Primary Prevention of Cardiovascular Disease

Question 1

How many mls and gs of pure alcohol is there in one unit?

Answer 1

10ml or 8g

Question 2

How many units are men and women recommended to not surpass?

Answer 2

14 units a week; equivalent to 6 pint of average-strength beer or 10 small glasses of low-strength wine

Question 3

What is the ABV?

Answer 3

Alcohol By Volume: amount of pure alcohol as a % of the total volume of liquid in a drink.

Question 4

How can you work out number of units from ABV?

Answer 4

Units = (Total volume of drink (ml) x ABV) / 1000

Question 5

How many units are in a shot of spirit?

Answer 5

1 unit

Question 6

How many units are in a small glass of Red/White/Rose wine (12%)?

Answer 6

1.5 units

Question 7

How many units are in a bottle of beer?

Answer 7

1.7 units

Question 8

How many units are in a can of lager/beer/cider?

Answer 8

2 units

Question 9

How many units are in a pint of lower-strength lager/beer/cider?

Answer 9

2 units

Question 10

How many units are in a standard glass of red/white/rose?

Answer 10

2.1 units

Question 11

How many units are in a pint of higher-strength lager/beer/cider?

Answer 11

3 units

Question 12

How many units are in a large glass of red/white/rose?

Answer 12

3 units

Question 13

Who is entitled to a CVD risk check for free on the NHS?

Answer 13

All patients aged between 40-74 years

Question 14

Which nationality is at a greater risk of CVD?

Answer 14

South Asian patients have 1.5x increased risk of CVD

Question 15

What are the physical activity recommendations for adults in the UK?

Answer 15

Strength exercises on 2 or more days a week to work major muscles, plus 150 mins of moderate activity or 75 mins of vigorous activity every week, and to reduce time sitting for prolonged periods.

Question 16

Which conditions have associations with CVD and thus mean modification of risk factors is even more important?

Answer 16

HIV, Renal disease, Gout, Erectile dysfunction

Question 17

How to diagnose HTN

Answer 17

Must take several readings, preferably in both arms, and ideally arrange for the patient to use a 24 hour ambulatory BP monitor. Could use a standard electronic BP monitor at home if ambulatory cant be tolerated.

Question 18

What is the TEnT PEGS acronym used for?

Answer 18

7 easy ways to help patients change their lifestyle

Question 19

What does TEnTPEGS stand for?

Answer 19

Tailored plans, ENvironmental change, Thoughts, Practice and record, Emotions, Goals, Social influences

Question 20

What class of medication should be offered to people <55 years old and not of African or Caribbean family origin to treat HTN? (First line)

Answer 20

ACEi (or low-cost ARB if ACEi not tolerated); don’t combine these for HTN.

Question 21

What class of medication should be offered to people >55 years old to treat HTN? (First line)

Answer 21

Calcium-channel blocker (CCB)
If not suitable (e.g. evidence of heart failure or high risk of heart failure) offer a thiazide-like diuretic (such as chlortalidone or indapamide)

Question 22

What medication should be offered to people of African or Caribbean family origin of any age to treat HTN? (First line)

Answer 22

Calcium-channel blocker (CCB)
If not suitable (e.g. evidence of heart failure or high risk of heart failure) offer a thiazide-like diuretic (such as chlortalidone or indapamide)

Question 23

Though beta-blockers are not the preferred initial therapy for HTN, when would you consider them?

Answer 23

In younger patients, particularly those with intolerance/contraindication to ACEi and ARB OR women of child-bearing potential OR people with evidenced of increased sympathetic drive

Question 24

What second-line HTN medication is offered?

Answer 24

CCB with either ACEi or ARB (in African or Caribbean family origin, consider ARB over ACEi with CCB)
If CCB not suitable (e.g. oedema or intolerance, heart failure or high risk of HF) offer a thiazide-like diuretic

Question 25

Third line HTN medication?

Answer 25

ACEi or ARB, CCB, and thiazide-like diuretic

Question 26

When is the QRISK score used?

Answer 26

Calculate a patient’s risk of suffering a cardiac event or a stroke over the next 10 years as a percentage. Takes into account age, cholesterol results, family hx, ethnicity, BP and other existing conditions

Question 27

If a patient has a QRISK score over 10%, what steps are recommended by NICE?

Answer 27

Discussion about lifestyle modification, support to make changes and the offer to re-assess risk after they have tried to change their lifestyle
Statins should be offered if lifestyle mods are ineffective/inappropriate

Question 28

What are some problems with statins?

Answer 28

Grapefruit can interfere, as well as other medications, so patient may need to change current meds.
Statins are taken every day for life
Repeat blood tests at 3 months for cholesterol, HDL and non-HDL, and liver tests at 3 months and 12 months
Common complaint with statins = muscle aches and pains

Question 29

What is absolute risk?

Answer 29

The risk of developing a condition over a time period

Question 30

What is relative risk?

Answer 30

A comparison between the risk in two cohorts of people e.g. those taking medication vs those not taking medication