Week 4 - QRISK and CV Disease Flashcards
What is Cardiovascular Disease (CVD)
Diseases relating to heart or blood vessels
Includes; coronary heart disease (angina, MI), stroke, heart failure, atrial fibrillation etc.
Causes more than ¼ of all deaths in UK
List the modifiable and non-modifiable risk factors for CVD
Modifiable:
(can be changed, controlled or treated)
- smoking
- unhealthy diet
- lack of exercise
- weight
- high level of LDL cholesterol or high non-HDL cholesterol
- low blood level of HDL cholesterol
Non-modifiable:
- Age
- Family history
- Ethnicity (EM have ↑ risk)
Others:
- Socioeconomic status
- people of lower status more likely to get CVD as access to healthy, fresh food, open space for activities may be limited
- Lack of social support
- people with depression + chronic illness more likely to develop CVD
List some lifestyle changes advisable for modifiable risks
- Stop / reduce smoking
- smoking cessation
- nicotine ↑ BP by constricting blood vessels
- nicotine ↓ O2 in blood + stimulates adrenaline production - ↑ physical activity + lose weight
= treat obesity - Don’t drink above recommended levels (14 units per week)
- alcohol has calories ~ prevent weight gain - Lower cholesterol (health eating)
- ↑ blood levels of HDL cholesterol + ↓ LDL cholesterol - Treat underlying health issues
- e.g. hypertension treatment (secondary prevention)
- keep BP in range to reduce risk of CV events
How does healthy eating reduce risk of CVD
- Reducing cholesterol by 5% can lower CVD risks significantly
Examples:
- eat 5 portions of fruit + veg daily
- have a balanced diet
- choose unsaturated oils, eat less processed foods
- reduce intake of foods high in fat, sugar and salts
- replace saturated fats with unsaturated fats
- drink plenty fluids (water, low-fat drinks etc.)
How does modifying obesity reduce risk of CVD
- Central obesity (fat in stomach) has the highest risk for CVD
- because more pressure will be applied to organs
- can lead to diabetes if pressure applied to pancreas (insulin resistance) = ↑ CVD risk
- EM more prone to this (have ↑ risk of health conditions with lower BMI) - Measure waist circumference
- BMI doesn’t take into account muscle mass, bone mass or where fat is distributed
- Men = <94cm | Women = <80cm
- BMI >30 = obese | BMI 25-29 = overweight
Examples:
- calorie restriction (diet)
- ↑ exercise
- 30 mins at least 5 or more days a week
- 45-60 mins a day to prevent obesity
- 60-90 mins if obese
- medication (Orlistat)
What do we use Orlistat for (obesity)
Helps manage obesity
- prevents absorption of fats / lipids from diet
Requirements:
- BMI = 30 or more
OR
- BMI = 28 or more + risk factors
- Given for 3 months
- if lost 5% of initial with can continue with drug
- 2 doses: (60mg) OTC | (120mg) prescription only
How does smoking cessation reduce CVD risk
NICE Recommend:
- Behavioural support
- NRT (nicotine replacement therapy)
- Varenicline
- VBA (very brief advice)
- e.g. info about risks of smoking, advise on how to stop, referrals
How does Vaping Cessation reduce CVD risk
- Ask patient why they was to stop vaping
- i.e. cost of vaping, harms of vaping, been advised by family / friends, worried about health etc. - Provide info, reassurance and clarify any misinformation
- re-iterate vaping is safer than cigarettes + do less harm to body than smoking nicotine - Assess their risk to relapse + offer tailored support
- Gradual Reduction (treatment) - reduce strength of vape every few weeks, extend time between vaping sessions, take shorter puffs
- Disposable Vapes (treatment) - buy different vape so can gradually reduce nicotine,
What is primary and secondary prevention
Primary prevention - for individuals who have NOT had a CV event
- thinking about initiating statin or providing advice
- managing existing conditions e.g. hypertensions, hyperlipidemia, obesity, diabetes etc.
- can signpost patients to support groups (encourage them to change habits)
Secondary prevention - for individuals who have HAD a CV event
- used to prevent reoccurrence
- may benefit from risk factor modification + cardiac rehabilitation (exercise support programmes)
What are statins used for + side effects
Lower total cholesterol by 20 to 30%
- bind to HMG-CoA reductase (enzyme) = reduced production of mevalonic acid = reduced cholesterol production
Atorvastatin is most potent + ↓ LDL most (compared to simvastatin)
Primary prevention - given 20mg
Secondary prevention - given 80mg
Use statin for 3 months, test to see if there’s improvement
SIDE EFFECTS:
- muscle pains
- headaches
- dizziness
- nausea
- constipation
- diarrhoea
What tests are required for statins
Use statin for 3 months, test to see if there’s improvement
- BEFORE prescribing statin need to take blood test (full lipid profile - pre-bloods)
- TAKE bloods at 3 months when start statins
- Take bloods ANNUALLY (if continue statins)
- Asses renal function
Full Lipid Profile Includes:
- HDL cholesterol
- Non-HD cholesterol
- Total cholesterol
- Triglyceride conc.
How does Simvastatin convert into its active form
Simvastatin is a pro drug
- Simvastatin has a lactone ring (inactive)
- Lactone ring is converted (in body) into a beta hydroxy acid metabolite = active form
- Converted via chemical reaction mediated by carboxyesterases
How does the lipophilicity of the active + inactive form of simvastatin differ and how does this effect distribution into liver
Statins are substrates of OATP1B1 transporters (uptake)
- transporter is expressed in liver cells = hepatic uptake and clearance
Inhibition of transporter = ↑ conc. of victim drug in blood
- lead to myopathy (muscle tissue disease) as it distributes to muscle instead of liver
What is the role and aim of NHS Health Checks
Assesses risk of developing CVD + identify them
- age: 40-74
Carry out many checks e.g. BP, height, weight, how much you smoke, family history of CVD
What is the QRISK tool used for
Identifies people at high risk of developing CVD
- calculates risk of developing CVD in the next 10 years
- ONLY valid if patient hasn’t already been diagnosed with CHD
- for transgender patients best to calculate QRISK for both genders and explain their score may lie in-between the 2
QRISK >10% = need to think of intervention for modifiable risk factors
In QRISK Tool
input: age, ethnicity, weight, height, family history, smoking status, BP
