Heart health Flashcards
What is ASCVD?
Peripheral artery dz (PAD)
Cerebrovascular dz
Coronary heart dx (CHD)
What is greatest cause of morbidity and mortality in DM?
ASCVD
What are the risk factors for ASCVD?
Overweight/obesity Smoking HTN HLD CKD albuminuria Family hx premature coronary dz
What is the ASCVD risk calculator?
10 year risk of 1st CV event
age 40-79
DM is a risk however doesn’t ask about duration or complications from DM
HF hospitalization is how much higher in PWD?
2x
Why should we do HTN tx?
Reduces HF, microvascular complications, ASCVD events
How should HTN be dx?
at every routine visit
3 abnormal values on separate occasions to dx
Treatment of HTN to what BP reduces CV events µvascular complications?
<140/90
Why should PWD monitor BP at home?
White coat syndrome
masked HTN
DTR effectiveness of meds
What are HTN goals in adults w/ DM?
<140/90 if low CV risk (ASCVD risk <15%) OR if adverse effects to intensive tx
<130/90 if existing ASCVD or 10 year risk >/=15%
BP goal in pregnant women w/ HTN
135/85
What are the risk of overtreating HTN?
hypotension
falls
acute kidney injury
electrolyte abnormalities
Who is at risk for overtreatment of HTN
CKD orthostatic HTN functional limitations significant comorbidities polypharmacy
How to treat HTN in pregnancy?
Do NOT use- spironolactone, ARB, ACE
Can use- labetolol, methyldopa, long acting nifedipine
May use hydralazine w/ preeclampsia
Diuretic only in late pregnancy for volume control
When to monitor BP after birth?
3 days in hospital
7-10 days PP
LT follow-up recommended s/t lifelong increased risk of CV
DASH diet
2,300 mg sodium/day
2-3 svgs LF dairy
8-10 svgs F/V combined
avoid excessive etoh
How to treat HTN if BP >140/90 but <160/100 AND w/o elevated UACR
1 med to start
ACE, ARB, CCB, or Thiazide like diuretic can be used
IF HTN + elevated UACR >30 but definitely >300
ACE or ARB
What if BP is >160/100
2 meds
Do NOT combine ARB + ACE
What to monitor if on ACE, ARB, or diuretic?
EGFR, serum K+, serum creatinine at least annually
Why should at least one HTN drug be given at night?
Reduces CV events
Why should ACE not be given with ARB?
Can cause hyperkalemia and/or AKI, which can increase risk of CV event/death
What is resistant HTN?
How to treat it?
On 3 classes of HTN meds including diuretic and still not meeting goals
Confirm that pt is taking meds as directed
Start mineralcorticoid, which can reduce albuminuria but may increase hyperkalemia risk
How does glycemic control effect lipids?
Poor glycemic control can raise TG
If a PWD is <40 years old, not on a statin, when should lipids be taken?
At dx, initial medical evaluation, q 5 years if <40
If pt is on a statin, when should lipid panel be taken?
@ initiation of statin or other lipid lowering medication
4-12 weeks after starting statin or changing dose
annually after
What do do w/ pt 40-75 w/o ASCVD for primary prevention
moderate intensity statin
What if pt is <40 but has ASCVD risk factors for primary prevention
may consider statin+lifestyle changes
In pts at higher risk (ASCVD risk factors, age 50-70) for primary prevention
use high intensity statin
if 10 year ASCVD risk is >20%, what can be added to reduce LDL by 50%
ezetimibe
what should all PWD w/ confirmed ASCVD get
high dose statin
If LDL >70 and on maximally tolerated statin w/ confirmed ASCVD
ezetimibe or PCSK9 inhibitor
Can you use a statin during pregnancy?
No
How much does a high intensity statin lower LDL compared to moderate?
50% versus 30-49%
What are the high dose statins?
Rosuvastatin
Atorvastatin
What can PCSK9 do?
Lower LDL 35-60%
IMPROVE IT trial
Ezetimibe for pts on statin w/ recent acute coronary syndrome
reduced absolute risk 5%, relative risk 14% for major adverse CV events
What can be given to pts who need TG lowering but LDL is normal?
Icosapent ethyl
TG 175-499
what HLD pattern is most common in DM?
High TG, low HDL
