Primary prevention Flashcards
What is QRISK3?
QRISK3 algorithm calculates a person’s risk of developing a heart attack or stroke over the next 10 years.
QRISK3 has been developed for the UK population and it replaces the QRISK2 algorithm.
Which factors does the QRISK3 score include?
QRISK3 score includes: • Age • Sex • Smoking history • Physical activity • Ethnicity • Family history • Diabetes status • Cholesterol/HDL ratio • BMI • Alcohol consumption • Diet • CKD including stage 3 • Migraine • Corticosteroids • SLE • Atypical antipsychotics • Severe mental illness • Erectile dysfunction • A measure of systolic blood pressure variability
Differences between QRISK2 and QRISK3
QRISK3 includes more factors than QRISK2 such as: • CKD including stage 3 • Migraine • Corticosteroids • SLE • Atypical antipsychotics • Severe mental illness • Erectile dysfunction • A measure of systolic blood pressure variability
Which conditions increase the risk of CVD?
Certain conditions such as HIV, renal disease, gout and erectile dysfunction increase the risk of CVD and modification of any risk factors is even more important.
What is the recommendation for physical activity?
At least 150 minutes of moderate intensity activity and strength exercises on 2 or more days a week to work major muscles.
What is the maximum limit for alcohol each week?
Less than 14 units is the current recommendation for maximum weekly units of alcohol.
What is a cardioprotective diet?
Cardioprotective diet:
• Reduce saturated fat intake and increase mono-unsaturated fat intake.
• Choose wholegrain varieties of starchy food,
• Reduce intake of sugar and food products containing refined sugars including fructose.
• Eat at least 5 portions of fruit and vegetables per day.
• Eat at least 2 portions of fish per week.
• Eat at least 4-5 portions of unsalted nuts, seeds and legumes per week.
How is QRISK3 score used to decrease the risk of CVD?
NICE (2016) recommends that patients with a risk score of 10% or more should have a discussion about lifestyle modification. If lifestyle intervention is ineffective or inappropriate, then statin treatment should be offered.
What is absolute risk?
Absolute risk of a disease is the risk of developing a condition over a time period.
What is relative risk?
Relative risk is used to compare the risk in two different cohorts of people e.g. those taking the medication vs those not taking it.
How does statins help in the primary prevention of CVD?
Currently the recommendation is 20mg atorvastatin for the primary prevention of CVD who have a 10% or greater 10-year risk of developing CVD, to reduce this risk.
MoA of statins
Statin works by inhibiting HMGcoA reductase in the liver, preventing the conversion of saturated fats into cholesterol.
What can interact with statins?
Other medications and foods, including grapefruit, can interfere with statins. This might mean that a person’s regular medications might need alteration, and that if they start on a new medication or buy over the counter medications, they need to ensure that the statin is known about.
Important features of statins
This medication would be taken for life, each day.
Repeat blood tests would be required at 3 months for total cholesterol, HDL and non-HDL cholesterol, plus liver function tests at 3 months and 12 months. This is because there is a small risk that atorvastatin can affect the liver.
Needs to be taken at night as this is when the metabolism of cholesterol occurs.
Side effects of statins
Every medication is associated with various possible side effects. Patients are often worried about muscle aches and pains, which is a common complaint with statins. They should be advised to return if they develop this, and to stop the statin and seek medical advice if they develop pain, tenderness or weakness of the muscles. If this happens further testing (e.g. Creatine Kinase levels) may be indicated.
