Question 6

What is given to reduce lipids (cholestrol) ?

Answer 6

Statin - atrovastatin

Question 7

Who should recieve statin treatment ?

Answer 7

• All people with established CVD (stroke, TIA, IHD, PVD)
• Anyone with a 10-year cardiovascular risk >= 10%
• Patients with T2DM should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
• Patients with T1DM who were diagnosed > 10 years ago OR are aged over 40 OR have established nephropathy

Question 8

What are the 3 different options which should be offered by the NHS if a patient wants to stop smoking ?

Answer 8

Nicotine replacement therapy (NRT), varenicline or bupropion

Question 9

If someone is unsuccessful in stopping smoking using NRT, varenicline or bupropion can they be offered a repeat prescription straight away ?

Answer 9

Do not offer a repeat prescription within 6 months unless special circumstances have intervened

Question 10

Can NRT, varenicline or bupropion be offered in combination with eachother to help stop smoking?

Answer 10

No

Question 11

When is combination NRT recommended ?

Answer 11

• NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray)
• For people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past

Question 12

What are the SE’s of NRT?

Answer 12

• nausea & vomiting,
• headaches and flu-like symptoms

Question 13

Which is more effective vareniciline or bupropion ?

Answer 13

Vareniciline

Question 14

What are the SE’s of vareniciline and when should it be used in caution ?

Answer 14

• Nausea
• Headache, insomnia, abnormal dreams
• Used with caution in patients with a history of depression or self-harm - possible increased risk of suicide
• Contraindicated in pregnancy and breastfeeding

Question 15

What is the risk of bupropion ?

Answer 15

Small risk of seizures

Question 16

When is use of bupropion contraindicated ?

Answer 16

• Epilepsy, pregnancy and breast feeding.
• Having an eating disorder is a relative contraindication