NHS Health Check - Vascular Disease

Question 1

What are the aims of the service?

Answer 1

• Targets 40 to 74 year olds to increase their awareness of their vascular risk and how to minimise it.
• Improve health outcomes + quality of life
• To prevent diabetes
• To sustain increase in life expectancy
• To reduce health inequalities
• To improve convenience + accessibility

Question 2

What are the most common vascular diseases?

Answer 2

• Coronary heart disease
• Stroke
• Diabetes
• Kidney disease

Question 3

What are the signs of a stroke?

Answer 3

FAST
Face - drooped on 1 side
Arms - not able to lift, weak/numb in 1
Speech - slurred, not able to talk at all
Time - call 999 immediately

Question 4

What are the signs of a heart attack?

Answer 4

Chest Pain - pressure, tightness
Pain in other parts of body
Feeling dizzy
Sweating
Shortness of breath
Feeling sick
Coughing/wheezing
Overwhelming sense of anxiety

Question 5

What is a cardio-protective diet?

Answer 5

• Total fat intake = <30% of total energy intake
• Saturated fat = <10% of total energy intake
• Dietary cholesterol = <300mg/daily
• Saturated fats replaced by mono/polysaturated fats

Question 6

What is the potential relationship between infection and vascular disease?

Answer 6

Poor oral health - endocarditis

Question 7

List the 5 modifiable risk factors for vascular disease.

Answer 7

1. Smoking
2. Physical inactivity/sedentary lifestyle
3. High BP
4. Raised cholesterol levels
5. Obesity

Question 8

What is the difference between a fixed and a modifiable risk factor?

Answer 8

A fixed factor cannot be change whereas a modifiable one can.

Question 9

List the 4 main fixed risk factors for vascular disease

Answer 9

1. Age
2. Gender
3. Family history of vascular disease
4. Ethnicity

Question 10

What is the purpose of the QRISK3-2018 calculator?

Answer 10

To identify areas in which a patient is at highest risk and to identify the likelihood of a heart attack/stroke occurring in the next 10 years based on the data provided

Question 11

How do I calculate BMI?

Answer 11

weight of a person (kg) / their height (m^2)

Question 12

What is the ideal BMI range?

Answer 12

18.5-24.9 kg/m2

Question 13

What other BMI measurements are there?

Answer 13

<18.5 = underweight
>24.9 = overweight
>30 = obese grade 1
> 35 = obese grade 2
> 40 = morbidly obese grade 3

Question 14

What is the ideal BP measurement?

Answer 14

90/60mmHg to 120/80 mmHg

Question 15

What is low BP?

Answer 15

Less than 90/60mmHg

Question 16

What is high BP?

Answer 16

More than 140/90 mmHg

Question 17

What is the normal total cholesterol measurement?

Answer 17

5.0mmol/L or less

Question 18

What is the normal LDL cholesterol measurement?

Answer 18

3.0mmol/L or less

Question 19

What is the normal HDL cholesterol measurement?

Answer 19

1.2mmol/L or more

Question 20

What is the normal TChol/HDL ratio?

Answer 20

4.5 or less

Question 21

What is the normal blood glucose measurement when FASTING?

Answer 21

4 to 6 mmol/L (72 to 108 mg/dL)

Question 22

What is the normal blood glucose measurement 2 HOURS AFTER EATING?

Answer 22

7.8 mmol/L (140 mg/dL)

Question 23

Who might be prescribed statins?

Answer 23

People with >10% risk of developing CVD in next 10 years

Question 24

What statins might be prescribed?

Answer 24

Atorvastatin 20mg ONCE DAILY

Question 25

What do statins do?

Answer 25

Inhibit 3-hydroxy-3-methylglutaryl co-enzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis.
This reduces LDL cholesterol levels by slowing production in the liver, increasing liver’s ability to remove the LDL.

Question 26

What interactions with statins are there?

Answer 26

LOTS

• Cytochrome P450 enzyme inhibitors lead to increased conc. of statins = inc. risk of myopathy or rhabdomyolysis
• Oral fusidic acid = fatal rhabdomyolysis (breakdown of damaged skeletal muscle)

Question 27

What interactions with atorvastatin are there?

Answer 27

• Potent CYP3A4 inhibitors (ending with -in, -ol, -azole)
• HIV protease inhibitors (-avir)
• Ciclosporin, telaprevir, tipranavir with ritonavir, DO NOT EXCEED 10mg daily
• Erythromycin + clarithromycin = Lower max dose of atorvastatin and monitoring

Question 28

What is classed as high risk in the QRISK-2018 calculator?

Answer 28

Score >20%

2 in 10 chance of CVD in next 10 years

Question 29

What is classed as moderate risk in the QRISK-2018 calculator?

Answer 29

Score 10% - 20%

Question 30

What is classed as low risk in the QRISK-2018 calculator?

Answer 30

Score <10%

Question 31

What is the course of action taken if high or moderate risk?

Answer 31

• Treatment w medicines usually advised (statins for cholesterol or BP medicine)
• Advice to tackle any lifestyle issues given
• Signposting to relevant support
• ALL HIGH RISK REFERRED TO GP FOR FURTHER INVESTIGATION

Question 32

What advice should be given to high or moderate risk patients?

Answer 32

• Cardio-protective diet
• Exercise 3 x 45/60 mins a week
• Reduce alcohol consumption, spread over 3 days, no more than 14 units a week
• 5 fruit + veg at least a day

Question 33

Why is postcode taken into account in the QRISK-2018 calculator?

Answer 33

Provides a geographical measure of deprivation + socio-economic factors