Primary prevention of CVD

Question 1

The main cause of cardiovascular disease is

Answer 1

atherosclerosis or thrombosis

Question 2

What is atherosclerosis?

Answer 2

Chronic inflammatory process within the artery walls that leads to endothelial dysfunction and the infiltration of macrophages and lipoproteins into the tissue (Plaque formation)

Question 3

What causes stenosis?

Answer 3

Plaques cause narrowing (stenosis) of the artery reducing flow of blood to the downstream tissues.

Question 4

How does a thrombus occur?

Answer 4

Plaques cause areas of weakness in the artery wall which can rupture and cause a blood clot (thrombus)

Question 5

What is cardiovascular risk?

Answer 5

Chance of someone experiencing a heart attack or a stroke at some point in the next ten years IF nothing about their current lifestyle changes.

Question 6

What is thrombosis?

Answer 6

The formation of a clot or thrombus inside the blood vesel obstructing the blood flow.

Question 7

What are the non-modifiable risk factors for CVD? [5]

Answer 7

Age
Family history
Gender
Ethnicity
RA (other co-morbidities)

Question 8

Why is RA a non-modifiable risk factor for CVD?

Answer 8

Chronic inflammation, inflammation never really good for the body. i.e. look at the process of atherosclerosis.

Question 9

What are some examples of modifiable risk factors for CVD?

Answer 9

Hypertension
Abnormal blood lipids
Physical inactivity
Obesity
Unhealthy diet
Diabetes
Stress
Alcohol use
Mental ill Health
Low socioeconomic status - ?
Smoking - > biggest thing to change.

Question 10

What are the guidelines for alcohol use?

Answer 10

14 units men/female.
7 glasses of wine,
5 pints of beer etc,
14 single measures of spirit.

Question 11

Patients should be encouraged to follow healthy eating guidance of __ portions of oily fish each week.

Answer 11

2 portions of oily fish each week.

Question 12

All patients should aim for no more than __ salt per day.

Answer 12

no more than 6g.

Question 13

What is a heathy BMI?

Answer 13

20-25

Question 14

Is the framingham a useful tool to assess CVD risk?

Answer 14

Nope. Removed from BNF.
Overestimated risk in uk pop, men of low/medium risk.

Underestimated risk in those over 70 etc.

Question 15

What tool does NICE now specify we must use to calculate CVD risk?

Answer 15

QRisk2

Question 16

For who should we not use the QRisk2 tool in? [4]

Answer 16

1. Type 1 diabetes.
2. eGFR <60ml/min (these people at increased risk)
3. Pre-existing CVD (MI, PAD, Angina)
4. Those at tisk of developing CVD because of FH.

Question 17

Who can the QRisk2 tool be used to evaluate?

Answer 17

People <84 years of age.

People with type 2 diabetes.

Question 18

Atorvastatin __mg should be offered to people with a __% 10-year risk of developing CVD estimated using QRisk2.

Answer 18

Atorvastatin 20mg od should be offered to those with a >10% 10-year risk of developing CVD.

Question 19

For peopl who are ___ years old, consider atorvastatin __mg as statins may be of benefit in reducing the risk of non-fatal myocardial infarcation.

Answer 19

> 85 years.

Atorvastatin 20mg.

Question 20

Statin treatment should be considered for primary prevention of CVD in all adults with

Answer 20

Type 1 diabetes.

Question 21

OFFER statin treatment for primary prevention of CVD in all adults with ______ diabetes, who are also:
Aged ___ years OR have had diabetes for >__ years, OR have established _______, OR have other ___ risk factors.

Answer 21

OFFER statin treatment for primary prevention of CVD in all adults with type 1 diabetes who are also aged >40 years old OR have had diabetes for longer than 10 years, OR have established neuropathy, OR have other CVD risk factors.

Question 22

What dose of what drug should be offered for primary prevention of CVD in patients with type 1 diabetes who are aged >40 years?

Answer 22

Atorvastatin 20mg.

Question 23

When should people with type 2 diabetes be offered treatment for primary prevention of CVD?

Answer 23

Atorvastatin 20mg, type 2 diabetes, >10% 10-year risk.

Question 24

Can people with CKD be offered atorvastatin 20mg for primary or secondary prevention of CVD?

Answer 24

Yes.

Increase the dose if a >40% reduction in non-HDL cholesterol is not achieved and the eGFR is still >30ml/min/1.73m2.

Question 25

When can people with CKD be offered atorvastatin 20mg for the primary or secondary prevention of CVD?

Answer 25

So long as >30ml/min eGFR, if lower seek specialist renal help.

Question 26

What monitoring is involved with statin use?

Answer 26

LFT within 3 months of starting and then again at 12 months, but not again unless clinically indicated.

Question 27

What is the target for statin treatment?

Answer 27

> 40% reduction in non-HDL cholesterol.

Question 28

After 12 months of statin use should cholesterol levels be checked?

Answer 28

Consider an annual non-fasting non-HDL test

Question 29

Should we stop statin use because of an increase in BG level or the Hb1Ac?

Answer 29

No

Question 30

Why is atorvastatin 20mg recommended?

Answer 30

NICE CG181 (2014)
Results in 43% reduction in non-HDL in a trial compared to other statins.

Question 31

How does aspirin fit into CVD prevention?

Answer 31

Not licensed or advised in primary prevention of CVD.

Recommended for secondary prevention.

Question 32

What is the NHS healthcheck?

Answer 32

Gov initiative to reduce cardiovascular disease through early indentification of those at risk.

Targets: 40-74 year olds every 5 years.