Cardiovascular Disease

Question 1

What does the term ‘atherosclerosis’ mean?

Answer 1

Combination of atheromas (fatty deposits) and sclerosis (hardening)

Question 2

What types of arteries are affected by atherosclerosis?

Answer 2

Medium and large arteries

Question 3

What are the primary causes of atherosclerosis?

Answer 3

Chronic inflammation and activation of the immune system in the artery wall

Question 4

List the consequences of atherosclerosis.

Answer 4

• Stiffening
• Stenosis
• Plaque rupture

Question 5

What condition can arise from the stiffening of artery walls due to atherosclerosis?

Answer 5

Hypertension

Question 6

What is stenosis in the context of atherosclerosis?

Answer 6

Reduced blood flow

Question 7

What can result from plaque rupture in atherosclerosis?

Answer 7

Thrombus formation leading to ischaemia

Question 8

Identify the non-modifiable risk factors for cardiovascular disease.

Answer 8

• Older age
• Family history
• Male

Question 9

Identify the modifiable risk factors for cardiovascular disease.

Answer 9

• Raised cholesterol
• Smoking
• Alcohol consumption
• Poor diet
• Lack of exercise
• Obesity
• Poor sleep
• Stress

Question 10

What are some medical co-morbidities that increase the risk of atherosclerosis?

Answer 10

• Diabetes
• Hypertension
• Chronic kidney disease (CKD)
• Inflammatory conditions
• Atypical antipsychotic medications

Question 11

What are the end results of atherosclerosis?

Answer 11

• Angina
• Myocardial infarction
• Transient ischaemic attacks
• Strokes
• Peripheral arterial disease
• Chronic mesenteric ischaemia

Question 12

What are the two main categories of cardiovascular disease prevention?

Answer 12

• Primary prevention
• Secondary prevention

Question 13

What does primary prevention of cardiovascular disease target?

Answer 13

Patients who have never had a diagnosis of cardiovascular disease

Question 14

What does secondary prevention of cardiovascular disease involve?

Answer 14

Management after a diagnosis of cardiovascular disease

Question 15

NICE guidelines recommend what percentage of total calories to be fat?

Answer 15

Less than 30%

Question 16

What is the recommended weekly aerobic activity according to NICE guidelines?

Answer 16

At least 150 minutes at moderate intensity or 75 minutes at vigorous intensity

Question 17

What is the QRISK3 score used for?

Answer 17

Estimating the percentage risk of stroke or myocardial infarction in the next 10 years

Question 18

What medication is initially offered for primary prevention when QRISK3 score is above 10%?

Answer 18

Atorvastatin 20mg

Question 19

What are the rare but significant side effects of statins?

Answer 19

• Myopathy
• Rhabdomyolysis
• Type 2 diabetes
• Haemorrhagic strokes

Question 20

What is the mechanism of action of statins?

Answer 20

Inhibit HMG CoA reductase to reduce cholesterol production in the liver

Question 21

What is Ezetimibe used for?

Answer 21

Inhibiting cholesterol absorption in the intestine

Question 22

What is the ‘4 As’ mnemonic for secondary prevention of cardiovascular disease?

Answer 22

• Antiplatelet medications
• Atorvastatin 80mg
• Atenolol (or alternative beta blocker)
• ACE inhibitor

Question 23

What is familial hypercholesterolaemia?

Answer 23

An autosomal dominant genetic condition causing very high cholesterol levels

Question 24

What is the difference between heterozygous and homozygous familial hypercholesterolaemia?

Answer 24

• Heterozygous: one abnormal gene copy (1 in 250 people)
• Homozygous: both abnormal gene copies (very rare, high cholesterol)

Question 25

What are the three important features for the diagnosis of familial hypercholesterolaemia?

Answer 25

* Family history of premature cardiovascular disease * Very high cholesterol * Tendon xanthomata

Question 26

What are the management steps for familial hypercholesterolaemia?

Answer 26

* Specialist referral for genetic testing * Statins