CVD Prevention

Question 1

What percentage of deaths are caused by CVD in the US yearly?

Answer 1

42% - more than anything else

Question 2

What are the modifiable risk factors for CVD?

Answer 2

HTN
Dyslipidemia
chronic inflammation
obesity
cigarette smoking
impaired glucose tolerance
physical inactivity
heavy ETOH use

Question 3

What are the non-modifiable risk factors for CVD?

Answer 3

age = male over 45 and female over 55 (or premature menopause without estrogen replacement)

family history of MI or sudden death (father younger than 55 and mother younger than 65)

Question 4

Which has more of an effect on CVD risk, systolic or diastolic HTN?

Answer 4

systolic

Question 5

What is hte LDL goal for the following groups: 0-1 risk factor for CVD, 2+ risk factors, and CHD or with CHD risk equivalent ov over 20% in 10 years?

Answer 5

1 risk factor: under 160
2 or more risk factors: under 130
current CHD or over 20% risk: under 100

Question 6

When do you deal with triglycerides?

Answer 6

You want them under 150, but you typically deal with the LDL first. Unless the triglycerides are over 500, in which case you deal with the triglycerides first to avoid pancreatitis

Question 7

When do you deal wtih HDL?

Answer 7

you want it over 40 mg in men and over 50 mg in women, but you deal with that after LDL

Question 8

What do you want your total cholesterol under?

Answer 8

200

Question 9

What percentage of adults have a total cholesterol of over 200?

Answer 9

over 50%!

and CAD double for every 50 mg increase over 200

Question 10

CAD risk descreases by ___% for every ___% drop in total cholesterol

Answer 10

2% for 1 %

Question 11

Under AHA diet recommendations, what percentage of the diet should total fat be?

Answer 11

only 25%

Question 12

What drug class makes up the only non-surgical treatment for cholesterol reduction that reduces mortality?

Answer 12

statins!

Question 13

Adivice from a physician can increase the smoking cessation rate to 10%, while medications along with behavioral modifications can increase the rate to what?

Answer 13

35%

Question 14

What is the “4A” smoking cessation program?

Answer 14

ask - inquire about smoking, durtaion and amount
advise - against smoking with role modeling, warn of risks, etc
assist - behvior modification techniques and drugs
arrange follow-up - most likely to fail during 1st 3 months

Question 15

What are the 5 stages of “change” to quit smoking?

Answer 15

precontemplation - smoking isn’t a problem
contempation - smoking is a problem, but no plan to quit
preparation - wanting to quit and plans made
action - plan carried out
maintenance - support and dealing with relapses

Question 16

What are the general medication options for smoking cessation in order of expense?

Answer 16

nicotine (gum cheapest, inhaler most expensive)
Bupropion
Chantix

Question 17

How does chantix (varenicline) work?

Answer 17

blocks neuronal nicotinic acetylcholine receptors

Question 18

How does bupropion work for htis?

Answer 18

it inhibits the uptake of NE, SE and DA 0 may reduce urge to smoke through effect on NT system (not fully understood)

Question 19

What percentage of diabetics die from CVD?

Answer 19

80% that’s huge! Diabetes is an ultimately risk factor

Question 20

WHat are the fasting glucose limits for impared glucose tolerance and diabetes

Answer 20

IGT: 110-125 mg/dl
Diabetes: over 125 mg/dl

Question 21

What are the components of metabolic syndrome?

Answer 21

1. insulin resistance
2. HTN
3. dyslipedemia
4. elevated CRP
5. central obesity

Question 22

What are the limits for central obesity in men and women?

Answer 22

over 35 inch waist in women

over 40 inch waist in men

Question 23

What BMI is considered obese?

Answer 23

over 30

Question 24

What should be the goals for physical activity and why?

Answer 24

30 minutes most days of the week - it increases HDL by 5% and improves insulin utilization because it upgrades the number of insulin receptors

Question 25

Describe the nuances of ETOH in relation to CVD?

Answer 25

2 or less dirnks a day may be a benefit by increasing HDLs higher amounts increase CVD risk - high calories with obesity, high triglycerides, cardiomyopathy, HTN, atrial fibrillation

Question 26

How does CRP related to screening for CVD risk?

Answer 26

high-sensitivity CRP assays over 3 are considered a risk factor for future CV disease - but can be elevated in a number of conditions including diabetes, MI and stroke

Question 27

Antioxidants for CV prevention? yay or nay?

Answer 27

may potentially be helpful but no evidence to support this beta carotene and vitamin E have actually been found to increase risk!

Question 28

When should you start aspirin in men? women?

Answer 28

age 45-79 in men with increased risk | age 55-79 in women - but this is to prevent stroke, not CVD here

Question 29

In what patient poplations should you treat hypercholesterolemia as if they had CVD?

Answer 29

noncoronary atherosclerosis like in carotid, aortic or peripherla arteries multiple risk factors diabetes mellitus chronic kidney disease

Question 30

What drug should you give to people at high risk of arrhythmic death due to a previous ischemic event?

Answer 30

amiodarone

Question 31

What drug should you give to people with previous ischemic event to avoid heart failure?

Answer 31

ACE inhibitor - inhibits remodeling

Question 32

What drugs can you give to people who already had an ischemic event to avoid clots?

Answer 32

clopidogrel and aspirin (warfain helps, but increases bleed risk)

Question 33

What drug is best to lower blood pressure in people who already had an ischemic event?

Answer 33

beta blockers

Question 34

What are some lifestyle changes that are likely to be beneficial in people who already had an ischemic event?

Answer 34

``` eating more fish mediterranean diet smoking cessation stress management one to two drinks of ETOH daily ```

Question 35

How often should you check total cholesterol and HDLs in low risk men? women?

Answer 35

every 5 years | starting at 35 for men, 45 for women (earlier if higher risk)