CVD

Question 1

When should CVD risk assessment be performed?

Answer 1

All adults 45-74yo (ATSI >30yo)

In adults >74yo, consider risks and benefits of treatment before initiating therapy to lower CVD risk

Question 2

Who is already at high risk of CVD?

Answer 2

• DM >60yo
• DM + microalbuminuria (male w ACR >2.5 or female >3.5)
• CKD w persistent proteinuria or eGFR <45
• PHx familial hypercholesterolaemia
• SBP ≥180 or DBP ≥110
• TC >7.5
• ATSI >74yo

Question 3

What is included in absolute CVD risk calculator?

Answer 3

Gender
Age
SBP
Smoking status - yes (or quit within 12m) or no
TC
HDL
DM
ECG LVH

Question 4

What are the clinical targets for BP?

Answer 4

≤140/90 without CVD
≤130/80 if high CVD risk, DM or albuminuria
SBP <120 if tolerated

Question 5

What are the clinical targets for lipids in primary prevention?

Answer 5

TC <4
HDL ≥1
LDL <2
TG <2
Non-HDL <2.5

Question 6

Name 9 modifiable and 4 non-modifiable risk factors for CVD

Answer 6

Modifiable: HTN, dyslipidaemia, smoking, diabetes, obesity, sedentary lifestyle, EtOH excess, poor nutrition, mental stress

Non-modifiable: FHx, increasing age, male gender, ethnicity

Question 7

Name 6 management steps for secondary prevention of CVD

Answer 7

1. Smoking cessation (inc. avoidance of second hand smoke)
2. EtOH reduction - ≤2/day and ≤10/week
3. Maintain a healthy diet - limit saturated fat + ≤4-6g salt/day, eg. Mediterranean diet +/- refer dietitian
4. Encourage physical activity - >150mins/week vigorous exercise or >300mins/week moderate exercise +/- refer exercise physiologist
5. Weight reduction - aim BMI <25 and waist circ <94cm for men and <80cm for women
6. Stress management (inc. treatment of comorbid mental health issues)

Question 8

What is the management step for tertiary prevention of CVD?

Answer 8

Aspirin 75-150mg daily if previous CVD event

Question 9

What are the clinical parameters for classifying HTN?
- Normal
- Mild HTN
- Moderate HTN
- Severe HTN
- Malignant HTN
- Refractory HTN

Answer 9

• Normal: SBP <140 and/or DBP <89
• Mild: SBP <160 and/or DBP <99
• Moderate: SBP <180 and/or DBP <109
• Severe HTN: SBP ≥180 and/or DBP ≥110
• Malignant HTN: DBP >120 + exudative vasculopathy in retina + kidneys
• Refractory: BP >140/90 despite max dose of 2 drugs for 3-4/12

Question 10

90-95% of HTN is essential - what are the secondary causes?

Answer 10

1. Kidney disease (<3%) inc. glomerulonephritis, reflux nephropathy, renal artery stenosis, polycystic kidneys
2. Endocrine disease (0.3-1%) inc. primary aldosteronism (Conn syndrome), Cushing syndrome, phaeochromocytoma, thyroid disease

Plus sleep apnoea, coarctation of the aorta, immune disease inc. polyarteritis nodosa, drugs (NSAIDs, corticosteroids, oral contraceptive, stimulants) and pregnancy

Question 11

What is the cut-off for LOW CVD risk?
What is the management?

Answer 11

<10% risk of a cardiovascular event in the next 5 years
Mx:
1. Provide lifestyle advice and monitor BP
2. If BP persistently ≥160/100, start anti-HTN
3. Review risk in 2 years
- BP 2yly
- Lipids 5yly

Question 12

What is the cut-off for MODERATE CVD risk?
What is the management?

Answer 12

10-15% risk of a cardiovascular event in the next 5 years
Mx:
1. Provide lifestyle advice and support
2. If BP persistently ≥160/100, FHx early CVD or at risk ethnicity
OR if risk has not improved in 3-6 months
-> Start anti-HTN +/- lipid therapy
3. Review risk in 6-12 months
- BP 6-12mthly
- Lipids 2yly

Question 13

What is the cut-off for HIGH CVD risk?
What is the management?

Answer 13

> 15% risk of a cardiovascular event in the next 5 years OR automatic clinically high CVD risk
Mx:
1. Provide frequent and sustained lifestyle advice and support
2. Start anti-HTN and lipid therapy
3. Monitor BP 6-12wkly; target <130/80
4. Monitor lipids yearly; target TC <4, LDL <2, HDL ≥1, TG <2
4. Screen for CKD via eGFR and ACR every 1-2y