prevention of cardiovascular disease

Question 1

what is the adverse effects of statins

Answer 1

myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase.

liver impairment:
LFT

some evidence that statins may increase the risk of intracerebral haemorrhage in patients who’ve previously had a stroke. For this reason the Royal College of Physicians recommend avoiding statins in patients with a history of intracerebral haemorrhage

Question 2

Risks factors for myopathy on statins?

Answer 2

advanced age,
female sex,
low body mass index and presence of multisystem disease such as diabetes mellitus.

Question 3

Myopathy is more common in lipophilic statins which are?

Answer 3

// SIMVASTATIN //

atorvastatin

Question 4

when patient is started on statin what are the biomarkers that needs to be checked ?

Answer 4

the 2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months.

Question 5

indication of primary prevention ?

Answer 5

primary prevention

for // THOSE 84 YEARS AND // younger
QRISK2 10-year cardiovascular risk >= 10%

OR

TYPE 1 diabetes
- >40 years
diabetes type 1 for more than 10 years
established nephropathy
have other CVD risk

OR
// CKD IF EGFR IS LESS THAN 60ML/MIN/M2 //

Question 6

NICE currently recommends what for the primary prevention of cardiovascular disease::

Answer 6

atorvastatin 20mg for primary prevention

Question 7

indication of secondary prevention ?

Answer 7

85 years

or
known IHD ,
CVD ,
peripheral arterial disease

or

!increase the dose to 80mg if non-HDL has not reduced for >= 40%! and eGFR >30

Question 8

NICE currently recommends what for the secondary prevention of cardiovascular disease

Answer 8

atorvastatin 80mg

Question 9

how do we calculate the CVD risk?

Answer 9

use the QRISK2 CVD risk assessment tool for patients aged <= 84 years.

Patients >= 85 years are at high risk of CVD due to their age

Question 10

QRISK2 may underestimate CVD risk in which of the following population groups?

Answer 10

PEOPLE TREATED FOR HIV

SERIOUS MENTAL HEALTH PROBLEMS

PEOPLE TAKING MEDICINES THAT CAN CAUSE DYSLIPIDAEMIA SUCH AS ANTIPSYCHOTICS, CORTICOSTEROIDS OR IMMUNOSUPPRESSANT DRUGS

PEOPLE WITH AUTOIMMUNE DISORDERS/SYSTEMIC INFLAMMATORY DISORDERS SUCH AS SYSTEMIC LUPUS ERYTHEMATOSUS

Question 11

when does NICE recommend considering the possibility of familial hypercholesterolaemia and investigating further?

Answer 11

total cholesterol level greater than 7.5 mmol/L
or
personal or family history of premature coronary heart disease (an event before 60 years in an index person or first-degree relative [parents, siblings, children])

Question 12

whom can we not use the QRISK2 ON?

Answer 12

type 1 diabetics (a different category used )

PATIENTS WITH AN ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) LESS THAN 60 ML/MIN

AND/OR ALBUMINURIA

PATIENTS WITH A HISTORY OF FAMILIAL HYPERLIPIDAEMIA

Question 13

type 2 diabetes mellitus should now be assessed using

Answer 13

QRISK2 like other patients are, to determine whether they should be started on statins

Question 14

statins discontinued if ?

Answer 14

Treatment discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Question 15

Familial hypercholestrolemia is a ?

Answer 15

AD condition - HETEROZYGOUS

high levels of LDL-cholesterol

Question 16

if one parent is affected by familial hypercholesterolaemia what should the clinician do?

Answer 16

arrange testing in children by age 10

Question 17

if both parents are affected by familial hypercholesterolaemia, arrange testing in children by

Answer 17

Age 5

Question 18

familial hypercholestrolemia presents with ?

Answer 18

tendon xanthomata

Question 19

Statins and what drug should not be given together?

Answer 19

Fibrates - bezafibrate -increases risk of myalgia/myosotis !!!

Nicotinic acid - myalgia / myosotis