Chapter 4: Cardiovascular risk assessment and prevention

Question 1

Who are at a higher risk of developing CVD?

Answer 1

Men
Ethnicity ( south asians)
Age (>50 years) (if >85 yrs even higher risk)
Family history of CVD

Question 2

What are the risk factors of CVD?

Answer 2

Hypertension 
Abnormal lipids 
Diet (salt intake, smoking,)
Diabetes 
Low physical activity 
Obesity 
Pyschosocial factors (depression, anxiety)

Question 3

What are the 3 main risk calculators for CVD used in the uk?

Answer 3

QRISK- ENGLAND AND WALES
JBS3- ENGLAND AND WALES
ASSIGN- SCOTLAND

Question 4

What does the QRISK risk calculator take into account? How are QRISK2 and QRISK3 different?

Answer 4

Age 
Sex
Ethnicity 
BMI 
AF 
smoking
diabetes
CKD (stage 4 or 5) 
treated hypertension 
RA
family history of premature CVD <60years

Qrisk3 has additional factors:

severe mental illness
SLE
Migraines
Erectile dysfunction 
on atypical antipsychotics
on regular steroids

Question 5

What does the JBS3 calculator take into account?

Answer 5

Age
Sex
Ethnicity
BMI 
Smoking
Diabetes
treated hypertension 
AF
RA
lipid profile (total cholesterol, non HDL cholesterol, HDL cholesterol).

Question 6

Which risk calculator estimates a 10 year CVD risk as aswell as a lifetime risk?

Answer 6

JBS3

Question 7

Who do not require risk assessment?

Answer 7

• People at high risk of CVD (those with established CVD, CKD, albuminuria, familial hypercholesterolaemia, those 40years < with diabetes).
• People aged >85 years
• People who have T1DM

Question 8

what lifestyle interventions should be recommended ?

Answer 8

 Diet increased Fruit and vegetables, reduced saturated fat and salt intake, 2 portions of fish/week.
 Exercise  150mins of moderate/intense activity or 75minutes of vigorous/ week
 Weight management  if overweight/obese aim to lose ~0.5-1kg/week
 Reduce alcohol consumption
 Smoking cessation  smoking is found to decrease the levels of HDL in your body.

Question 9

What drug treatment should be offered for the primary prevention of CVD?

Answer 9

1. Lipid Lowering therapy

Statin – Recommended treatment for primary prevention of cardiovascular disease
NICE recommends low dose Atorvastatin 20 mg/day should be offered to those with:
• 10-year risk of CVD of ≥10%
• CKD.
• T1DM and are >40 yrs./ had diabetes for over 10 years/ established nephropathy/ have other CVD risk factors.
• Consider for all patients with T1DM
• Patients aged ≥85 years may also benefit from low dose atorvastatin.

2. Anti hypertensive
   • Antihypertensive drug treatment should be offered to patients who are at high risk of CVD and has a sustained elevated BP of >140/90mmhg and/or diastolic blood pressure over 90 mmHg.

(Anti platelet- Aspirin is NOT recommended for the primary prevention of CVD).

Question 10

What should be offered for the secondary cardiovascular risk prevention?

Answer 10

1. Lipid lowering therapy: Treatment with a high dose Atorvastatin 80mg/day
2. Antihypertensive therapy: Antihypertensive drug treatment is recommended in patients with established CVD and has a sustained elevated BP of >140/90mmhg.
3. Antiplatelet therapy:
   • low dose aspirin should be offered to patients with established atherosclerosis disease.
   • Alternatively, clopidogrel should be given if intolerant to aspirin.

Question 11

How often should a medication be reviewed for those on statins?

Answer 11

Annually

Question 12

Why is high dose simvastatin generally avoided in secondary CVD prevention?

Answer 12

risk of myopathy.