Primary Prevention of Cardiovascular Disease

Question 1

Non modifiable risk factors for atherosclerosis

Answer 1

-Age
-Gender (male)
-Family history (member <55)

Question 2

Modifiable risk factors for atherosclerosis

Answer 2

-Hypertension
-Hyperlipidaemia
-Diabetes
-Smoking
-Alcohol
-Diet and Exercise
-Obesity

Question 3

Treatment of hypertension

Answer 3

-May be evidence of end organ damage on investigation especially if significantly hypertensive (e.g. > 180/110) - LVH, renal impairment (proteinuria, haematuria, CKD), hypertensive retinopathy.
-Treat if consistently >140/90mmHg (clinic), >135/85mmHg (home), or > 180/110mmHg
=1st line - <55, not black or afro Caribbean -ACEi or ARB
=1st line - > 55 or black or afro Caribbean - CCB (amlodipine), 2nd line thiazide diuretic

Question 4

Assessing hyperlipidaemia

Answer 4

-Assess for risk with risk scoring tool (QRISK3) and x1 full lipid sample (total cholesterol, LDL, HDL and triglycerides)
-Consider referral to lipid clinic if total cholesterol >7.5mmol/l in association with family history of premature coronary artery disease

Question 5

Treating hyperlipidaemia

Answer 5

-Often appropriate to try diet and lifestyle changes 1st and reassess risk and lipids
-If remain elevated commence statin (atorvastatin 20mg OD- if cardiovascular events high diose 80mg) aiming for 40% reduction in non-HDL cholesterol

Question 6

Aiding smoking cessation

Answer 6

-Assess patient’s desire to stop smoking.
-Smoking Cessation team in hospital. Variety of community supports.
-Aids include gum, inhalators and patches.
-‘Every little helps’ – ideally patients stop completely but even cutting down helps.

Question 7

Assessing T2DM

Answer 7

-Consider risk factors (family history, obesity) and symptoms (polydipsia, polyuria, weight loss, recurrent infections) in addition to glucose levels.
-Diagnosis based on glucose or HBA1c levels – x2 abnormal results in the absence of symptoms or x1 abnormal result plus symptoms.
-Thresholds - HBA1c >48, Fasting PG >7, Random PG >11.1
-Impaired glucose tolerance – OGTT 7.8-11.1, Impaired FG 6.1-6.9

Question 8

Additional risk factors

Answer 8

-T1DM
-CKD
-HIV
-Mental health issues (anti-psychotics- metabolic syndrome)
-Autoimmune (SLE, Rheumatoid)
-Systemic inflammatory diseases (psoriasis)
-Long-term corticosteroids (diabetes)

Question 9

Risk scoring systems

Answer 9

No diagnosis of CHD!!!

-Q-Risk – Comprehensive. Updated annually to reflect population changes. Recommended for use by NICE. Online calculator. If >10% 10yr risk of CVD statin recommended.
-Framingham – Online calculator. Not for use in elderly or diabetics. Based on American population. Replaced in Scotland by Assign scoring system.
-Assign – Developed locally (Dundee). Recommended by SIGN. Includes socio-economic data in scoring system.