Public Health

Question 1

what are the behavioural risks of CVD?

Answer 1

physical inactivity 
smoking 
high cholesterol 
high blood pressure 
diet 
harmful drinking

Question 2

what are the social and environmental risks of CVD?

Answer 2

employment 
housing
family history 
pollution 
poverty

Question 3

modifiable risk factors of CVD

Answer 3

reducing BP 
decreasing cholesterol 
reducing alcohol due to link with hypertension 
anticoagulation 
meeting physical activity guidelines

Question 4

what is primary prevention of CVD?

Answer 4

reducing incidence in a population

Question 5

what is secondary prevention of CVD?

Answer 5

detection and treatment of pre-symptomatic disease

Question 6

what is tertiary prevention of CVD?

Answer 6

reducing incidence/ recurrences of chronic incapacity among those with symptomatic disease

Question 7

what can doctors do to tackle risk factors?

Answer 7

identity authoritative guidelines
clarify nature of the problem
identify approaches to risk reduction

Question 8

describe risk scores

Answer 8

they cannot perfectly predict absolute risk

useful in assessing or estimating risk and in prioritising treatment on an equitable basis

Question 9

what is absolute CVD risk calculated from?

Answer 9

ASSIGN

Question 10

what is in ASSIGN?

Answer 10

age 
sex 
smoking 
systolic BP 
total cholesterol 
HDL cholesterol 
family history of premature CVD 
diagnosis of diabetes 
diagnosis of rheumatoid arthritis
deprivation

Question 11

what is the absolute risk?

Answer 11

the % chance of an individual having a CVD event over a given period time

Question 12

what is the relative risk?

Answer 12

the risk of someone having a CVD event compared to someone else

Question 13

why does assessing risks matter?

Answer 13

most CVD deaths will occur in individuals at moderate risk as they constitute the largest group
high-risk individuals have the most to gain from risk factor modification -> therefore clinically given highest priority

Question 14

which individuals will true risk be higher in?

Answer 14

people with atrial fibrillation
people from specific minority ethnic groups
women with premature menopause

Question 15

which individuals should be considered high CV risk?

Answer 15

Established CVD
Stage 3 or greater CKD/micro/macroalbuminuria
Familial hypercholesterolaemia
> 40 years old + DM
<40 + DM and 20 years of disease duration/ target organ damage / elevated CVD RFs

Question 16

when should asymptomatic individuals be considered high risk?

Answer 16

if they are assessed as having ≥ 20% risk of a first cardiovascular event within ten years

Question 17

diet recommendations

Answer 17

If overweight/obese target with interventions with aim of reducing weight by 3kg

Question 18

lipid lowering recommendations

Answer 18

If at high risk and no CVD, offer treatment with atorvastatin 20mg/day following informed discussion of risks and benefits

Question 19

smoking recommendations

Answer 19

All people who smoke should be advised to stop and offered help to facilitate this
Varenicline or combination NRT should be offered alone or as part of a smoking cessation programme
E-cigarettes….?

Question 20

alcohol recommendations

Answer 20

Advise all patients to reduce alcohol consumption and that even light to moderate consumption may increase cardiovascular risk
Brief interventions should be used if current intake is hazardous to health