Module 4 (a) Flashcards
Cardiovascular Dz Prevention
-Recommendations?
Look at article**
CVD
-Modifiable Risk Factors
- Smoking
- Dyslipidemia
- DMT2
- Increased waist to hip ratios
- Physical inactivity
- Poor diet
- HTN
- Psychosocial stress
ASCVD Risk Assessment
-What is it?
- Estimate a patients initial 10-year ASCVD risk in ages 40-79 yrs old ***
- You can only do LIFETIME risk not 10 year risk outside of the age range
- Low risk (<5%)
- Borderline Risk (5-7.5%)
- Intermediate risk (>/=7.5-20%)
- High risk (>/=20%)
ASCVD
-Risk?
- Most Potent risk factor for ASCVD over age 50 is diabetes
Diabetes T2DM Med Management
-SGLT-2 & GLP-IR
- SGLT-2
- Significant reduction in ASCVD events and HF
- “Flozin” meds - GLP-IR Agonists
- Found to significantly reduce ASCVD events w/ T2DM and high risk
- “utide” meds
Lipids
-Labs to monitor
- Fasting Lipid panel and CMP
- Follow up in 4-12 wks to check adherence and for med changes
- Check yearly once stable
- Check CMP and CK if pt is symptomatic of liver dz or has myalgias
Lipid Labs
-Total cholesterol?
- Total cholesterol below 200 mg/dl is Optimal; High is above 240 mg/dl
Lipid Labs
-LDL-C?
- LDL below 100 mg/dl is Optimal; VERY HIGH is above 190 mg/dl
Treat to the LDL
Lipid Labs
-HDL?
- HDL above 60 is optimal; Very low is below 40
Lipid Labs
-Triglycerides
- Below 150 is Optimal; Very high is above 500
If Triglycerides come back high, question if patient was fasting**
Hypertriglyceridemia
-FIBRATES
- Fasting serum Triglyceride level > 400mg/dl
- FIBRATES decrease triglyceride values by 35-50% and increase HDL levels 5-20%
- NO FIBRATES to pt’s with severe hepatic or renal dysfunction
- Complication risk is Increased when used with Statins
- MONITOR LFT’s to detect and prevent liver damage
Hypertriglyceridemia
-Complications
- HTG is the 3rd most common cause of acute pancreatitis after alcohol and gallstones
- If Triglyceride level is persistently above 886 mg/dl, start drug therapy to lower risk of pancreatitis
Hypertriglyceridemia
-Management
- Statins
- Bile Acid sequestrants
- Nicotinic acid
- Fibric acids
- Cholesterol absorption inhibitors
Hyperlipidemia
-Primary Prevention
- Assess risk factors beginning in childhood
- Age <19 w/ familial hypercholesterolemia = START STATIN
- Age 20-39 = estimate lifetime risk and promote healthy lifestyle
- Consider statin in those w/ family hx of premature ASCVD and LDL-C >/= 160
Hyperlipidemia
-Treatment Guideline (High Intensity)
- Ages 20-75 + LDL-C >/=190 mg/dl = high intensity statin w/out risk assessment
- T2DM >/= 10 yrs, T1DM >/=20 years, renal dz, retinopathy, PVD with ABI <0.9
- High intensity statin w/ aim to lower LDL by 50%
Hyperlipidemia
-Treatment Guideline (Moderate Intensity)
- Ages 40-75 + T2DM = Moderate intensity statin
- Use risk assessment to see if patient needs high intensity statin
Hyperlipidemia
-Treatment Guideline CAD
If a patient has known coronary disease, they need to be on a statin.
Treatment guidelines are for patient w/out known coronary artery disease
Breakdown of Risk and Treatment
-Borderline Risk
- 5-7.5%
- Reduce present modifiable factors
- Discuss moderate intensity statin
- Consider coronary artery calcium score
Breakdown of Risk and Treatment
-Intermediate Risk
- > 7.5-20%
- Use moderate intensity statin
- Use High intensity statin if Pt has increased Risk factors (Risk stratification w/ CAC if risk is uncertain
*Coronary artery calcium score (CAC)
Breakdown of Risk and Treatment
-High Risk
- > /= 20%
- Risk discussion to initiate high intensity statin
- Goal to reduce LDL by >/=50%
Coronary Artery Calcium Score (CAC)
-CAC scores?
- Score of 0
- Can avoid statins and recheck CAC in 5-10 yrs. (Make sure pt doesn’t smoke) - Score 1-100
- Reasonable to initiate moderate intensity statin - Score >100
- >75th percentile; Use a statin at any age
Coronary Artery Calcium Score (CAC)
-More Info
- A score of ZERO does not imply zero risk
- ALWAYS incorporate w/ other known risk factors
- Doesn’t replace a stress test
Primary Prevention of ASCVD
-Aspirin Use?
- Consider low dose aspirin (75-100mg daily) for
- 40-70 yr old adults who have higher risk for ASCVD but NO increased risk of bleeding
Primary Prevention
-Weight Control
- Obesity BMI >/= 30
- Overweight BMI 25-29.9
- Both Obesity and overweight increase risk for ASCVD, HF, A fib, compared to normal weight - Meaningful weight loss is considered >/= 5% of initial weight
- 5-10% loss can result in improvement in BP, lipids, glucose and can delay T2DM
- Document DMI and waist circumference during each visit.