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medicine > Prevention of cardiovascular disease __ عبد الامير > Flashcards

Prevention of cardiovascular disease __ عبد الامير Flashcards

1
Q

what’re the prevention methods of the CVD ?

A

1- primary prevention.

2-secondary prevention

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2
Q

whats the differecnce of the primary and secondary prevention ?

A

1-primary prevention:
modifications of risk factors in order to prevent or delay the onset of vascular diseases.

2-secondary prevention:
intiation of therapy to reduced recurrence of vascular events & decrease cardiac mortality in patients with established vascular diseases.

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3
Q

how much the Coronary Artery Disease are sever ?

A

4 out of every 10 individuals who develop
a heart attack or sudden death from
coronary artery disease
have no prior warning or symptoms

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4
Q

what’re the risks factors of CVD?

A

non- modifing factors
1- Age age of 45-55
increases as we get older

2-Family History :This is especially powerful if your mother, father, sister, or brother experienced heart disease in their 50’s or 60’s or younger

3-Gender more in male because of estrogen is protective factors Men have a higher risk of heart disease earlier in life. After menopause, women catch up.

thsese are modifing factors

  • Physical inactivity
  • Stress
  • Obesity
  • Smoking
  • Diabetes
  • High Cholesterol, high triglycerides, low HDL
  • High blood pressure
  • High fat diet
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5
Q

how to perform the primary prevention ?

A
  • Individual risk assessment by medical history ,physical examination and investigations.
  • Determination of global risk score for CHD (Framingham Risk Score)
  • Life style changes & education.
  • Drugs ( Aspirin,statins,HRT,others)
  • Devices (ICD ,CRT )
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6
Q

what’re the variables in the global risk score for CHD

(Framingham Risk Score)?

A

it’s assess the risk of CVD in 10 years

1-AGE				
2-GENDER			
3-RACE
4-SMOKING			
5-DM 				     
5-TC total cholestrol
6-HDL				
7-SBP                   
8-systolic  HTN
9- reciveing treatment for the BP
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7
Q

what’re the drugs are used in primary prevention ?

A
  • Aspirin : low dose 75-100mg daily for those with moderate-high risk score ( 10-year ASCVD ≥ 10 %)
  • Statin : moderate-high intensity statin for those with DM ,LDL≥ 190mg/dl & 10-year ASCVD≥7.5%
  • Antihypertensive &Antidiabetic drugs(ACEI,Angiotensin II receptor blockers (,metformin)
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8
Q

what’re the Components of Secondary Prevention ?

A 
1- cigrate ceastion 
2-BP contraolas 
beta blockers and reinin agngiotensin blochers 
3-lipid mangment 
4-physical activity 
5-weight loss 
6-DM control 
7- antiplatlet and anticoagulant 
8- influenza vacine
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9
Q

whats the Cigarette Smoking Recommendations?

A

Goal: Complete Cessation and No Exposure to Environmental Tobacco Smoke

Ask about tobacco use status at every visit.
اسأل عن حالة تعاطي التبغ في كل زيارة
Advise every tobacco user to quit.
Assess the tobacco user’s willingness to quit.
Assist by counseling and developing a plan for quitting.
Arrange follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and bupropion.
Urge avoidance of exposure to environmental tobacco smoke at work and home.

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10
Q

what’re Blood Pressure Control Recommendations ?

A

Goal: <130/80 mm Hg or <130/80 if diabetes or chronic kidney disease

Blood pressure 120/80 mm Hg or greater:
· Initiate or maintain lifestyle modification: weight control, increased physical activity, alcohol moderation, sodium reduction, and increased consumption of fresh fruits vegetables and low fat dairy products

Blood pressure 140/90 mm Hg or greater (or 130/80 or greater for chronic kidney disease or diabetes)
· As tolerated, add blood pressure medication, treating initially with beta blockers and/or ACE inhibitors with addition of other drugs such as thiazides as needed to achieve goal blood pressure

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11
Q

what the recomonaded weight ?

A

(BMI=18.5-24.9)

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12
Q

if i lose 10kg the BP will decrease by …

A

5-20 mmHg/10 kg weight lost

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13
Q

what the diet recomindation ?

A

Diet rich in fruits, vegetables, low fat dairy and reduced in fat

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14
Q

will the diet recomindation reduce the pressure ?

A

8-14 mmHg

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15
Q

how much salt?

A

<2.4 grams of sodium per day

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16
Q

if the sodium is less2.4 the BP decrease by

A

2-8 mmHg

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17
Q

what’s the Physical activity recommindation?

A

Regular aerobic exercise for at least 30 minutes on most days of the week

18
Q

if we do exersice the BP reduce by …

A

4-9 mmHg

19
Q

what’s the alchohol recommindation ?

A

<2 drinks/day for men and <1 drink/day for women

20
Q

reduce the achohol will decrease the BP by …

A

2-4 mmHg

21
Q

the normal LDL-Cholestrol ?

A

LDL-C should be less than 100 mg/dL

but when Further reduction to LDL-C to < 70 mg/dL is reasonabl e

22
Q

normal TG level ?

A

TG >200 mg/dL

23
Q

what the level of

A

non-HDL-C
*Non-HDL-C = total cholesterol minus HDL-C

If TG >200 mg/dL, non-HDL-C should be < 130 mg/dL*

24
Q

what’s the ATP

A

( Adult Treatment Panel)

25
Q

Saturated fat*
Polyunsaturated fat
Monounsaturated fat
Total fat

A

sturated. <7% of total calories
un saturated Up to 10% of total calories
monosaturated Up to 20% of total calories
total. 25%–35% of total calories

26
Q

carbohydrate

A

50%–60% of total calories

27
Q

carbs

A

20–30 g/d

28
Q

Protein

A

~15% of total calories

29
Q

Cholesterol

A

<200 mg/d

30
Q

Diabetes Mellitus Recommendations ?

A

Goal: Hb A1c < 7%
Lifestyle and pharmacotherapy to achieve near normal HbA1C (<7%).

Vigorous modification of other risk factors (e.g., physical activity, weight management, blood pressure control, and cholesterol management as recommended).

Coordinate diabetic care with patient’s primary care physician or endocrinologist. )

31
Q

Weight Management Recommendations ?

A

Goal:
BMI 18.5 to 24.9 kg/m2

Waist Circumference: Men: < 40 inches Women: < 35 inches

Assess BMI and/or waist circumference on each visit and consistently encourage weight maintenance/
reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated.

If waist circumference (measured at the iliac crest) >35 inches in women and >40 inches in men initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.

The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline. With success, further weight loss can be attempted if indicated

32
Q

BMI is calculated

A

BMI is calculated as the weight in kilograms divided by the body surface area in meters2.

Overweight state is defined by BMI=25-30 kg/m2.

Obesity is defined by a BMI >30 kg/m2.

33
Q

Overweight

A

BMI=25-30 kg/m2.

34
Q

Obesity

A

BMI >30 kg/m2.

35
Q

Physical Activity Recommendations؟

A

Goal: 30 minutes 7 days/week,
minimum 5 days/week

Assess risk with a physical activity history and/or an exercise test, to guide prescription

Encourage 30 to 60 minutes of moderate intensity aerobic activity such as brisk walking, on most, preferably all, days of the week, supplemented by an increase in daily lifestyle activities

Advise medically supervised programs for high-risk patients (e.g. recent acute coronary syndrome or revascularization, HF)

36
Q

Aspirin Recommendations

A

Start and continue indefinitely aspirin 75 to 162 mg/d in all patients unless contraindicated as asthma , sensivity ,or peptic ulcer so use clopidegrl

For patients undergoing CABG, aspirin (100 to 325 mg/d) should be started within 48 hours after surgery to reduce saphenous vein graft closure

Post-PCI-stented patients should receive 325 mg per day of aspirin for 1 month for bare metal stent, 3 months for sirolimus-eluting stent and 6 months for paclitaxel-eluting stent

+Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.

37
Q

Clopidogrel Recommendations?

A

Start and continue clopidogrel 75 mg/d in combination with aspirin

for post ACS or post PCI with stent placement patients for up to 12 months

for post PCI-stented patients
>1 month for bare metal stent,
>3 months for sirolimus-eluting stent
>6 months for paclitaxel-eluting stent

+acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina

38
Q

ACE Inhibitor Recommendations?

A

Use in all patients with LVEF < 40%, and those with diabetes or chronic kidney disease indefinitely, unless contraindicated

Consider for all other patients

Among lower risk patients with normal LVEF where cardiovascular risk factors are well controlled and where revascularization has been performed, their use may be considered optional

+Left ventricular ejection fraction LVEF

+ACE inhibitors are contraindicated in people with:
Pregnancy or breastfeeding.
Previous angioedema associated with ACE inhibitor therapy.
Bilateral renal artery stenosis.
Hypersensitivity to ACE inhibitors.

39
Q

Aldosterone Antagonist Recommendations ?

A

Use in post MI patients, without significant renal dysfunction or hyperkalemia, who are already receiving therapeutic doses of an ACE inhibitor and beta blocker, have an LVEF < 40% and either diabetes or heart failure

Contraindications include abnormal renal function (creatinine >2.5 mg/dL in men or >2.0 mg/dL in women) and hyperkalemia (K+ >5.0 meq/L)

40
Q

Influenza Vaccination?

A

Patients with cardiovascular disease should have influenza vaccination

41
Q

Definition of the Metabolic Syndrome

A

Defined by presence of >3 risk factors
1-Waist circumference (abdominal obesity
men more or equal 40cm
female more or equal 35cm

2-Triglyceride level
more than 150

3-HDL-C level
men less than 50
female less 40

4-Blood pressure more 130/85

5-Fasting glucose more or equal 100mg

medicine (12 decks)

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