Vascular and metabolic disease Flashcards
What are the most important risk factors for CVD?
Smoking, diabetes, hypertension, dyslipidaemia, obesity, poor diet, physical inactivity
Who should have a CVD risk assessment?
Patients aged
> 45 - 74 years
> 35 years AND Indigenous
WITHOUT established CVD
AND not clinically determined to be at high risk
What scenarios are patient’s automatically at high risk of CVD?
- Diabetes and > 60 years old
- Diabetes with microalbuminuria
- CKD stage 3b or worse
- Familial hypercholesterolaemia
- Previous BP reading > 180 / 110
- Serum total cholesterol > 7.5mmol/L
- ATSI patient 75 years and older
How often should CVD risk assessments be performed?
Every 2 years
When do we start screening for hypertension?
From the age of 18 years old - BP checks recommended every 2 years
When should BP readings be interpreted in the context of absolute CVD risk?
Adults > 45 years
ATSI > 35 years
What should be done for a patient with hypertension and low CVD risk?
Lifestyle advice and education
If sBP 140-159 - review after 2 months of lifestyle modification
If BP persistently > 160/100 - offer anti-hypertensives
Repeat BP minimum every 2 years
Who has a low CVD risk ?
Absolute CVD risk of < 5%
< 5% chance of developing CVD in the next 5 years
Who has a moderate CVD risk?
Absolute CVD risk of 5-10%
- 5-10% chance of developing CVD in the next 5 years
Who is of high CVD risk?
Patients with a high CVD risk are those with either:
1) Absolute CVD risk > 15% (i.e. 15% chance of developing CVD in the next 5 years)
2) Patients with clinically determined high risk (not explored here)
What should be done for a patient with hypertension and moderate CVD risk?
Intensive lifestyle advice
‘Consider’ starting anti-hypertensives if SBP 140-159 or DPB 90-99
Offer anti-hypertensive if > 160/100
Repeat BP 6-12 months
What should be done for a patient with hypertension and high CVD risk?
Intensive lifestyle advice
Offer anti-hypertensives
What is the BP target for a patient with hypertension and high CVD risk, who DOES NOT have diabetes, CKD or existing CVD?
< 140/90
What is the BP target for a patient who has hypertension AND diabetes WITHOUT albuminuria?
< 140/90 (Heart Foundation)
< 130/80 (Red Book)
What are the definitions of microalbuminuria?
Males - spot urine ACR > 2.5mg/mmol
Females - spot urine ACR > 3.5mg/mmol
What is the BP target for a patient with hypertension AND chronic kidney disease (i.e. a GFR reduction or albuminuria)
< 130/80
- aiming towards 120/80
What treatment should be offered to a patient with LOW CVD risk and an LDL level of 3.2?
Lifestyle advice only
How often should you repeat lipid testing for a patient with dyslipidaemia and low CVD risk?
Every 5 years
What lipid levels would prompt you to consider that dyslipidaemia may be due to familial hypercholesterolaemia?
LDL > 4
Total cholesterol > 7.5
What should be done in a patient with moderate (5-10%) CVD risk AND a dyslipidaemia
Intensive lifestyle advice
Consider starting lipid lowering medication if
- not reaching target after 6 months
- family history premature CVD
- ATSI / Islander
How often should you repeat lipid testing in a patient with dyslipidaemia and moderate CVD risk?
Every 2 years
What should be done if a patient with high CVD risk, or established CVD presents with dyslipidaemia
Start lipid lowering therapy
Intensive lifestyle advice
How often should you repeat lipids in a patient with established CVD or with a high CVD risk?
Every 12 months (unless doses to lipid lowering meds are changed)
True or false
All adults 40 years and over (and ATSI 18 years and older) without obvious comorbidities elevating them to high risk, are at intermediate risk of diabetes.
True