Cardiovascular Risk Factors - Brown Flashcards Preview

Adult/Ped Medicine 4 > Cardiovascular Risk Factors - Brown > Flashcards

Flashcards in Cardiovascular Risk Factors - Brown Deck (15):
1

define: risk factor

characterisitc or feature of an individual or population that is present in early life and is associated with an increased risk of developing future disease

2

non-modifiable cardiac risk factors

  • age
    • male > 45
    • female > 55
  • male gender
  • family history
    • male < 55
    • female < 65

3

modifiable cardiac risk factors

  • hyperlipidemia
  • smoking
  • hypertension
  • insulin resistance and diabetes
  • sedentary lifestyle
  • obesity
  • unhealthy diet

4

describe the modification of risk factors and thier role in prevention of heart disease

HYPERLIPIDEMIA

  • increased TC is a modifiable risk factor
  • early trials - decrease TC = decreased CHD events

ATP III Classification LDL

  • < 100 optimal
  • 100-129 near optimal
  • 130-159 borderline high
  • 160-189 high
  • > 190 very high

 

level of treatment is based on overall CV risk assessment 

  • Clinical ASCVD: moderate to high-intensity statin
  • LDL > 190 - high intensity statin
  • Diabetic pts - moderate intensity statin
  • without ASCVD or DM; LDL 70-189 mg/dL estimated 10 year risk > 7.5% - moderate to high intensity statin

5

High-Intensity Statin Therapy

lowers LDL by > 50%

  • Atrovastatin
  • Rosuvastatin

6

Moderate-Intensity Statin Therapy

lowers LDL by 30-49%

  • Atrovastatin
  • Rosuvastatin
  • Simvastatin
  • Pravastatin
  • Lovastatin
  • Fluvastatin
  • Pitavastatin

7

describe the modification of risk factors and thier role in prevention of heart disease

DIABETES, INSULIN RESISTANCE AND HYPERTRIGLYCERIDEMIA

  • patients with diabetes tend to cluster other risk factors
  • insulin resistance increases risk
  • patients with type 1 and type 2 diabetes are at high risk
  • added sugars
    • should be less than <100 cal/day in women; <150 cald/day in men
    • > 21% of daily calories - double risk of CV
    • > 7 sugar-sweetened beverages increase risk of CV death by 29%

8

Metabolic Syndrome

waist circumfrence: > 40 men, > 35 women

insulin resistance: fasting glucose > 100

high blood pressure: BP > 130/85

dylipoproteinemia

  • elevated plasma triglycerides: TG > 150
  • reduced HDL levels: < 40 men, 50 women

9

describe the modification of risk factors and thier role in prevention of heart disease

HYPERTENSION

lowering diastolic BP (5-6 mmHg) reduces 

  • risk of stroke
  • risk of vascular mortality
  • risk of coronary heart disease

slows the progression of

  • congestive heart failure
  • renal failure
  • ophthalmologic complications

10

describe the modification of risk factors and thier role in prevention of heart disease:

SMOKING

 

single most important modifiable risk factor for coronary artery disease

benefits of cessation

  • reduce cardiovascular risk of 50% in the first 1-2 years
  • risk approaches baseline in 5-15 years

11

Smoking: Mechanisms of Atherosclerosis

  • enhances oxidation of LDL
  • reduces levels of HDL
  • increases inflammatory markers (hs-CRP, fibrinogen)
  • spontaneous platelet aggregation
  • increases monocyte adhesion
  • increased prevalence of coronary spasm
  • reduces threshold for ventricular arrhythmias

12

describe the modification of risk factors and thier role in prevention of heart disease:

Sedentary Lifestyle

 

250,000 deaths annually can be attributed to physical activity

recommendation: 40 minutes of moderate intensity daily

activity can help reduce - non-fatal cardiovascular events and cardiovascular deaths

13

Physiologic Benefits of Regular Exercise

  • reduced myocardial oxygen demand
  • increased exercise performance
  • reduced blood pressure
  • weight control
  • reduced cholesterol, increased HDL
  • improved glucose tolerance
  • improved endothelial function
  • enhances fibrinolysis
  • reduces platelet reactivity

14

Inflammation Markers

present in every stage of atherothrombosis

  • hs-CRP
  • ICAM-1
  • IL-6
  • TNF-a

15

describe the modification of risk factors and thier role in prevention of heart disease

hs-CRP

inflammatory marker

strong predictive value in men, women, elderly, smokers, stable and unstable angina, prior MI

higher hsCRP - lower survival after MI; can predict recurrent events with CVA and PAD

modifiable risk factor?

  • Aspirin
  • Statins
  • Angiotensin converting enzyme inhibitors
  • thiazolidine derivatives