Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular diseases > Cardiovascular risk assessment > Flashcards

Cardiovascular risk assessment Flashcards

1
Q

What are the current national guidelines relating to cardiovascular risk assessment?

A
  1. NICE Guidelines - Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary & secondary prevention of cardiovascular disease.
  2. JBS 3: Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is primary cardiovascular risk reduction?

A

Cardiovascular risk reduction with aim of preventing CVD in those at risk of developing it e.g. Diabetes Mellitus

  • Not yet got established CVD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is secondary cardiovascular risk reduction?

A

Cardiovascular risk reduction in those with established cardiovascular disease (e.g. myocardial infarction) to reduce the risk of further CV events/deterioration in CV function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What tools are used for the estimation of cardiovascular risk?

A
  1. Framingham Equations
  • Firstly came in the form of cardiovascular risk assessment charts
  • They’re based on equations developed from the Framingham Heart Study and it gave us an estimation of cardiovascular risk based on:
    • Age
    • Gender
    • BP
    • Smoking status
    • Cholesterol (TC:HDL ratio)
  1. Assign (online tool)
  • Includes social deprivation & family history as part of the risk analysis
  • Assign gives you a score between 1-99
  • You are considered to have a high CVD risk if you score greater than 20
  1. QRISK (Recommended by NICE)
  • Includes ethnicity, treated HT, social deprivation, BMI, family history or premature CVD, other conditions (e.g. AF, DM, CKD, RA) as part of the risk analysis
  • Online tool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the Framingham Heart Study?

A
  • Was started back in 1948, around 5,209 men and women aged 30-62 were recruited from Framingham.
  • The aim of the study was to identify risk factors for the development of cardiovascular disease.
  • These people were assessed at baseline and then followed up every 2 years
  • 1971 the study recruited second generation, so children of the original men and women from 1948
  • In 2002 there was a third generation recruit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the limitations of using the cardiovascular risk assessment charts?

A
  1. They do not take into account other major risk factors which now we know that definitely affect CVD risk development:
  • Ethnicity
  • Family history of CVD
  • BMI
  • Socioeconomic status
  1. Framingham based equations for risk reflect risks of CVD in 1960s-1980s in a North America Cohort
  • Tend to overestimate risk in current UK population
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What additional/further risk factors does QRISK 3 (April 2018) include?

A
  1. Chronic kidney disease (CKD) stage 3 (as well as stages 4 or 5)
  2. Migraine
  3. Corticosteroids
  4. Systemic lupus erythematosus (SLE)
  5. Atypical antipsychotics
  6. Severe mental illness
  7. Erectile dysfunction
  8. Variability in systolic bp readings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do we identify and assess CVD risk?

A

As healthcare professionals we should be identifying people who at risk of developing CVD and selecting them for full formal risk assessment. In order for this tp happen, there should be:

  1. A systematic system in place (systemic strategy)
  2. Should cover anybody over the age of 40, to look and identify/estimate their QRISK score.
  3. Prioritise anybody for full formal risk assessment if their risk of developing cardiovascular disease from the QRISK assessment over the next 10 years is greater that 10%.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

As tools only provide an approximation of CVD risk, what should the interpretation of CVD scores always reflect on?

A

Informed clinical judgement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

For what ages does the NICE guidelines suggest you use QRISK3 to assess CV risk for primary prevention?

A

For ages 25-84 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For what ages does NICE recommend to use QRISK3 to assess CV risk in Type 2 DM patients?

A

For ages 25-84 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which group of patients is QRISK not appropriate?

A
  • Type 1 DM
  • Anyone with renal impairment defined eGFR <60ml/min &/or albuminuria
  • Risk of familial hypercholesteolaemia/other inherited lipid abnormality
  • > 85 yrs (especially if smoker/Hypertension)

ALL AUTOMATICALLY CONFIRMED AS HIGH RISK AND SHOULD BE TARGETTED FOR MANAGEMENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How may underestimation of risk occur?

A
  • If underlying medical condition increase CV risk e.g. HIV, severe mental illness, autoimmune disorders or other inflammatory disorders
  • In patients already treated with antihypertensives or lipid modification therapy, or recently stopped smoking
  • If taking any treatment which causes dyslipidaemia e.g. immunosuppressant drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is smoking status important in CVD risk assessment?

A
  • Patients who have stopped smoking in previous 5 years should be considered as smokers for CV risk
  • Risk from smoking more that 5 years ago depends on life-time exposure and risk will lie somewhere between non-smoke and smoke => Use clinical judgement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a pack-year?

A

Smoking status should be recorded for a patient in pack years.

  • A pack-year is smoking 20 cigarettes a day for one year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can you work out pack years?

A

Method 1:
Number of pack years = (packs smoked per day) x (years as a smoker)

                      or

Method 2:
Number of pack years= (number of cigarettes smoked per day x number of years smoked)/20 (1 pack has 20 cigarettes)

17
Q

Before offering statins for primary prevention, what has to be done?

A
  • Discuss benefits of lifestyle changes (may need support)
  • Optimise management of other modifiable risk factors (e.g. bp, BG)
18
Q

Always present ABSOLUTE risk and not RELATIVE risk of both disease and treatments. True or False

A

True

19
Q

What is absolute risk?

A

Is the risk of developing it over a period of time, taking into account what that patients original risk is.

20
Q

What is relative risk?

A

Is used to compare the risk in 2 groups, those treated and those not treated, and doesn’t take into account anything relating to their original risk.

Relative risk often looks better and makes the data look more positive.

21
Q

What is ‘Number needed to treat (NNT)’?

A

NNT is defined as the number of people that we need to treat with a statin to prevent 1 stroke/Myocardial infarction heart attack.

= 100/ARR (Absolute risk reduction)

22
Q

Can aspirin be offered routinely for primary prevention of CVD?

A

No

Do not routinely offer aspirin for primary prevention, as risks of bleeding outweighs anything else.

23
Q

What lifestyle factors are important in cardiovascular risk management?

A
  • Behaviour change (patients often require support)
  • Healthy eating
  • Cardioprotective diet
  • Physical activity (min 150mins per week of exercise)
  • Weight management (target BMI of 18.5 and 24.9)
  • Alcohol consumption (14 units per week)
  • Smoking cessation
24
Q

For what age range is the NHS Health Check Service offered to?

A

To all 40-74 yrs

25
Q

What is the lifetime risk tool?

A

This is recommended to healthcare professionals to inform discussions of CVD and motivate lifestyle changes for those people that don’t fit into the automatic high risk category for their QRISK score:

  • QRISK of less than 10%
  • Under the age of 40 but have known CVD risk factors

They can consider the use of the online risk tool called: QRISK3-lifetime

  • This instead of estimating a 10 year risk, it estimates the risk of getting CVD over lifetime (up to 99 years) and compare risk with good control of: smoking, BMI, TC/HDL ratio and systolic BP

Cardiovascular diseases (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions