SCORE system for CVD risk

Question 1

What is the SCORE system for CVD risk, and for whom is its use recommended?

Answer 1

The Systematic COronary Risk Evaluation charts are used to assess the percent likelihood of dying from CVD in the next ten years.
SCORE chart use is recommended for all adults over the age of 40.

It is a useful tool to direct interventions aimed at preenting death from CVD.

Question 2

What variables is the SCORE risk calculation based on, and whch variables is prevention focused on?

Answer 2

5 main variables:

1. Gender
2. Age
3. Total cholesterol
4. Systolic Blood Pressure
5. Smoking Status

Prevention is focused on the preventable risk factors: Cholesterol, BP; and smoking

Question 3

Please tell me the interventions advised for lowering total cholesterol:

Answer 3

Lifestyle modification is 1st line! Whether given statins or not, all patients are advised to make lifestyle changes.

Question 4

What lifestyle changes are conducive to lowering total cholesterol? (remember, this is not trivial - this is the foundation for health)

Answer 4

Aerobic exercise, weight loss for overweight patients, and reducing saturated fat consumption.
NB: Evidence suggest long-term compliance is low . a dietician’s advice more ffective than physicians in short term… (not me, I’ll CBT them patients into long-term compliance!)

Question 5

So, horse won’t drink kinda situation: What is the use of statins, and how ought they be used in the context of CVD risk reduction?

Answer 5

Well, for one: Statins are the standard medications for reducing LDL cholesterol.

GPs are often tasked with determining specific drug and dosage - supposedly this knowledge is important for the test. Thus more this follows, I will learn this!

Question 6

Which statins are the MOST IMPORTANT to remember?

Answer 6

Well, according to fam-med sensei, they are:

1. Atorvastatin &
2. Rosuvastatin

These two are used for HIGH doses, the rest are moderat doses.

*How to remember these? not sure, will make a mnemonic

Question 7

Okay, Here come questions regarding dosage of statins:

Gimme the dosages of high-dose statins, and the reduction in 10 year risk they offer:

Answer 7

High-dose statins offer >10% 10 year risk. As previously learned: the two high-dose statins are Atorvastatin (tentative mnemonic: a THOR (powerful god) + vastatin and Rosuvastatin. (tentative mnemonic: Russ (is a top-tier DIY musician, more power to him, thus: Ros (Russ + vowel + vastatin).

Atorvastatin: 40 - 80mg once daily
Rosuvastatin: 20 - 40 mg once daily

Question 8

What are the dosages of moderate-dose statins (gitt du vet hvilke de er?):

Answer 8

Well, it seems that a(THOR)vastatins and RUSSuvastatin appear again! But they is now joined by the moderate newcomers:

Lovastatin: 40 mg once daily
Pravastatin: 40mg once daily
Simvastatin: 40mg once daily

Atorvastatin: 20 mg once daily
Rosuvastatin (two possible doses it seems): 5mg once daily & 10mg once daily

Memory-aid: the moderate-dosages are contained within the ranges of the high-doses (except rosuvastatin, which gets reduced by half twice)

Moderate-dose statins offer a 7.5 - 10% 10 year risk reduction.

Question 9

Who gets statins (dvs. what LDL levels are indicative)?

Answer 9

Well: Anyone with an LDL>4.9 mmol/L gets a statin!

Question 10

Bonus question (woop woop): what are reference values for LDL??

Answer 10

Your LDL cholesterol number is: Optimal if it is less than 2.6 mmol/L (100 mg/dL) Near optimal/above optimal if it is 2.6 – 3.3 mmol/L (100-129 mg/dL) Borderline high if it is 3.4 – 4.1 mmol/L (130-159 mg/dL)