CVD Risk Reduction Flashcards
What are the non-modifiable risk factors for CVD?
Personal history of CVD
Family history of CVD
Age
Gender (women > men)
What are some modifiable risk factors for CVD?
Smoking Alcohol Hypertension Dyslipidaemia Diabetes Obesity Physical activity Thrombogenic factors Deprivation?
How do you assess someones CVD risk and what is involved?
ASSIGN score:
- age
- sex
- smoking
- systolic BP
- total cholesterol
- HDL cholesterol
- family history of premature CVD
- diabetes
- rheumatoid arthritis
- deprivation
What is the aim of primary prevention?
To reduce incidence in a population
before disease
What is the aim of secondary prevention?
Detection and treatment of pre-symptomatic disease
What is the aim of tertiary prevention?
Reduce incidence/recurrences of chronic incapacity among those with symptomatic disease
What are the SIGN key recommendations for overweight/obesity?
Target with interventions, aiming to reduce weight by 3 kg
What is the recommended amount of dietary saturated fat?
Men < 30g per day
Women < 20g per day
What is the recommended amount of dietary fish?
Twice per week, 1 of which is oily fish
What is the recommended amount of dietary salt?
< 6g per day
Which type of diet is recommended for CVD health?
Mediterranean
What is the recommended amount of physical activity per week?
150 mins moderate exercise OR 75 mins vigorous
Resistance training at least twice per week
Minimise time spent sedentary
Is there a role for anti platelet therapy in primary prevention of CVD?
Not recommended for primary prevention
If atherosclerosis –> 75mg aspirin daily
When should lipid lowering drugs be considered for primary prevention of CVD and what should be offered?
If at high risk and no evidence of CVD
Offer statin following discussion of risks/benefits
–> Atorvastatin 20mg/day
How might hyperlipidaemia manifest clinically?
Xanthomata
Xanthelasma
Corneal arcus
Milky blood/serum
Apart from CVD, what are high triglycerides a risk factor for?
Acute pancreatitis
How are cholesterol and triglycerides transported in the blood?
Lipoproteins e.g. HDL and LDL
Which pattern of lipoproteins is associated with CVD?
High LDL
Low HDL
Which type of cholesterol is ‘bad’ and why?
LDL
assist in the production of atheromatous plaques
Which cholesterol is ‘good’ and why?
HDL
key role in removing excess cholesterol from cells by transporting it to the liver
How is cholesterol removed from the body?
Only liver has capacity to remove cholesterol from the body
–> secreted into bile or used to synthesise bile salts
How do statins work?
Inhibit HMG-CoA reductase
–> reduce total and LDL cholesterol
How are statins taken?
Orally at night
What are some side effects of statins?
GI upset
Myositis
Rhabdomyolysis (rare)
Which drugs are first line for patients with very high triglyceride levels?
Fibrates
Which other drugs can be given when statin alone does not control cholesterol?
Ezetimibe
PCSK9 inhibitors e.g. alirocumab, evolocumab
How does Ezetimibe work?
Reduces cholesterol absorption in duodenum
What are some side effects and contraindications to ezetimibe?
SE: diarrhoea, abdominal pain
CI: breastfeeding
Which genetic disorder causes high cholesterol and what is its pattern of inheritance?
Familial hypercholesterolaemia
Autosomal dominant
Which lipid reducing drug and dose should be prescribed for secondary prevention?
Atorvastatin 80mg
What needs to be checked before starting a statin?
LFTs
