High Risk of Cardiovascular Disease Flashcards
What is the mechanism of action of Statins?
HMG-CoA reductase inhibitor, regulating the rate limiting step of hepatic cholesterol synthesis
What is the main side-effect of Statins? What particular statins are increased at risk of precipitating this?
Myopathy (Myalgia, myositis, rhabdomyolysis)
This is more common in lipophillic statins such as Atorvastatin and Simvastatin instead of the hydrophillic statins
Statins cause ___ impairment. What tests should therefore be performed when monitoring someone on this drug?
Liver impairment
LFTs at baseline, 3 months and 12 months
What patients should statins be administered to? Two groups of patients
- All patients with ischaemic heart disease
- All patients with a QRISK2 >10%
When should statins be taken in the day and why?
At night, because this is when the cholesterol synthesis takes place
What is the starting dose of statins for primary and secondary prevention of CVD?
Primary prevention - 20mg
Secondary prevention - 80mg
A patient is taking statins 20mg for primary prevention, but his non-HDL levels have not improved. What is the next stage?
If non-HDL levels have not reduced by >40%, consider increasing dose from 20mg to 80mg
What is the mechanism of action of Aspirin?
Non-selective COX-1 and COX-2 Inhibitor, reducing synthesis of Thromboxane A2
Why should aspirin NOT be administered to children under 16?
Risk of Reye’s syndrome (fatal encephalopathy)
Aspirin potentiates what three medications?
Warfarin
Oral hypoglycaemic agents
Steroids
What is the NICE recommendation for alcohol intake in patients at risk of CVD?
Males - do not drink more than 3-4 units a day
Females - do not drink more than 2-3 units a day
Avoid binge drinking. Maximum limit of 14 units a week
What is the NICE recommendation for physical activity in patients at risk of CVD?
Perform 150 mins of moderate exercise / 75 mins of vigorous exercise per week
Perform 2 strength activities per week
What is the NICE recommendation for fat intake in patients at risk of CVD?
A diet with a total fat content of <30% total energy, saturated fats <7% of total fat, and cholesterol <300 mg / day
What is Primary, Secondary and Tertiary prevention?
Primary prevention refers to preventing onset of disease through intervention, thus reducing incidence of disease
Secondary prevention refers detecting disease in early stages and preventing it from progressing
Tertiary prevention refers to improving quality of life and reducing existing symptoms of disease
What are the six main risk factors to CVD?
Hypertension Diabetes Overweight / Obesity Inactivity Smoking Hypercholesterolaemia
