Primary Prevention of Cardiovascular Disease Flashcards
Which patients are eligible for a CVD risk check (cholesterol testing)?
All patients aged 40-74, even if they are asymptomatic
What information do we need to ask patients in a CVD risk health check?
- Physical activity
- FHx - 1st degree relative with an MI or stroke before 60 has an increased risk for CVD
- Diet - reducing salt and saturated fats in the diet can reduce BP
- Alcohol intake
- Smoking
- Ethnicity - 1.5x increase risk of CVD in South Asian patients
What physical activity is recommended to patients, particularly those over the age of 65?
Balance and co-ordination activities to reduce the risk of falls
How often should strength exercises be conducted in adults (UK recommendation)?
2/7
How many minutes of VIGOROUS exercise is recommended for UK adults weekly?
75 minutes
What is the definition for ‘VIGOUROUS’ activity?
Activity that causes;
- Fast breathing
- Difficulty talking
How many minutes of ‘MODERATE’ intensity exercise is recommended for UK adults weekly?
150 minutes
What is the definition of ‘MODERATE’ intensity activity?
Activity that increases breathing, but patients can still talk.
Which major muscles should be worked for strength activity?
- Legs
- Hips
- Back
- Abdomen
- Chest
- Shoulders
- Arms
In mls and g, what does 1 unit of alcohol mean?
10mls
8g of pure alcohol
What does ‘1 unit of alcohol’ actually mean?
Around the amount of alcohol that the average adult can process in one hour.
How can we work out the alcoholic units in a drink?
Strength (ABV) x Volume (ml) ÷ 1,000 = units of alcohol
What is the recommended alcohol intake weekly?
No more than 14 units, and spread evenly over the week, ideally having some alcohol-free days
Which 4 conditions have associations with CVD?
- HIV
- Renal Disease
- Gout
- Erectile Dysfunction
How do we calculate BMI?
Weight (kg) / Height(m2)
What are the parameters for BMI in classifying patients as; underweight, normal, overweight and obese?
<18.5 = underweight 18.5-25 = normal 25-30 = overweight >30 = obese
When is hypertension diagnosed after a 7 day, 24-hour ambulatory BP monitor regime?
If the average reading is >135/85 then the patient is diagnosed with HTN
What 5 dietary recommendations can be made to individuals with an increased risk for CVD?
- Choose wholegrain varieties of starchy food
- Reduce sugar intake and foods containing refined sugar (fructose)
- Eat at least 5 portions of fruit and vegetables per day
- Eat 2< portions a week of fish, including one oily fish
- Eat 4-5 portions of unsalted nuts, seeds and legumes per week
What is HDL?
High density lipoproteins
Why is HDL ‘Good Cholesterol’?
It carries cholesterol away from the blood vessel wall to the liver. Therefore, the higher the HDL, the more cholesterol comes away from the blood vessels, reducing the risk of atherosclerosis and stroke.
What is LDL?
Low density lipoproteins
Why is LDL considered ‘Bad Cholesterol’?
LDL travels the opposite way to HDL, it carries cholesterol from the liver to the vessels and increases the number of atheromatous plaques.
What is the QRISK score?
This is a tool used in primary care to calculate a patients’ risk of suffering a cardiac event or stroke within the next 10 years as a percentage.
What threshold is recommended, when crossed, that statins are commenced?
If the risk <10% from the QRISK3 score, then a statin should be commenced
What should be encouraged before commencing a statin?
Behavioural lifestyle changes should be encouraged, such a stopping smoking, reducing alcohol intake, improving diet and increasing physical activity.
What is the recommended dosage of statin for primary prevention of CVD?
20mg OD
What dose of statin is recommended for secondary CVD prevention?
80mg OD
When should a repeat cholesterol blood test be undertaken in patients who have started a statin?
After 3 months of treatment
What is a satisfactory reduction in non-HDL cholesterol after commencing a statin?
> 40% reduction
What advice can be given if patients haven’t had a >40% reduction in non-HDL cholesterol after 3 months of statin treatment?
- Discuss medication adherence and timing of dose (should be taken at night)
- Optimise adherence to lifestyle and diet measures
- Consider increasing medication dose
What does the QRISK3 score take into account about a patient?
- Age
- Cholesterol results
- FHx
- Ethnicity
- BP
- Chronic conditions
- Height
- Weight
