Public Health Flashcards
what are the behavioural risks of CVD?
physical inactivity smoking high cholesterol high blood pressure diet harmful drinking
what are the social and environmental risks of CVD?
employment housing family history pollution poverty
modifiable risk factors of CVD
reducing BP decreasing cholesterol reducing alcohol due to link with hypertension anticoagulation meeting physical activity guidelines
what is primary prevention of CVD?
reducing incidence in a population
what is secondary prevention of CVD?
detection and treatment of pre-symptomatic disease
what is tertiary prevention of CVD?
reducing incidence/ recurrences of chronic incapacity among those with symptomatic disease
what can doctors do to tackle risk factors?
identity authoritative guidelines
clarify nature of the problem
identify approaches to risk reduction
describe risk scores
they cannot perfectly predict absolute risk
useful in assessing or estimating risk and in prioritising treatment on an equitable basis
what is absolute CVD risk calculated from?
ASSIGN
what is in ASSIGN?
age sex smoking systolic BP total cholesterol HDL cholesterol family history of premature CVD diagnosis of diabetes diagnosis of rheumatoid arthritis deprivation
what is the absolute risk?
the % chance of an individual having a CVD event over a given period time
what is the relative risk?
the risk of someone having a CVD event compared to someone else
why does assessing risks matter?
most CVD deaths will occur in individuals at moderate risk as they constitute the largest group
high-risk individuals have the most to gain from risk factor modification -> therefore clinically given highest priority
which individuals will true risk be higher in?
people with atrial fibrillation
people from specific minority ethnic groups
women with premature menopause
which individuals should be considered high CV risk?
Established CVD
Stage 3 or greater CKD/micro/macroalbuminuria
Familial hypercholesterolaemia
> 40 years old + DM
<40 + DM and 20 years of disease duration/ target organ damage / elevated CVD RFs
when should asymptomatic individuals be considered high risk?
if they are assessed as having ≥ 20% risk of a first cardiovascular event within ten years
diet recommendations
If overweight/obese target with interventions with aim of reducing weight by 3kg
lipid lowering recommendations
If at high risk and no CVD, offer treatment with atorvastatin 20mg/day following informed discussion of risks and benefits
smoking recommendations
All people who smoke should be advised to stop and offered help to facilitate this
Varenicline or combination NRT should be offered alone or as part of a smoking cessation programme
E-cigarettes….?
alcohol recommendations
Advise all patients to reduce alcohol consumption and that even light to moderate consumption may increase cardiovascular risk
Brief interventions should be used if current intake is hazardous to health
