NHS Health check and vascular disease

Question 1

NHS HC -describe how the service is operated - what data needs to be collected

Answer 1

Age;
Gender;
Smoking status;
Level of physical activity;
Family history of vascular disease;
Ethnicity;
Body Mass Index;
Random blood cholesterol measurement (Total and HDL cholesterol); and
Blood pressure

Question 2

NHS stages of assessment

Answer 2

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Question 3

aims of service

Answer 3

• To improve health outcomes and quality of life by enabling more people to be identified at an earlier stage of vascular change, with a better chance of putting in place positive ways to substantially reduce the risk of cardiovascular morbidity, premature death or disability.
• To enable the prevention of diabetes in many of those at increased risk of this disease.
• To sustain the continuing increase in life expectancy and reduction in premature mortality that are under threat from the rise in obesity and sedentary living.
• To offer a real opportunity to make significant inroads into reducing health inequalities, including socio-economic, ethnic and gender inequalities.
• To improve convenience and accessibility of testing facilities by offering increased choice of location and extended hours of availability

Question 4

state the most common vascular diseases in relation to this service

Answer 4

• coronary heart disease (heart attacks and angina);
• stroke;
• diabetes; and
• kidney disease.

Question 5

symptoms of a

heart attack

Answer 5

• chest pain – the chest can feel like it’s being pressed or squeezed by a heavy object, and pain can radiate from the chest to the jaw, neck, arms and back
• shortness of breath
• feeling weak or lightheaded, or both
• an overwhelming feeling of anxiety

Question 6

symptoms of a stroke

Answer 6

Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have dropped.

Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm.

Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you’re saying to them.

Question 7

describe potential relationship between infection and vascular disease

Answer 7

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Question 8

modifiable risk factors and advice for them

Answer 8

smoking;
physical inactivity and a sedentary lifestyle;
high blood pressure;
raised cholesterol levels; and
obesity.

Question 9

difference between fixed and modifiable risk factors

Answer 9

Fixed factor can’t be changed but modifiable can - fixed is age/gender/family history of vascular disease/ ethnicity.

Question 10

QRISK3-2018 calculator

assessment score

Answer 10

High risk - if your score is 20% or more. This is a 2 in 10 chance or more of developing a cardiovascular disease within the following 10 years.
Moderate risk - if your score is 10-20%. This is between a 1 in 10 and 2 in 10 chance. This should be re-assessed every year.
Low risk - if your score is less than 10%. This is less than a 1 in 10 chance. This should be re-assessed every five years.

Question 11

cardioproactive diet

Answer 11

Advise people at high risk of or with CVD to eat a diet in which total fat intake is 30% or less of total energy intake, saturated fats are 7% or less of total energy intake, intake of dietary cholesterol is less than 300 mg/day and where possible saturated fats are replaced by mono‑unsaturated and polyunsaturated fats. Further information and advice can be found at NHS Choices .

Question 12

Advise people at high risk of or with CVD to:

Answer 12

• reduce their saturated fat intake.
• increase their mono-unsaturated fat intake with olive oil, rapeseed oil or spreads based on these oils and to use them in food preparation.
• Advise people at high risk of or with CVD to do all of the following:
• choose wholegrain varieties of starchy food
• reduce their intake of sugar and food products containing refined sugars including fructose
• eat at least 5 portions of fruit and vegetables per day
• eat at least 2 portions of fish per week, including a portion of oily fish
• eat at least 4 to 5 portions of unsalted nuts, seeds and legumes per week. Further information and advice can be found at NHS Choices

Question 13

physical activity

Answer 13

Advise people at high risk of or with CVD to do the following every week:

• at least 150 minutes of moderate intensity aerobic activity or
• 75 minutes of vigorous intensity aerobic activity or a mix of moderate and vigorous aerobic activity in line with national guidance for the general population (see Physical activity guidelines for adults at NHS Choices).

Question 14

alcohol consumption

Answer 14

No more than 14 units per week - if you drink this much, spread it over 3 days or more. Should have several alcohol free days per week.

Question 15

how to calculate BMI

Answer 15

Body Mass Index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in metres squared

Question 16

interactions with statins 1

Answer 16

Cytochrome P450 enzyme inhibitors have been shown to lead to markedly increased concentrations of statins, resulting in a greatly increased risk of myopathy or rhabdomyolysis.

Question 17

ATORVASTATIN

interactions with statins

Answer 17

Co-administration of potent CYP3A4 inhibitors (such as ciclosporin, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole, and HIV protease inhibitors including ritonavir, lopinavir, atazanavir, indinavir, and darunavir) should be avoided if possible. If co-administration cannot be avoided, lower starting and maximum doses of the statin should be considered and appropriate clinical monitoring of the person is recommended.

With ciclosporin, telaprevir, and tipranavir combined with ritonavir: do not exceed 10 mg of atorvastatin daily.
With erythromycin and clarithromycin: a lower maximum dose of atorvastatin and clinical monitoring of these people is recommended. Consider temporary cessation of atorvastatin if antibiotic treatment is short term.

Question 18

SIMVASTATIN

Answer 18

Concurrent use of simvastatin and the following drugs is contraindicated due to an increased risk of myopathy or rhabdomyolysis: itraconazole, ketoconazole, posaconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors (for example nelfinavir), nefazodone, ciclosporin, danazol, and gemfibrozil.
With amiodarone, amlodipine, verapamil, and diltiazem: do not exceed 20 mg of simvastatin a day.

Question 19

interactions with statins 4

Answer 19

Oral fusidic acid should not be given with statins because of the risk of potentially fatal rhabdomyolysis [ MHRA, 2011 ].