Primary Prevention of Cardiovascular Disease

Question 1

What are some non modifiable risk factors?

Answer 1

Age, sex, race, family history of CVD

Question 2

What are behavioral risk factors?

Answer 2

Sedentary lifestyle, diet, alcohol, smoking

Question 3

What are physiological risk factors? (4)

Answer 3

HTN, obesity, lipid problems, diabetes

Question 4

What are the primary risk factors for CVD? (7)

Answer 4

1. Smoking
2. Diet
3. Physical inactivity
4. Obesity
5. Dyslipidemia
6. HTN
7. Diabetes

Question 5

True or False: Those at highest risk cannot be helped with therapy

Answer 5

False. Those at highest risk derive the greatest benefit from therapy.

Question 6

What is the 3 ways for timing of risk assessment?

Answer 6

1. Cross-sectional (one point)
2. Over time (interval- typically 10 years)
3. Lifetime

Question 7

True or False: Risk is multifactorial

Answer 7

True. There are several independent and dependent risk factors that all combine to determine someone’s overall risk.

Question 8

How do you adjust intensity of treatment based on risk?

Answer 8

Higher risk = more intense treatment

Question 9

At what ages is treating CVD not really done?

Answer 9

79 y

Question 10

How often should you assess traditional risk factors for patients 20-79 y/o?

Answer 10

every 4-6 years

Question 11

What age group do you assess 10 y risk with pooled cohort equations?

Answer 11

40-79 y/o

Question 12

What age group do you assess 30 y or lifetime risk?

Answer 12

20-59 y/o that have a low 10-y risk.

Question 13

What are pooled cohort equations?

Answer 13

Based on data from multiple community based populations. These equations were developed with AA and white men and women between age 40-79. So, if you’re another race, you have to keep in mind that it overestimates for Asian Americans and Hispanics and underestimates for American Indians, some Asians, and some Hispanics. (wow this isn’t very useful. ok)

Question 14

What is the cutoff for “elevated” risk when looking at 10-y risk?

Answer 14

> or = 7.5%

Question 15

True or False: Physician-patient discussion is important.

Answer 15

True

Question 16

Should you treat based on risk or to target?

Answer 16

Treat based on risk. There is a lack of evidence that supports the efficacy of targets.

Question 17

Does raising HDL reduce CV events?

Answer 17

No

Question 18

Does lowering TG reduce CV events?

Answer 18

No

Question 19

In primary prevention of CVD, what is the recommendation for Adults 50-59 years with a >10% 10-y CVD risk?

Answer 19

Low-dose aspirin

Question 20

In primary prevention of CVD, what is the recommendation for Adults 60-69 years with a >10% 10-y CVD risk?

Answer 20

Possible low-dose aspirin. It is an individual’s choice

Question 21

In primary prevention of CVD, what is the recommendation for adults younger than 50 years?

Answer 21

No recommendation (insufficient evidence)

Question 22

In primary prevention of CVD, what is the recommendation for adults 70 years or older?

Answer 22

No recommendation (insufficient evidence)

Question 23

What’s the major risk with using aspirin? what are 4 factors that increase this risk?

Answer 23

Bleeding.

Primarily GI bleeding is increased by 58%

Suggested increased risk of hemorrhagic stroke by 27%

Factors associated with increased risk

• age
• male
• diabetic
• NSAID use

Question 24

True or false: for older patients, you want to avoid treating BP to too low of a target

Answer 24

True

Question 25

Is glycemic control effective at primary prevention?

Answer 25

No

Question 26

True or false: a population based approach should be taken to prevent CVD

Answer 26

True. We need to shift the whole bell curve, not just treat the tail end on the right. We want to address individuals at the tail but also the whole population.

This is done by encouraging good behavior/lifestyle changes