CM- Cardio -5- prevention of CVD

Question Answer

What is primary vs secondary prevention of CVD

Primary-involves prevention of onset of disease in asymptomatic persons

Secondary- involves prevention of death or recurrence of disease in persons with symptoms

What are the modifiable risk factors for CVD smoking
diet/alcohol intake
inactivity/sedentary lifestyle
What are the modifiable physiological risk factors hypertension
what are the non modifiable risk factors Family Hx of premature CVD
Age M>45 F>55
Female postmenopausal status
what is the framingham heart study study started in 1948 of 10,000 residents of framingham massachusetts. subject have been followed having in depth PE every two years with lab tests.
HOw many generations have the framingham study been following so far 3rd generation was enrolled in 2002

what is the framingham risk score

giving points to identifiable risk factors to calculate persons 10yr risk of heart attack

risk factors include
hdl and ldl values
blood pressure
personal history
family history

if patient has 0-1 risk factors what is their average 10yr risk should you calculate a full 10yr risk score risk is <10% so don't bother doing a 10yr risk assessment
What group automatically qualifies for at risk needing a 10yr risk assessment diabetics
what is the 10yr risk of heart attack in hard CHD >20%
what other forms of atherosclerotic disease have a greater than 20% chance of heart disease besides CHD abdominal aortic aneurysm
peripheral vascular disease
carotid artery disease
How does BP relate to CVD risk relationship is continous consistent and independent of other risk factors so high BP correlates to high risk of CVD
What does increasing HTN by 20/10 increaments do to risk of CVD doubles the risk of CVD for each 20/10 increament BP is raised from 115/75
What needs to be done at prehypertension patient needs to be educated on risk factors and started on reducing BP to avoid CVD
what benefits do you see in lowering BP w/
stroke incidence
myocardial infarction
heart failure
stroke incidence is reduced 35-40%
MI reduced 20-25%
Heart Failure reduced 50%
How can you prevent 1 death in every 11 stage 1 HTN patients reaching a sustained 12mmHG reduction in SBP over 10 years will prevent 1 death for every 11 patients
why should you treat diabetic patients as if they already had CAD because they are at increased risk of suffering MI and CAD over non diabetic patients. Their risk of having a first MI is the same as a non diabetic patient having a second MI
What is the 10yr risk of CHD for diabetics about 20%
What is metabolic syndrome related to CAD, stroke and DM symptoms that when clustered together increase likelihood of developing CAD, stroke and DM
they are
Abdominal Obesity
high Triglycerides
insulin resistance
How many of the following =metabolic syndrome
Blood pressure ?130/85 mmHg
Blood sugar ?100 mg/dL
Large waist circumference
Men – ?40in
Women – ?35in
Low HDL cholesterol:
Men – <40 mg/dL
Women – < 50 mg/dL
Triglycerides ?150 mg/dL
having 3 or more of the conditions listed on other slide equals having metabolic syndrome
what condition has been established as a strong, consistent risk factor for coronary atherosclerosis Hypercholesterolemia
What drug has been proven to reduce the risk of death and nonfatal cardiovascular events associated with hypercholesterolemia statins (HMG-CoA-reductase)
what are some secondary causes of dyslipidemia diabetes
obstructive liver disease
chronic renal failure
drugs that raise LDL cholesterol and lower HDL cholesterol (progestins, anabolic steroids, corticosteroids)
What is the LDL cholesterol goal in LDL lowering therapy with statins and other drugs get LDL <100mg/dl

What are the two A recomendations for screening for CVD

measure annual blood pressure, weight, height and BMI in pts older than 18

Measure cholesterol in M>35 and F>45 and every 5 yrs after

What are the three therapeutic lifestyle changes you need to stress every visit smoking cessation
exercise-30minutes daily
increase fruits and veggies at leasts 9 servings daily
What medical interventions might you perscribe or suggest for reducing risk of CVD lipid lowering agents (statins)
HTN management
Low Dose Aspirin
HOw can you increase adherence to prevention and tx for CVD simplify medication regimens
provide explicit instruction and use good couseling techniques
use prompts to help patient remember tx
get family support
reward adherence
increase visits for pt not adhering
involve pt in care and self monitoring

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