Primary CVD prevention: debunking myths Flashcards
Impact of HTN on CV system
1) incr resistance to flow and vasoconstriction
2) accel atherosclerosis
effect of HTN on heart structure
LVH –> LV dilation –> HF
___ is the #1 risk factor for heart failure
hypertension
older you are, higher the risk
what is #1 risk factor for stroke in US?
systolic blood pressure
lowering ____ reduces risk of stroke, MI, and CV death at any age
systolic blood pressure
Big 4 CVD risk factors
1) smoking
2) DM
3) HTN
4) dyslipidemia
how have CVD deaths changed over last 20 yrs
40% decr
what factors have most contributed to 40% decline in CVD mortality in last decade?
1) BP control
2) lipid control
myth #1: raising HDL with drug saves lives
no benefits in high risk (DM and CAD) patients by incr HDL
risk is not improved BEYOND a certain point
good Effects of statins
1) lower CV disease (primary and secondary)
a
a
a
a
a
a
bad effects of statins
risk of muscle pain
incr blood sugar and HbA1c
potential for non-serious/reverisble cognitive
a
a
a
a
role of glycemic control in decr CV risk in diabetics
intense glucose control had no effect on macrovascular disease but does improve microvascular disease and incr risk of CVD death
a
A
a
a
if glycemic control not beneficial, what should we focus on?
tight systolic BP control
does taking more medicines to control BP in high risk patients confer benefit?
no even with multiple agents –> don’t reach goal
is aspirin per day in type II DM >40 y/o evidence based or myth
MYTH
no CV benefits of ASA in primary prevention
a
a
a
a
which patients should be taking asa
CAD and stroke
NOT DM or PAD
NOT PRIMARY PREVENTION
asa role in primary prevention
NO
SMALL !!!!!!
major risk for bleeding
not approved for primary prevention or in PAD
a
a
how to help control patient BP?
focus on patient as individual and community for behavior change/adherence
a
a
costs assoc with interrupted BP therapy?
a
a
a
a
a
Major patient reason for nonadherence to HTN meds?
just forget
NOT JUST THE $$$$
___ type drugs improve adherence
once/day anti-hypertensives
when is extra vigilance needed to improve compliance
in depresed patients
3x more likely to be non-adherent
a
a
a
a
role of policy in affecting acute MI’s
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a
a
do smoking bans decr heart attack?
unclear fully if acute MI hospitalization rate declines with no smoking
how to treat HTN
1) exercise
2) weight loss
3) limit salt/alcohol
most often with HTN, patients require ___
multi-drug therapy
what is JNC-7 guideline for HTN meds?
start 2 drugs simultaneously if systolic >20 or diastolic >10 above goal
how to prevent CVD in elev LDL?
start a statin
no longer needed to monitor LFT’s and lipids
how to improve patient buy-in?
frequent visits and encouragement
once daily/combination
assess for depression and co-factors
health care delivery alone is ____
NOT ENOUGH
need community based programs
what is problem with US health care?
too little prevention
incr medicare spending correlates with decr quality of care
what do you do?
51 y/o male
Hx DM, HTN, CAD s/p triple bypass, CHF
NO THERAPY IS NEEDED; REASSURANCE
issues with JNC-8
1) relieved Rx target (150/90) for > 60 y/o
2) diabetic Rx target from 130/80 to 140/90
3) CKD target from 130/80 to 140/90 with proteinuria
what do you do?
1) 57 y/o
2) Hx CVD s/p PCI to LAD
3) no angina
4) LDL = 69, HDL = 58
Triglyceride = 125
BP = 114/70
Asa 81 mg/day
Lipitor 80 mg/day
CAD irrespective of cholesterol
