Macrovascular Flashcards
What four classes of anti hypertensives are preferred? In no particular order and in patients with no CV disease or CKD.
Thiazides
ACE
ARB
Dihydropyridine Ca blockers. Ie: amlodipine, nifedepine, felodipine
If a patient is already on an ACE and needs BP therapy intensified, what is the drug of choice?
CCB rather than thiazides
Why should all patients with ACS be screened for diabetes prior to discharge?
More than 2/3 patients with an MI have diabetes or pre-diabetes
What particular treatments for ACS are different for people with diabetes?
None. They should be treated the same and have the same interventions as a non-diabetic
Which is preferred in diabetic patients with ACS:
Clopidogrel
Ticagrelor (brillinta)
Prasugrel (Effient)
Undergoing PCI:
Ticagrelor or prasugrel Preference to ticagrelor as
Prasugrel only use if 65kg and no Hx of stroke.
What are the BP
TARGETS and Thresholds?
Both 130/80
Why should patients with stroke be screened for diabetes?
Because men with D have a 2-3 fold increase and women have a 2-5 fold increase of risk of stroke
Is diabetes a cause of heart failure or only secondary to Ischemia?
Diabetes can cause HF independent of ischemic heart disease by causing diabetic cardiomyopathy that may manifest with normal or reduced left ventricular ejection fraction.
What is the recommendation ace/arb dosing and monitoring in a D patient with heart failure but Also with an eGFR less than 60?
Starting dose of ACE/ARB should be HALVED
Within 7-10 days of initiation or titration of therapy, monitor:
Electrolytes, eGFR, BP, weight and heart failure sx and signs.
Dose up more gradually but target same doses as non diabetics even B Blockers.
People with diabetes have a CV age _____ years in advance of their chronological age.
10-15 years
Reduced life expectancy is __ years due to CVD.
12
ASA for primary prevention?
No reduction of CAD events but increase in bleeding.
MAY be considered if high risk.
At what age should an ACE or ARB be started if signs of microv
Age 55
OR younger if clinical macrovascular disease or microvascular disease
When should a statin be initiated? 4
Age > 40
Age > 30 if diabetes > 15 years.
Microvascular complications
Framingham high risk.
The presence of CAD in type one pts is related to:
Age Duration of D Higher A1C Higher albumin excretion Traditional factors (smoking, weight, total and LDL cholesterol)
Are type 1 diabetics at higher CAD risk than people without D?
Type 1 D is an independent risk factor for premature CV disease and MORTALItY in young adults (20-39)
In secondary prevention, what if ASA cannot be tolerated?
Clopidogrel cAn be used
What is the most common lipid panel seen when a type 2 is tested?
ALSO, What’s the difference in LDL particles in non-D people and D people?
High TG
Low HDL
Normal LDL-C
Note:the atherogenicity of LDL is increased in D due to glucagon and oxidation!!
LDL particles are smaller and denser
If a patient cannot fast for a lipid panel, what markers can be used which are NOT affected by fasting?
Non HDL cholesterol
Apo-B
How often should a lipid panel be done in all patients with D?
Upon dx
Then yearly or as clinically indicated.
OR every 3-6 months if treatment is initiated.
Which pts are automatically high risk Framingham, Ie: >= 20%
Age > 40
Age > 30 if D more than 15 years
Microvascular disease.
Clinical vascular disease
Abdominal aortic aneurysm
CKD
High risk HTN
Low risk Framingham is at what percent?
Less than 10%
When should a baseline ECG be done?
How often should it be repeated?
Age > 40
Age greater than 30 if D more than 15 years
Cardiac risk factors such as HTN, proteinuria, reduced pulses or vascular Bruits (sound heard in artery due to narrowing)
Microvascular or macrovascular damage
Every 2 years!
What is the initial test for investigation of CAD if indicated ?
Exercise ECG stress testing.
