Lecture 1 - NHS Health Check, CVD Risk and Case Studies Flashcards
What is the NHS Health Check programme?
Government initiative to reduce cardiovascular disease through early identification of those at risk excluding those who already have CVD
What ages does the NHS Health Check programme target?
Target 40-74 year olds in England every 5 years
What higher risk problems is the NHS Health Check checking for?
Heart disease, Diabetes, Kidney disease and stoke
What typical checks will the health professional carry out?
Height and weight, blood pressure and do a blood test
Alcohol intake and whether you smoke
Age, gender, ethnicity
For every 30-40 people having an NHS Health Check how many people are diagnosed with high blood pressure?
1 person
For every 80-200 people who are having a NHS Health Check how many people are diagnosed with type 2 diabetes?
1 person
For every 6-10 people having a health check how many people identified as being at a high risk of CVD?
1 person
Name the two outcomes of a NHS Health Check
1) Be given a lifestyle advice and invited back in 5 years
2) Meet a referral point for GP assessment because of:
- Raised blood pressure
- Raised lipids
- High calculated CV risk
- Raised blood glucose
Define cardiovascular risk
Is the chance of experiencing a heart attack or stroke (or developing cardiovascular disease) in the next 10 years if nothing about their current lifestyle changes
Define QRisk3
Validated assessment tool for people between 25-84 years old which identifies individual non-modifiable and modifiable CVD risk factors to calculate an estimation of CD risk
What percentage is CV risk low?
Less than 10%
What percentage is CV risk moderate?
10-20%
What percentage is CV risk high?
Greater than 20% - referral to GP
What are the key points in a consultation about CV risk?
Do not use jargon
Simplify the maths
Find out what they already know about their CVD risk and how they feel about it
Involve them in the consultation
Inform them of current evidence and best practice
Assess their readiness and confidence to make changes to their lifestyle
What is BMI?
Body mass index, calculated from weight (kg) divided by height (m2)
If BMI is below 18.5 you are…
Underweight range
If your BMI is between 18.5-24.9 you are…
Healthy weight
If your BMI is 25-29.9 you are…
Overweight range
If your BMI is between 30-39.9…
Obese range
What is the max amount of alcohol you should consume in a week?
14 units
How much physical exercise should be recommended per week?
150 minutes a week of moderate-intensity or 75 minutes a week of vigorous exercise and 2 days a week of strength sessions
What is offered to patients who have a CVD risk of 10% or greater 10 year risk of developing CVD
Offer atorvastatin 20mg for the primary prevention of CVD
Consider lifestyle modification first
If more than 85 years old consider atorvastatin 20mg - may benefit in reducing the risk of non-fatal MI
When should you offer statin treatment for the primary prevention of CVD to adults with type 1 diabetes?
Over 40 years old or have had diabetes for more than 10 years or have established neuropathy or other CVD risk factors
Start atorvastatin 20mg
What should you offer patients with CVD (secondary prevention ie. MI/stroke/PAD/angina) with atorvastatin 80mg?
Atorvastatin 80mg
Do not delay to improve risk factors
Use a lower initial dose of 20mg daily for some people such as Chronic Kidney Disease (CKD) or if any of following apply:
- Potential drug interactions
- High risk of adverse effects
- Patient preference
What monitoring is required when treatment on statins has started?
Measure liver transaminase enzymes within 3 months of starting treatment and at 12 months but not again unless clinically indicated - liver function tests
Measure total cholesterol - HDL and non-HDL within 3 months of starting treatment
Consider annual non-fasting non-HDL tests
DO NOT STOP STATINS BECAUSE OF AN INCREASE in blood glucose or HbA1c
What percentage reduction in non-HDL cholesterol do we aim for?
40% reduction in non-HDL
What is the side effect of statins which deter people from taking them?
Muscle effects - muscle pain
What are the common side effects of statins?
Inflammation of the nasal passage, pain in the throat, nose bleed
Allergic reaction
Headache
Nausea, constipation, wind, indigestion, diarrhoea
When is Aspirin recommended?
In secondary prevention
