Week 2: cardiovascular risks and assessment

Question 1

Cite common cardiovascular risk factors.

Answer 1

1. Age
   - Men>45yo, women>55 yo
2. Gender
   - Men have higher risk of heart disease at any age
   - women have higher risk of stroke over 70yo
3. High blood pressure
4. Cholesterol
   - low HDL: found in those who smoke, are sedentary, insulin resistant, high TGs, inflammatory disorders
5. High triglycerides
6. Family hx of premature CV disease
7. Chronic kidney disease
8. obesity
9. Atherogenic lipoprotein particles
10. inflammation: CRP-use if treatment decision uncertain
11. fasting Plasma insulin levels (high)-insulin resistance

Question 2

List the components of the metabolic syndrome.

Answer 2

Any 3 of the following:
-abdominal obesity
-elevated triglycerides
-low HDL
-elevated bp
-elevated fasting blood sugar
Metabolic syndrome is promoted by: obesity, atherogenic diet (high carbs and high satd fat), physical inactivity
-often associated with erectile dysfunction

Question 3

Describe lifestyle management and its benefits.

Answer 3

• therapeutic lifestyle change: aerobic exercise 4-6x/week
• low alcohol intake
• weight reduction
• good diet, less sat and trans fats
• balanced carb intake: low glycemic index
• mediterranean diet

Question 4

Differentiate principles of primary and secondary prevention of cardiovascular disease.

Answer 4

-Primary prevention: aimed at individuals at risk for CV disease without observable disease
Includes: smoking cessation, controlling bp with diet, weight loss, meds, glycemic control, therapeutic lifestyle change
-secondary prevention: aimed at individuals with proven disease to prevent progression of disease

Question 5

Understand principles of 2013 ACC/AHA practice guidelines for risk assessment and treatment.

Answer 5

• assess traditional ASCVD risk factors every 4-6 years in adults 20-79 yo who are free from ASCVD
• focus on treatment of blood cholesterol to reduce ASCVD risk in adults
• identify individual likely to benefit from cholesterol lowering therapy-statins: secondary prevention, primary prevention for LDL>190 mg/dL, DM age 40-75 w/ LDL 70-189 w/out clinical ASCVD, No DM or ASCVD age 45-75 w/ LDL 70-189 and estimated 10 yr risk>7.5

Question 6

Workup of an individual to assess CV risks.

Answer 6

• complete hx and PE: bp, BMI
• CBC, fasting comprehensive metabolic panel
• fasting insulin (HbAIC ic suspect diabetes)
• fasting cholesterol, TGs, HDL, calculated LDL
• calculate non HDL cholesterol
• Apolipoprotein B-optional
• C reactive protein-optional
• thyroid fxn tests?