Lecture 1 - NHS Health Check, CVD Risk and Case Studies

Question 1

What is the NHS Health Check programme?

Answer 1

Government initiative to reduce cardiovascular disease through early identification of those at risk excluding those who already have CVD

Question 2

What ages does the NHS Health Check programme target?

Answer 2

Target 40-74 year olds in England every 5 years

Question 3

What higher risk problems is the NHS Health Check checking for?

Answer 3

Heart disease, Diabetes, Kidney disease and stoke

Question 4

What typical checks will the health professional carry out?

Answer 4

Height and weight, blood pressure and do a blood test
Alcohol intake and whether you smoke
Age, gender, ethnicity

Question 5

For every 30-40 people having an NHS Health Check how many people are diagnosed with high blood pressure?

Answer 5

1 person

Question 6

For every 80-200 people who are having a NHS Health Check how many people are diagnosed with type 2 diabetes?

Answer 6

1 person

Question 7

For every 6-10 people having a health check how many people identified as being at a high risk of CVD?

Answer 7

1 person

Question 8

Name the two outcomes of a NHS Health Check

Answer 8

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

Question 9

Define cardiovascular risk

Answer 9

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

Question 10

Define QRisk3

Answer 10

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

Question 11

What percentage is CV risk low?

Answer 11

Less than 10%

Question 12

What percentage is CV risk moderate?

Answer 12

10-20%

Question 13

What percentage is CV risk high?

Answer 13

Greater than 20% - referral to GP

Question 14

What are the key points in a consultation about CV risk?

Answer 14

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

Question 15

What is BMI?

Answer 15

Body mass index, calculated from weight (kg) divided by height (m2)

Question 16

If BMI is below 18.5 you are…

Answer 16

Underweight range

Question 17

If your BMI is between 18.5-24.9 you are…

Answer 17

Healthy weight

Question 18

If your BMI is 25-29.9 you are…

Answer 18

Overweight range

Question 19

If your BMI is between 30-39.9…

Answer 19

Obese range

Question 20

What is the max amount of alcohol you should consume in a week?

Answer 20

14 units

Question 21

How much physical exercise should be recommended per week?

Answer 21

150 minutes a week of moderate-intensity or 75 minutes a week of vigorous exercise and 2 days a week of strength sessions

Question 22

What is offered to patients who have a CVD risk of 10% or greater 10 year risk of developing CVD

Answer 22

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

Question 23

When should you offer statin treatment for the primary prevention of CVD to adults with type 1 diabetes?

Answer 23

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

Question 24

What should you offer patients with CVD (secondary prevention ie. MI/stroke/PAD/angina) with atorvastatin 80mg?

Answer 24

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

Question 25

What monitoring is required when treatment on statins has started?

Answer 25

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

Question 26

What percentage reduction in non-HDL cholesterol do we aim for?

Answer 26

40% reduction in non-HDL

Question 27

What is the side effect of statins which deter people from taking them?

Answer 27

Muscle effects - muscle pain

Question 28

What are the common side effects of statins?

Answer 28

Inflammation of the nasal passage, pain in the throat, nose bleed
Allergic reaction
Headache
Nausea, constipation, wind, indigestion, diarrhoea

Question 29

When is Aspirin recommended?

Answer 29

In secondary prevention