Cardiovascular disease
-risk factors
-Age
-FH
-smoking
-BMI
-HT
-DM
-High cholesterol
-CKD/RA
-anti-psychotics
-sedentary lifestyle
-alcohol XS
QRISK every 5 years
-offer statin age <85 and >10% risk
Consider if less than 10% may do lifetime risk
-type 1 DM 40 yr or older, more than 10years, reprobate
-CKD
-familial hypercholesterolEmia
Explain CArdiovascular disease
This is looking at health of the heart and the vessels.
Mainly those taking oxygen to the tissue the arteries.
- if these have narrowing or block they can cause symptoms such as angina, heart attack, stroke, poor circulation in the legs
Cardiovascular red flags
Chest pain
- comes on with exercise relief by rest
-pain at rest or more frequent crescendo angina
-MI crushing central chest pain, not resolved but rest, associated sweating, nausea, can go into arm
Collapse
Statins aim
Often aim for total cholesterol <5 but no strict guidance
Primary prevention
-20 atorvastatin
-aim 40% reduction in non HDl cholesterol
Secondary prevention
Offer to all with CVD irrespective of cholesterol
Aim is to stabilise plaques and prevent rupture as well as reduce new plaques minimise chance of serious MI, CVA
-80mg atorvastatin except in CKD when start at 20mg
-aim LDL<2.0 or non hdl <2.6
Contra-indication to statin
Pregnancy
- stop for 3 months prior to trying
Interactions with medication
- erythromycin / clarithromycin- if short courses with hold statin
- grapefruit juice- large quantity >1.2l
-amlodipine can increase dose of statin therefore careful for muscle
aches etc
-colchicine- again discuss awareness of muscle aches
Familial hypercholesterolaemia
Total cholesterol >9
Non hdl >7.5
Triglyceride persistent >10 fasting sample
FH
- autosomal dominant
Refer all the secondary care
Looking for 50 drop in non HDL
Statin monitoring
Baseline
-lipid profile
LFT’s
- if ALT raised but less than 3x start statin and repeat at 4 weeks
-if ALT greater than 3x. Do not start statin repeat at 4 weeks if still high- investigate.
Muscle aches- prior to start
-do Ck if <5x start statin at lower dose
If CK more than 5x repeat 5-7 days if still this high - do not start statin
If raised HBA1C start statin but be aware may unmask Dm
If no to statin
- try ezetimibe
The lipid target for the secondary prevention of cardiovascular disease (CVD) is low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol/L or less or non-high-density lipoprotein (non-HDL) cholesterol levels of 2.6 mmol/L or less.
Monitor LfT’s and lipids at 3 months and 1 year
If ALT x3 or more stop statin
If Muscle aches CK if 5x or greater stop statin
If ok at 12 months no further monitoring required
Cardiovascular disease bloods
U&e for CKD
Lipids
LFT- NAFLD in case statin needed
HBA1c for donates
Diet for CVD
Low processed food
Low fat
Low salt
5 fruit and veg
2 oily fish
Nuts
Use traffic lights on food for saturated fats
- PIL on CVD and diet- BHF
Exercise 150 mins per week
But all movement is good
Less alcohol
No smoke or drugs
Statin common side effect
Gastrointestinal
Slight unmask diabetes
Muscle aches
Headache
Bloating
Nausea
Many improve with time
Muscle pain- need review
Sex after MI
Approx 4 weeks. But when able to walk uphill/ stairs no problems
No viagra for 6 months
- CI if on nitrate or nicorandil
Hypertension target
<80 140:90 clinic 135/85 home
>80 150/90 clinic 145/85 home
