CV risks and assessment

Question 1

Risks for atherosclerotic CVD 1

Answer 1

• Age: men >45 and women >55
• Genger: men>women for heart disease @ every age, women>men for stroke after age 70
• Diabetes
• Smoking
• HTN: 18-60 60 <140/90
• Cholesterol, HDL, LDL, triglycerides: want low of everything except HDL (but high HDL does not mean lower risk)

Question 2

Risks for atherosclerotic CVD 2

Answer 2

• Family history: premature CV disease (male<65), inherited hypercholesterolemia
• Chronic kidney disease (CKD): low GFR is bad sign
• Weight: overweight (esp. obese), and underweight both increase risk
• Chronic inflammation: use CRP level as tie breaker
• Increased insulin levels
• Metabolic syndrome
• Coronary Ca score: use CT of Ca in vessels as tie breaker

Question 3

Atherogenic particles

Answer 3

• All cholesterol except HLD (TChol - HDL)
• Can also look at apolipoprotein B (one moiety/particle)
• Use TAGs, LDL

Question 4

Metabolic syndrome

Answer 4

• Insulin resistance syndrome, consisting of any 3 of the following (note does not include LDL requirement):
• Abdominal obesity
• Elevated TAGs
• Low HDL
• High BP (>140/90)
• Elevated fasting glc
• Greatly increases risk for CV mortality, T2 diabetes
• Is promoted by atherogenic diet, physical inactivity, obesity

Question 5

Primary vs secondary prevention

Answer 5

• Primary prevention: pts at risk for CVD but w/o observable disease
• Secondary prevention: pts w/ proven disease to prevent progression of disease

Question 6

Primary prevention Rx modalities

Answer 6

• Smoking cessation, control BP/glc
• Lifestyle change (most important): diet (low carbs, mediterranean diet), exercise, etoh/smoking
• Medical Rx: statins to reduce cholesterol (statins indicated for 3 groups of primary prevention, and for all secondary prevention)

Question 7

Rxing metabolic syndrome

Answer 7

• Lifestyle change (!)
• Rx of HTN
• Rx of high glc
• Possible statins