When do you screen for primary prevention of CAD/CVA?
beginning at age 20 & repeated Q4-6 years in those without establisted or cerebrovascular disease
what does ASCVD stand for
atherosclerotic cardiovascular disease
what does CAD/CHD stand for?
coronary artery disease
what does CVA stand for?
cerebrovascular accident
stoke/TIA
why do you screen for primary prevention?
systematically identify risk factors for CAD/CVA-> provide 10-yr risk-> use data to encourage risk factor modification
if age 40-79 use
- a 10-yr pooled cohort risk eqn to estimate short-term ASCVD risk
- performs well in non-hispanic black & whites.
if age 20-39 or low risk (<7.5%) & age 40-59
- use a 30-yr framingham score
- provides more useful data t facilitate risk modification in young people since they may have low 10-yr risk despite risk factors (smoking, DM, HTN)
HTN primary prevention w/o compelling indications
ACEI/ARB or thiazide or CCB
HTN coronary artery disease
beta-blocker & ACEI/ARB
HTN recurrent stroke prevention
thiazide +/- ACEI
HTN CDK or DM
ACEI/ARB
systemic approach to assessment/prevention of CAD & CVA
- HTN
- dyslipidemia
- DM
- lifestyle
- antithrombotic?
DM
- lifestyle changes & pharmacological management w/ individualized A1C target
- glycemic control does not generally reduce CV events but will prevent progression of microvascular complications (neuropathy, nephropathy, retinopathy
- if impaired fasting glucose or glucose intolerance is present, perform lifestyle modifications to prevent progression to frank DM
Lifestyle
- complete cessation of tobacco
- obesity: target BMI 18.5-24.9 (10% in 6 mo)
- diet
- exercise: >40 mod intensity activity 3-4 days/wk
- cardiac rehab: recommended for those with a history of CAD, esp after MI & chronic stable angina
- alcohol: <1drink/day in women
antithrombotic approach will be specific to
the disease state, sex, age & risk of atheroembolic vs. cardioembolic events
atheroembolic events
- where plaque rupture may/has caused a MI or stroke/TIA, therapy is spearheaded by antiplt agents
- atheroembolic-> ASA
cardioembolic events
- where abnormal blood flow/inflammation/ endothelial damage puts you at risk od activation of clotting factors lead to a stroke/TIA (or DVT/PE) therapy is focused on anticoagulants
- cardioembolic->coumadin
atherosclerotic cardiovascular diease (ASCVD)
“silent”
- > 50^ obstruction of coronary artery
- chronic stable angina
- carotid artery disease
- PAD
atherosclerotic cardiovascular diease (ASCVD) overt/”hard”
- ACS
- stroke/TIA
primary prevention
- meaures taken to prevent onset of disease (decr or stop atherosclerosis leading to ASCVD)
- i.e. prevent CAD/CSA/MI/stroke/TIA by controlling BP, dyslipidemia, tobacco abuse, lifestyle factors & potentially initiating antithrombotic therapy for high-risk pts (ASA)
secondary prevention
- measures taken to prevent recurrence/progression of diagnosed ASCVD
- i.e. prevent CAD/CSA/MI/stroke/TIA by controlling BP, dyslipidemia, tobacco abuse, lifestyle factors & INITIATING antithrombotic therapy for ALL pts w/out CI
CV risk
- 5 fingers!
- HTN
- dyslipidemia
- DM
- lifestyle
- antithrombotic
coronary artery disease
- arterial sclerosis leads to plaque rupture. plts play a large role in treatment & prevention hence antiplts (i.e. ASA/plavix/etc)
atheroembolid stroke
- arterial sclerosis leads to plaque rupture. plts play a large role in treatment & prevention hence antiplts (i.e. ASA/plavix/etc)
