Primary Prevention of CVD

Question 1

What is QRISK?

Answer 1

A validated risk stratification tool to calculate a patient’s risk of having a heart attack/stroke in the next 10 years.

More information can be found at https://qrisk.org/

Question 2

When is QRISK not appropriate?

Answer 2

If there is a history of:
* Cardiovascular disease
* CKD
* Type 1 diabetes mellitus
* Familial hypercholesterolaemia
* Age > 85

Question 3

What should be done if QRISK is < 10%?

Answer 3

Give lifestyle advice and reassess in 5 years.

Question 4

What should be done if QRISK is > 10%?

Answer 4

Commence lipid modification (atorvastatin 20mg) + give lifestyle advice.

Question 5

Who should be offered lipid modification without calculating QRISK?

Answer 5

Patients with Type 1 DM who have any of the following:
* Age > 40
* DM for more than 10 years
* Established nephropathy
* Any other RFs for CVD
* CKD
* Familial hypercholesterolaemia

Question 6

What is the first-line medication for lipid modification?

Answer 6

Atorvastatin 20mg ON.

Question 7

What should be considered if a reduction in non-HDL cholesterol of 40% is not achieved?

Answer 7

Consider increasing the dose.

Question 8

What are pharmacological management options for smoking cessation?

Answer 8

• Nicotine replacement therapy
• Varenicline
• Bupropion

Question 9

What is the mechanism of Varenicline?

Answer 9

Nicotine receptor partial agonist.

Question 10

What are the contraindications for Varenicline?

Answer 10

• Suicidal ideation
• Depression
• Pregnancy or breastfeeding

Question 11

What is the mechanism of Bupropion?

Answer 11

Nicotinic antagonist, dopamine reuptake inhibitor.

Question 12

What are the adverse effects of Bupropion?

Answer 12

Seizures (1/1000).

Question 13

What are the contraindications for Bupropion?

Answer 13

• Epilepsy
• Pregnancy or breastfeeding