Level 2 - Cardiovascular Disease (Class 7) Flashcards
ASCVD
Coronary heart disease
Peripheral artery disease
Cerebrovascular disease
How can we assess ASCVD and HF? (6) How often?
1) Duration of diabetes
2) BMI
3) Dyslipidemia
4) Smoking
5) FH of premature coronary disease
6) CKD - presence of albuminuria
YEARLY
At 10 years, is when the risk of complications increase
(TRUE/FALSE)
In insulin resistance, the alpha cells in the pancreas are deactivated.
FALSE
Hyperactive; which leads to reduced insulin secretion from the beta-cells, leading to hyperglycemia
(TRUE/FALSE)
In insulin resistance, there is increased lipolysis.
TRUE
This stems from decreased glucose uptake and expression of GLUT-4, leading to an increased release of inflammatory. mediators (TNF), causing increased lipolysis and therefore, increased FFA secretion
List some factors associated with IR (8).
1) Visceral adiposity
2) Sedentary lifestyle
3) Genetics / ethnicity
4) GDM
5) PCOS (Polycystic Ovary Syndrome)
6) Acanthosis Nigricans
7) OSA
8) Cancer
(TRUE/FALSE)
According to the Nurse’s Study, any elevation in blood sugar is going to increase the risk of CVD, MI, or stoke; specifically, the risk exponentially increases the closer to a diabetes diagnosis.
TRUE
What 5 pillars can reduce diabetes complications?
1) Glycemic mgmt
2) BP mgmt
3) Lipid mgmt
4) Agents with CVD and CKD benefits
5) Lifestyle modification and diabetes education
What are the ABCs of diabetes?
A) 1c less than 7% (individualize)
B) lood pressure (< 130 / 80)
C) holesterol (statin based on age & risk)
If 40+ with ASCVD risk, decrease 50%, LDL < 70 (use HIGH-intensity statin)
If 40+ with ASCVD, decrease 50%, LDL < 55
TG < 150
HDL > 40
If LDL remains above 70 mg/dL, which classes of medications should be considered?
1) Ezetimibe
2) PCSK9 inhibitor
What 2 medications and their doses, are considered high-intensity statins?**
1) Lipitor (atorvastatin): 40-80 mg
2) Crestor (rosuvastatin): 20-40 mg**
What is the LDL goal for those who have had a previous stroke or MI?**
LDL < 55 mg/dL
Achieved with high-intensity statin
(TRUE/FALSE)
For those who are 40-75 y/o with diabetes, w/o ASCVD and are at low risk for CVD, it is recommended to start a moderate-intensity statin.
TRUE
Smoking increases the risk of diabetes, by how much?
30%
ASK AT EVERY VISIT
(TRUE/FALSE)
Periodental disease can increase the risk of CVD.
TRUE
What classes as at risk for ASCVD?
55 y/o or greater, with 2 or more:
- obesity
-HTN
-smoking
-dyslipidemia
-albuminuria
Which classes of medication are the most effective based on the Cardiovascular Outcome Trials?
GLP-1 RAs (3 meds)
SGLT-2 (3 meds)
Which 3 GLP-1s are effective in cardiovascular protection?
1) Semaglutide (Ozempic)
2) Liraglutide (Victoza)
3) Dulaglutide (Trucility)
Which 3 SGLT-2 medications are effective in cardiovascular protection?
1) Empagliflozin (Jardiance)
2) Canagliflozin (Invokana)
3) Dapagliflozin (Farxiga)
Which medication is FDA approved for preserved EF in HF? **
Empagliflozin**
Which class of medication should be avoided with HF? Why?**
TZD because they can cause fluid retention**
Which class of medication do we use for HF?
All SGLT-2s
“flozin” = flows out
Which class of medication is preferred for reducing CKD progression?
SGLT-2
When is aspirin therapy appropriate?
A secondary prevention strategy in those 50+ with diabetes and hx of ASCVD
What is the first line medication class for HTN?
Person with albuminuria or ASCVD
Start ACE or ARB
What is the first line medication class for HTN?
Person w/o albuminuria
1) ACE inhibitor
2) ARBs
3) Thiazide-like diuretics, OR
4) Calcium channel blockers
When should two BP medications be started?
If BP is > 150/90
For patients who are hypoglycemic and taking beta blockers what are the 2 signs that will experience?**
1) Dizziness
2) Sweating
The beta blocker will block the other hypo symptoms**
When are beta-blockers appropriate?
Take 3 years after an MI
