Cardiovascular Disease

Question 1

Define cardiovascular disease

Answer 1

The accumulation of lipids in arterial walls which can lead to reduced blood flow and hypertension

Question 2

Describe the pathophysiology of cardiovascular disease

Answer 2

• Cardiovascular disease revolves around atherosclerosis
• It is a duo of atheroma (fatty lipid deposits) and sclerosis (stiffening of the vessel walls)
• It is a result of chronic inflammation in an artery which results in the deposition of lipids

Question 3

What can atherosclerosis lead to?

Answer 3

• Stiffening of the arterial walls which contributes to hypertension
• Stenosis which results in reduced blood flow
• Plaque rupture which can form a thrombus that can go on to block a vessel and cause ischaemia

Question 4

What are modifiable risk factors of cardiovascular disease?

Answer 4

Smoking
Obesity
Alcohol
Sedentary Lifestyle
Poor Diet
Stress
Poor Sleep

Question 5

What are non modifiable risk factors of cardiovascular disease?

Answer 5

Older Age
Family History
Male

Question 6

What are medical co-morbidities of cardiovascular disease?

Answer 6

Diabetes
Hypertension
Chronic Kidney Disease
Inflammatory Conditions
Atypical antipsychotic medications

Question 7

What advice can you give someone to alter their modifiable risk factors for cardiovascular disease?

Answer 7

Advice on diet, exercise and weight loss
Stop smoking
Stop drinking alcohol
Tightly treat co-morbidities

Question 8

What treatment would you give for cardiovascular disease?

Answer 8

Statins

Question 9

What do statins do?

Answer 9

reduce cholesterol production in the liver

Question 10

What side effects do statins have?

Answer 10

• myopathy, rhabdomyolysis, T2DM and haemorrhagic strokes
• but the benefits outweigh the risks

Question 11

What is the primary prevention treatment for cardiovascular disease?

Answer 11

• 20mg of Atorvastatin
• Given based on QRISK3 score

Question 12

What is a QRISK3 score?

Answer 12

estimates risk of stroke or MI in the next 10 years

Question 13

What QRISK3 score would you offer statins for?

Answer 13

If it is over 10%, offer a statin

Question 14

Who else would be offered statins for primary prevention of cardiovascular disease?

Answer 14

Patients with T1DM (had for over 10 years) or CKD are offered statins by default

Question 15

What is the secondary prevention treatment for cardiovascular disease?

Answer 15

4 A’s

A – Antiplatelet (e.g. aspirin and clopidogrel)
A – Atorvastatin 80mg
A – Atenolol (or another beta-blocker)
A – Ace Inhibitor (usually Ramipril)

Question 16

What are complications of cardiovascular disease?

Answer 16

Angina
Myocardial Infarction
Transient Ischaemic Attacks
Strokes
Peripheral Arterial Disease
Chronic Mesenteric Ischaemia

Question 17

What do the NICE statin guidelines say?

Answer 17

1. Check lipids at 3 months- aim for increasing the dose to aim for a 40% reduction in non-HDL Cholesterol- always check adherence first!
2. Check LFTs within 3 months and at 12 months, don’t need to be checked again if normal
3. Statins can cause a transient and mild raise in ALT and AST in the first few weeks of use and don’t need stopping if the rise is less than 3 times the upper limit of normal