Primary prevention of CVD Flashcards
The main cause of cardiovascular disease is
atherosclerosis or thrombosis
What is atherosclerosis?
Chronic inflammatory process within the artery walls that leads to endothelial dysfunction and the infiltration of macrophages and lipoproteins into the tissue (Plaque formation)
What causes stenosis?
Plaques cause narrowing (stenosis) of the artery reducing flow of blood to the downstream tissues.
How does a thrombus occur?
Plaques cause areas of weakness in the artery wall which can rupture and cause a blood clot (thrombus)
What is cardiovascular risk?
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.
What is thrombosis?
The formation of a clot or thrombus inside the blood vesel obstructing the blood flow.
What are the non-modifiable risk factors for CVD? [5]
Age Family history Gender Ethnicity RA (other co-morbidities)
Why is RA a non-modifiable risk factor for CVD?
Chronic inflammation, inflammation never really good for the body. i.e. look at the process of atherosclerosis.
What are some examples of modifiable risk factors for CVD?
Hypertension Abnormal blood lipids Physical inactivity Obesity Unhealthy diet Diabetes Stress Alcohol use Mental ill Health Low socioeconomic status - ? Smoking - > biggest thing to change.
What are the guidelines for alcohol use?
14 units men/female.
7 glasses of wine,
5 pints of beer etc,
14 single measures of spirit.
Patients should be encouraged to follow healthy eating guidance of __ portions of oily fish each week.
2 portions of oily fish each week.
All patients should aim for no more than __ salt per day.
no more than 6g.
What is a heathy BMI?
20-25
Is the framingham a useful tool to assess CVD risk?
Nope. Removed from BNF.
Overestimated risk in uk pop, men of low/medium risk.
Underestimated risk in those over 70 etc.
What tool does NICE now specify we must use to calculate CVD risk?
QRisk2
For who should we not use the QRisk2 tool in? [4]
- Type 1 diabetes.
- eGFR <60ml/min (these people at increased risk)
- Pre-existing CVD (MI, PAD, Angina)
- Those at tisk of developing CVD because of FH.
Who can the QRisk2 tool be used to evaluate?
People <84 years of age.
People with type 2 diabetes.
Atorvastatin __mg should be offered to people with a __% 10-year risk of developing CVD estimated using QRisk2.
Atorvastatin 20mg od should be offered to those with a >10% 10-year risk of developing CVD.
For peopl who are ___ years old, consider atorvastatin __mg as statins may be of benefit in reducing the risk of non-fatal myocardial infarcation.
> 85 years.
Atorvastatin 20mg.
Statin treatment should be considered for primary prevention of CVD in all adults with
Type 1 diabetes.
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.
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.
What dose of what drug should be offered for primary prevention of CVD in patients with type 1 diabetes who are aged >40 years?
Atorvastatin 20mg.
When should people with type 2 diabetes be offered treatment for primary prevention of CVD?
Atorvastatin 20mg, type 2 diabetes, >10% 10-year risk.
Can people with CKD be offered atorvastatin 20mg for primary or secondary prevention of CVD?
Yes.
Increase the dose if a >40% reduction in non-HDL cholesterol is not achieved and the eGFR is still >30ml/min/1.73m2.
When can people with CKD be offered atorvastatin 20mg for the primary or secondary prevention of CVD?
So long as >30ml/min eGFR, if lower seek specialist renal help.
What monitoring is involved with statin use?
LFT within 3 months of starting and then again at 12 months, but not again unless clinically indicated.
What is the target for statin treatment?
> 40% reduction in non-HDL cholesterol.
After 12 months of statin use should cholesterol levels be checked?
Consider an annual non-fasting non-HDL test
Should we stop statin use because of an increase in BG level or the Hb1Ac?
No
Why is atorvastatin 20mg recommended?
NICE CG181 (2014) Results in 43% reduction in non-HDL in a trial compared to other statins.
How does aspirin fit into CVD prevention?
Not licensed or advised in primary prevention of CVD.
Recommended for secondary prevention.
What is the NHS healthcheck?
Gov initiative to reduce cardiovascular disease through early indentification of those at risk.
Targets: 40-74 year olds every 5 years.
