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Preventative health > Vascular and metabolic disease > Flashcards

Vascular and metabolic disease Flashcards

1
Q

What are the most important risk factors for CVD?

A

Smoking, diabetes, hypertension, dyslipidaemia, obesity, poor diet, physical inactivity

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2
Q

Who should have a CVD risk assessment?

A

Patients aged
> 45 - 74 years
> 35 years AND Indigenous

WITHOUT established CVD
AND not clinically determined to be at high risk

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3
Q

What scenarios are patient’s automatically at high risk of CVD?

A
  1. Diabetes and > 60 years old
  2. Diabetes with microalbuminuria
  3. CKD stage 3b or worse
  4. Familial hypercholesterolaemia
  5. Previous BP reading > 180 / 110
  6. Serum total cholesterol > 7.5mmol/L
  7. ATSI patient 75 years and older
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4
Q

How often should CVD risk assessments be performed?

A

Every 2 years

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5
Q

When do we start screening for hypertension?

A

From the age of 18 years old - BP checks recommended every 2 years

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6
Q

When should BP readings be interpreted in the context of absolute CVD risk?

A

Adults > 45 years

ATSI > 35 years

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7
Q

What should be done for a patient with hypertension and low CVD risk?

A

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

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8
Q

Who has a low CVD risk ?

A

Absolute CVD risk of < 5%

< 5% chance of developing CVD in the next 5 years

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9
Q

Who has a moderate CVD risk?

A

Absolute CVD risk of 5-10%

  • 5-10% chance of developing CVD in the next 5 years
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10
Q

Who is of high CVD risk?

A

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)

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11
Q

What should be done for a patient with hypertension and moderate CVD risk?

A

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

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12
Q

What should be done for a patient with hypertension and high CVD risk?

A

Intensive lifestyle advice

Offer anti-hypertensives

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13
Q

What is the BP target for a patient with hypertension and high CVD risk, who DOES NOT have diabetes, CKD or existing CVD?

A

< 140/90

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14
Q

What is the BP target for a patient who has hypertension AND diabetes WITHOUT albuminuria?

A

< 140/90 (Heart Foundation)

< 130/80 (Red Book)

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15
Q

What are the definitions of microalbuminuria?

A

Males - spot urine ACR > 2.5mg/mmol

Females - spot urine ACR > 3.5mg/mmol

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16
Q

What is the BP target for a patient with hypertension AND chronic kidney disease (i.e. a GFR reduction or albuminuria)

A

< 130/80

  • aiming towards 120/80
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17
Q

What treatment should be offered to a patient with LOW CVD risk and an LDL level of 3.2?

A

Lifestyle advice only

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18
Q

How often should you repeat lipid testing for a patient with dyslipidaemia and low CVD risk?

A

Every 5 years

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19
Q

What lipid levels would prompt you to consider that dyslipidaemia may be due to familial hypercholesterolaemia?

A

LDL > 4

Total cholesterol > 7.5

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20
Q

What should be done in a patient with moderate (5-10%) CVD risk AND a dyslipidaemia

A

Intensive lifestyle advice

Consider starting lipid lowering medication if

  • not reaching target after 6 months
  • family history premature CVD
  • ATSI / Islander
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21
Q

How often should you repeat lipid testing in a patient with dyslipidaemia and moderate CVD risk?

A

Every 2 years

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22
Q

What should be done if a patient with high CVD risk, or established CVD presents with dyslipidaemia

A

Start lipid lowering therapy

Intensive lifestyle advice

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23
Q

How often should you repeat lipids in a patient with established CVD or with a high CVD risk?

A

Every 12 months (unless doses to lipid lowering meds are changed)

24
Q

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.

A

True

25
Q

What are the components of the AUSDRISK screen for type 2 diabetes?

A

Point based scoring system looking at

  • Age
  • Sex
  • ATSI/Islander/Maori
  • Where you were born - Australia / Asia etc
  • Family history of diabetes
  • Previously detected high BSL?
  • Blood pressure meds?
  • Smoker?
  • Daily fruit / veg?
  • Exercise - 2.5 hours per week?
  • Waist measurement
26
Q

What patients are considered high-risk for developing diabetes?

A

> 40 years old AND overweight or obese

AUSDRISK > 12

Patients with impaired glucose tolerance test or impaired fasting glucose

Established CVD

Women who have had GDM

High risk race (Indian, Pacific Islanders)

Women with PCOS

Patients on anti-psychotics

27
Q

What diabetic screening should be offered to patients less than 40 years of age?

A

None, unless clinically indicated

28
Q

What diabetic screening should be offered to patients at intermediate risk of developing diabetes?

A

AUSDRISK assessment, every 3 years

29
Q

What diabetic screening should be offered to patients at high risk of developing diabetes?

A

Fasting BSL

HBa1C

30
Q

How often should patients, with high risk of diabetes, be screened with a fasting BSL and HbA1c?

A

In general, high risk patients should be screened every three years.

Except for patients with impaired glucose tolerance or impaired fasting glucose - should be screened yearly.

31
Q

How is diabetes diagnosed?

A

Fasting BSL > 7mmol/L OR
HbA1C > 6.5% OR
2 hour, post OGTT > 11.1mmol/L

In the absence of unequivocal symptomatic hyperglycemia, the diagnosis must be confirmed on a different day by repeat measurement, repeating the same test for confirmation.

If the patient has symptomatic hyperglycaemia, then one measurement is enough

32
Q

What is the definition of impaired fasting glucose?

A

Definition: Fasting BSL between 5.5–6.9 mmol/L

33
Q

What can be done for a patient with impaired fasting glucose?

A

Screen for diabetes yearly with a HbA1c or OGTT

Provide intensive lifestyle advice

34
Q

What is the significance of impaired fasting glucose?

A

It is a prediabetic condition.
Without lifestyle modification, diabetes may develop.
It is a component metabolic syndrome.

35
Q

What is metabolic syndrome?

A

Elevated waist circumference (values vary for gender and ethnicity)

Elevated triglyceride levels ≥1.7 mmol/L

Reduced HDL-C
<1.0 mmol/L in men
<1.3 mmol/L in women

Hypertension (>130/85)

Elevated fasting glucose - BSL 5.5–6.9 mmol/L

36
Q

What is the significance of metabolic syndrome?

A

The MetSy identifies patients at an increased risk of CVD, diabetes and CKD.

It provides an estimate of relative risk.

Patients with MetSy are 2-3 times more likely to develop CVD, CKD or diabetes compared to similar patients who do not have MetSy.

37
Q

How do you manage metabolic syndrome

A

Intensive lifestyle modification.

Consider medications to control BP and dyslipidaemia.

Yearly screening for diabetes.

38
Q

When should you start checking lipids in the general population?

A

Adults > 45 years

ATSI > 35 years

39
Q

What is the target LDL level for primary prevention?

A

< 2 mmol/L

40
Q

What is the target HDL level for primary prevention?

A

> 1 mmol/L

41
Q

What is the target TG level for primary prevention?

A

<2 mmol/L

42
Q

What is the target total cholesterol for primary prevention?

A

< 4 mmol/L

43
Q

What is impaired glucose tolerance?

A

Two-hour plasma glucose between 7.8

and 11.0 mmol/L

44
Q

Who is at high absolute risk of stroke?

A

High CVD risk
Patients with previous stroke
Patients with previous TIA
Patients with AF and CHADSVASC = 2 or more

45
Q

What is the ABCD2 score?

A

Risk assessment tool

Predicts stroke risk after a TIA withing 2 days and 90 days.

46
Q

What are the components of the ABCD2 score?

A 
Age > 60 (1 point)
BP  >140/90 (1 point) 
Clinical features 
- unilateral weakness (2 point)
- speech impairment without weakness (1 point) 
Duration 
 > 60 minutes (2 points)
 10-59 minutes (1 point)
Diabetes (1 point)
47
Q

A 65 year old diabetic tells you that she had unilateral arm weakness, lasting 60 minutes 2 days ago. What do you do?

A

Send to hospital.
TIA suspected and has an ABCD2 score of 4 or greater.
She is at high risk (4% 2 day risk and ~ 8% 90 day risk) of developing a stroke, and will need a workup.

48
Q

A 51 year old male with no comorbidities presents following an episode of slurred speech lasting 15 minutes yesterday. After taking a careful history, you find that this is the first episode, he is normotensive, he does not have AF and his neuro exam is normal. You suspect a TIA. What is his ABCD2 score and what does this mean?

A

ABCD2 = 2

Low risk

2 day stroke risk is 1%
90 day stroke risk is 3%

Could, in theory, be managed as outpatient with urgent CT scan, aspirin and risk factor reduction.

49
Q

Which patients are at high risk of developing CKD?

A 
Smokers
Obese 
Family history of kidney failure
Diabetes
Hypertension
ATSI >30 years
Established CVD or PVD 
History of AKI
Chronic opioid users
Chronic NSAID users
50
Q

How do you screen patients for CKD?

A

BP
Urine ACR

Perform every 2 years for high risk patients, and yearly in hypertensives or diabetics.

51
Q

What ACR ratio constitutes macroalbuminuria

A

Males > 25 mg/mmol

Females > 35 mg/mmol

52
Q

What is the definition of stage 1 CKD?

A

eGFR >90 mL/min/1.73 m2 AND microalbuminuria, proteinuria or haematuria with the presence of structural or pathological abnormalities.

53
Q

What is the definition of stage 2 CKD?

A

eGFR 60–89 mL/min/1.73 m2 AND microalbuminuria, proteinuria or haematuria with the presence of structural or pathological abnormalities

54
Q

What is the definition of stage 3a CKD?

A

eGFR 45–59 mL/min/1.73 m2

55
Q

What is the definition of stage 3b CKD?

A

eGFR 30–44 mL/min/1.73 m2

56
Q

What is the definition of stage 4 CKD?

A

eGFR 15–29 mL/min/1.73 m2

57
Q

What is the definition of stage 5 CKD?

A

eGFR <15 mL/min/1.73 m2 (or on dialysis)

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