Module 7: CV Risk Assessment Overview Learning Outcomes Flashcards
Describe the components of, and be able to perform, a cardiovascular risk assessment
- 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
Determine the difference between genetic and environmental dyslipidemia
If total cholesterol lvls higher than 6.5 mmol/l, LDL cholesterol higher than 4.5 mmol/l, TGs higher than 3 mmol/l, or HDL cholesterol lower than 0.7 mmol/l likely genetic factors, not the patients fault, and frequently will not be corrected with lifestyle measures alone
Generate a family pedigree and ask questions about family history when doing a cardiovascular risk assessment
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Describe the physical signs of hyperlipidemia
- 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)
Describe and calculate a Framingham Risk Score
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
- Age
- Total cholesterol leve
- Smoking status
- HDL cholesterol
- Systolic BP depending on whether they are treated or untreated for high BP
Describe the findings of Framingham and INTERHEART studies.
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Observe a cardiovascular risk assessment
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Determine the key unmodifiable and modifiable risk factors of cardiovascular disease/atherosclerosis
Unmodifiable: age, gender, and heredity
Modifiable: hypercholesterolemia, low HDL, smoking, high blood pressure, and diabetes, psychosocial stress and abdominal obesity, diet
Discuss newer markers of cardiovascular disease risk
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Describe the clinical and laboratory findings in the major genetic disorders of lipid metabolism
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Discuss the issues surrounding screening for dyslipidemia.
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Discuss the major predictors/risk factors of cardiovascular risk.
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Describe why apolipoprotein(B) (apo B) is a better predictor of risk and treatment outcomes than LDL-cholesterol.
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Describe the role of CRP in assessment of CV risk.
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Discuss the role of HDL-cholesterol, triglycerides and lipid ratios as predictors of risk.
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