Module 7: CV Risk Assessment Flashcards
Describe the main steps to completing a medical history form
- Initial interaction and history of ischemic vascular disease
- Dyslipidemia
- Smoking
- Elevated blood glucose or known diabetes
- High blood pressure (hypertension)
- Exercise
- Weight history
- Alcohol intake
- Psychosocial stress
- Other past history
- Medications
- Dietary assessment
How is premature CVD in a first degree relative defined as?
evidence of vascular disease or event in the patients’ FATHER or BROTHER before age 55, or MOTHER or SISTER before age 65
What to ask about family history?
- Are parents living? If dead, ask at what age and cause
- Ask if parents had any known heart disease or stroke. If they did, ask what age they knew of heart problem or stroke (to determine if it was premature)
- Ask if siblings had heart attack or stroke
- For all 1st degree relatives, ask what that person’s risk factors were e.g. smokers, high BO
What must be done during a Physical Examination to Identify Cardiovascular Risk
Measure:
- weight
- height
- BMI (kg/m^2)
- waist circumference
- narrowest point between the lower ribs (costal margin) and the top of the hip (iliac crest) - BP (sitting)
- if elevated at sitting, measure again supine after 5 mins of lying down - Pulse
- listen for carotid bruits or blockage in carotid arteries by placing stethoscope over carotid pulse
- feel ankle (posterior tibial) and foot (dorsalis pdis) pulses for presence and strength - Physical signs of inherited dyslipidemia
What is considered an elevated waist circumference
In Caucasians > 102 cm in men or > 88 cm in women; In Asians or South-Asians > 90 cm in men or > 80 cm in women
What does an elevated waist circumference suggest
indicates abdominal obesity and is one criterion of the metabolic syndrome and a major predictor of insulin resistance
What are the physical signs of inherited dyslipidemia?
- corneal arcus (white ring overlying outer edge of iris in the eye)
- xanthelasma (flat or raised yellow patches on eyelids or just below eyes)
- planar xanthomas of the palms (orange-brown palm creases)
- tendon xanthomas (thickening or nodules in the Achilles tendons and possibly the extensor tendons of the hands and patellar tendons)
- in the case of very high triglycerides, eruptive xanthomas (single or bunches or reddish-yellow bumps over the back, buttocks, hands, elbows or feet)
What is the Framingham Risk Score (FRS)
The # of points achieved is converted into an estimate of their risk for having a heart attack or coronary death over the next 10 yrs, also based on outcomes of the Framingham Heart Study
What characteristics is the Framingham Risk Score (FRS) based on?
- Age
- Total cholesterol leve
- Smoking status
- HDL cholesterol
- Systolic BP depending on whether they are treated or untreated for high BP
When are upward adjustments of the FRS made?
- premature vascular disease in first degree relatives
- presence of other risk factors including elevated lipoprotein (a) [Lp(a)] or high sensitivity C-reactive protein (hs-CRP)
Can the The Framingham Risk Score provide an estimate of the lifetime risk of coronary disease?
No
Criticism of the FRS?
- based on a study done mainly in white men, underestimating risk in women
- underestimating long term risk associated with genetic dyslipidemias or other family history
- not accurately estimating risk in ethnic groups other than Caucasians
What are unmodifiable risk factors for Atherosclerosis
age, gender, and heredity
In the INTERHEART study, what are some confirmed strong risk factors for MI?
hypercholesterolemia, low HDL, smoking, high blood pressure, and diabetes, psychosocial stress and abdominal obesity.
According to the INTERHEART, what is protective against myocardial infarction
daily consumption of fruits and vegetables, regular physical activity, and regular alcohol intake
INTERHEART concluded that known modifiable risk factors account for ____% of the population attributable risk in men, and ____% in women, for myocardial infarction
- Men: 90%
- Women: 94%
What category contributes the largest # of points when scoring an individual’s risk of coronary disease by the FRS
Age
How does aging contribute to atherosclerotic plaque?
Over a lifetime an individual’s blood vessels are exposed to a variety of factors that damage the single cell-thick layer of endothelium lining the vessels, setting up a repair and inflammatory process that initiates the formation of atherosclerotic plaques
What are some of the damaging factors that damage the single cell-thick layer of endothelium lining the vessels, setting up a repair and inflammatory process that initiates the formation of atherosclerotic plaques?
- molecules in food e.g. trans or saturated fats and high dietary cholesterol, elevated levels of harmful lipoproteins [low density lipoproteins (LDL) or remnant lipoproteins)
- harmful chemicals in cigarette smoke
- elevated blood glucose
- elevated BP
- cytokines released into the blood stream from sites of inflammation
Which gender has an earlier onset of CHD generally in the population?
Men
Why do men have an earlier onset of coronary heart disease generally in the population than do women?
protective effects of estrogen on the blood vessel wall and endothelium in wome
How does menopause affect the risk of CHD in women?
After menopause, the risk of CHD rises sharply in women and to the same level as seen in men in older age group
Why does the risk of CHD rises sharply in women after menopause?
protective effects of estrogen on the blood vessel wall and endothelium in women is lost when estrogen production in women by the ovaries stops at menopause
How can the protective effect of estrogen be lost in premenopausal women
if they are diabetic
