Overview Flashcards
global attributable deaths due to risk factors
females: high bp
male: tobacco then high bp
most often leading to CV diseases
top diseases leading to diability
Risk factors predict disease and disease predicts disability
Ischaemic hd, stroke, diabetes is high
2nd leading cause of death in Canadians
IHD
progression of coronary atherosclerosis
normal –> fatty streak –> plaque –? increasing plaque –> obstructive atherosclerotic plaque –> plaque fissure or erosion results in thrombosis
Clinically silent is normal
Obstructive is clincially apparent when there is 70% or more of diameter obstructed
Anginga, plaque rupture –> heart attack
Primary Prevention
vs Secondary Prevention
• Primary: Intervening before health effects occur.
– Examples: vaccination, altering risk-modifiable behaviours
(such as poor eating habits)
– Goal: to delay or prevent disease of concern
• Secondary: preventing a second event (typically
through drug therapy) after a first event has occurred
(ie: post MI or stroke).
what is the defintiin f of risk factors
• A clearly defined occurrence or characteristic that
has been associated with the increased rate of a
subsequently occurring disease
• Many cardiac diseases have risk factors that predispose patients to these diseases
• EACH cardiac disease state has its own set of risk
factors
– Many of these risk factors overlap between diseases
– Evaluating these risk factors helps you assess the
likelihood of disease(s) being present
CVD Risk Factors
Non-modifiable
Age - Male > 45yr - Female > 55 yrs Male Family history of premature CVD in a 1st degree relative - Female <65 y - Male <55 y
Modifiable
can be changed
Lifestyle Smoking Sedentary lifestyle Obesity (body mass index [BMI] >25) Hypertension Dyslipidemia Diabetes
CV risk factorrs lead to>
Coronary atherosclerosis,
symptomatic CHD = angina
Plaque rupture and thrombosis –> acute coronary syndrome
lead to chronic heart failure
Exponential increase of “CHD events” with
number of RF
Stacking up risk factors
LVH = left ventricular hypertrophy = enlarging of heart
Hypertension, marker of poor prognosis
Prevalence can go up to almost 50%
“Other” CVD Risk Factors
Shown to increase risk of CV disease, BUT no proof that modifying these (if possible) improves outcomes
- C-reactive protein
- Homocysteine
- Fibrinogen
- Lipoprotein (a)
- Ethnicity
- Psychosocial
Individualized CV
Risk Assessment
- Identify risk factors
- Use a clinical tool to transform risk factors to
risk score (%). Four common ones are: - Framingham Risk Score (FRS)
- Cardiovascular Life Expectancy Score
- ASCVD
- UKPDS (Diabetes)
- Discuss with patient:
– CV risk & modifiable risk factors
Selecting a tool
what 3 things to consider?
- Is the tool measuring a clinically important
outcome over a relevant timeline? – Framingham (US): 10 year estimation of total CVD (MI + angina + heart failure + strokes + intermittent claudication (PAD) - Can I collect the risk factors / parameters easily and reliably in practice?
- Has the tool been validated in the patient population I’m interested in using it for?
– Is it accurate?
– Is it precise (reliable)?
FRS, doesn’t represent ethnicities
PAD = peripherial arterial disease
risk stratification trend
the higher the severty, the less ppl affected
Tend to use less costly and easy to implement interventions for lower risk
FRS
riszk factors
age, HDL, total cholesterol. systolic BP, smoker, diabetes
Age is a driver of risk Modify other factors as age increases Low risk = blue Yellow = mod Red = high risk = more than 20% over a 10 year period, 2% per year
Risk Stratification
Why Do We Do This?
– grouping based on risk – ensure benefits outweigh risks – higher risk patients benefit more – determine intensity of treatment – utilization of resource
High risk
RRR = 30% means a greater abs risk reduction
