Cardiovascular disease Flashcards
What are atheroma?
fatty deposits in the artery walls
What is sclerosis?
The process of hardening or stiffening of the blood vessel walls
What arteries does atherosclerosis affect?
The medium and large arteries
What causes atherosclerosis?
chronic inflammation and activation of the immune system in the artery wall
What do plaques cause?
Stiffening of the artery walls leading to hypertension
Stenosis leading to reduced blood flow (e.g. angina)
Plaque rupture giving off a thrombus that blocks a distal vessel leading to ischaemia
What are the non-modifiable risk factors for atherosclerosis?
older age
family history
male
What are the modifiable risk factors for atherosclerosis?
smoking alcohol consumption poor diet low exercise obesity poor sleep stress
What medical co-morbidities increase the risk of atherosclerosis?
diabetes hypertension chronic kidney disease inflammatory conditions such as RA atypical antipsychotic medications
What are the end results of atherosclerosis?
angina MI TIA Strokes Peripheral vascular disease chronic mesenteric ischaemia
How can modifiable risk factors be optimised?
advise of diet, exercise and weight loss
stop smoking
stop drinking alcohol
tightly treat co-morbidities
What score can be used to assess the risk of MI (primary prevention)?
QRISK score
If risk is >10% start a statin (atorvastatin 20mg at night)
Who should always be offered a statin?
all patients with chronic kidney disease or type 1 diabetes (atorvastatin 20mg at night)
What should be checked 3 months after commencing a statin?
lipids (aim for >40% reduction in non-HDL cholesterol)
LFTs - can cause transient and mil d raise in ALT and AST in the first dew weeks
Describe the secondary prevention of cardiovascular disease
Aspirin (and anti-platelet for 12 months)
Atorvastatin 80mg
Atenolol (or other) to maximum tolerated dose
ACE inhibitor (ramipril) to max tolerated dose
What are the notable side effects of statins?
myopathy (check creatine kinase)
Type 2 diabetes
Haemorrhagic strokes (rare)
