Cardiovascular risk management Flashcards
(50 cards)
indications for clinically determined high risk
moderate-severe kidney disease
familial hypercholesterolaemia
for which age groups should you use the risk calculator
all people aged 45-79
people with diabetes 35-79
first nations 30-79
modifiable risk factors on the CVD check
smoking
cholesterol
blood pressure
non modifiable risk factors on the CVD check
age
sex
postcode (socioeconomic)
diabetes
chronic kidney disease
familial hypercholesterolaemia
evidence of atrial fibrillation
people who are already at known increased risk and do not need an absolute CVD risk assessment
moderate or severe CKD
a previous diagnosis of familial hypercholesterolaemia
what are some additional factors to consider in people with diabetes
uACR (urine albumin:creatinine)
eGFR
BMI
HbA1c
Insulin
Time since diagnosis
reclassification factors
ethnicities that may raise risk
First Nations
maori people
pacific islander people
south asian (indian, Pakistani, bangladeshi, sri lankan, nepali, bhutanese, maldivian)
ethnicities that may lower risk
east asain (chinese, japanese, korean, taiwanese, mongolian)
what is coronary artery calcium score
performed via CT, does not require contrast or IV access
low radiation exposure, similar to mammogram
provides a score related to the amount and density of calcified plaque for each coronary artery
is coronary artery calcium score recommended
not recommended for generalised population screening for CVD risk
not covered by medicare
ankle brachial index
not used for CVD risk calculation as it provides little risk discrimination beyond existing CVD risk calculators
useful for assessing people with suspected PVD
high sensitivity CRP
non specific marker of inflammation
not used for CVD risk calculation
persistently elevated CRP in people with chronic inflammatory conditions (eg. SLE, RA, psoriasis) but no known CVD may be a useful predictor of increased risk of CVD events
chronic autoimmune inflammatory conditions
RA, systemic sclerosis, addison’s, SLE, T1DM are all asssociated with increased CVD risk but are not useful reasons to change CVD risk prediction level
for people <5% (low) 5-year risk
lifestyle measures
pharmacotherapy not usually used
reassess at least every 5 years or 2 for First Nations
5-9% 5-year risk
lifestyle measures
consider blood pressure lowering and lipid-modifying pharmacotherapy, depending on clinical context
reassess everyone at least every 2 years
10+% 5-year risk
lifestyle measures
lipid lowering and antihypertensives
formal reassessment generally not required as calculated risk is unlikely to go down
should these guidelines be followed rigidly
more about shared decision making
mediterranean diet
supportive RCTs with clinical CV outcome reduction in both secondary and primary prevention - probably the best evidence we have
hypertension symptoms
usually asymptomatic - you need to look for it
major risk factor for IHD, heart failure, stroke, renal failure
treatment lifelong
how to check blood pressure
seated, relaxed, take 3 readings and average the last two
home or ambulatory BP should be offered to reduce white coat
hypertension thresholds
hypertension initial evaluation
full Hx/PMHx/Meds etc.
end organ disease? evidence of secondary HT causes? medicines that may raise BP? anything to contraindicate certain anti-hypertensives
Ex: pulse rate/rhythm/ JVP/ cardiomegaly/failure signs, vasculopathy signs, fundi, near signs, palpable kidneys, endocrine abnormalities, BMI
hypertension Ix
U&E + GFR
ACR
lipids
fasting glucose
Hb
ECG (?AF, ?LVH, ?IHD)
