CM- Cardio -5- prevention of CVD
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| What is primary vs secondary prevention of CVD | Primary-involves prevention of onset of disease in asymptomatic persons
Secondary- involves prevention of death or recurrence of disease in persons with symptoms
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| What are the modifiable risk factors for CVD | smoking
diet/alcohol intake
inactivity/sedentary lifestyle
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| What are the modifiable physiological risk factors | hypertension
dyslipidemia
obesity
diabetes
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| what are the non modifiable risk factors | Family Hx of premature CVD
Age M>45 F>55
Gender
Female postmenopausal status
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| what is the framingham heart study | study started in 1948 of 10,000 residents of framingham massachusetts. subject have been followed having in depth PE every two years with lab tests.
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| HOw many generations have the framingham study been following so far | 3rd generation was enrolled in 2002
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| what is the framingham risk score | giving points to identifiable risk factors to calculate persons 10yr risk of heart attack
risk factors include
gender
age
hdl and ldl values
blood pressure
smoking
personal history
family history
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| if patient has 0-1 risk factors what is their average 10yr risk should you calculate a full 10yr risk score | risk is <10% so don't bother doing a 10yr risk assessment
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| What group automatically qualifies for at risk needing a 10yr risk assessment | diabetics
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| what is the 10yr risk of heart attack in hard CHD | >20%
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| what other forms of atherosclerotic disease have a greater than 20% chance of heart disease besides CHD | abdominal aortic aneurysm
peripheral vascular disease
carotid artery disease
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| How does BP relate to CVD risk | relationship is continous consistent and independent of other risk factors so high BP correlates to high risk of CVD
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| What does increasing HTN by 20/10 increaments do to risk of CVD | doubles the risk of CVD for each 20/10 increament BP is raised from 115/75
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| What needs to be done at prehypertension | patient needs to be educated on risk factors and started on reducing BP to avoid CVD
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| what benefits do you see in lowering BP w/ stroke incidence myocardial infarction heart failure | stroke incidence is reduced 35-40%
MI reduced 20-25%
Heart Failure reduced 50%
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| How can you prevent 1 death in every 11 stage 1 HTN patients | reaching a sustained 12mmHG reduction in SBP over 10 years will prevent 1 death for every 11 patients
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| why should you treat diabetic patients as if they already had CAD | because they are at increased risk of suffering MI and CAD over non diabetic patients. Their risk of having a first MI is the same as a non diabetic patient having a second MI
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| What is the 10yr risk of CHD for diabetics | about 20%
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| What is metabolic syndrome related to CAD, stroke and DM | symptoms that when clustered together increase likelihood of developing CAD, stroke and DM
they are
Abdominal Obesity
HTN
high Triglycerides
insulin resistance
Low HDL
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| How many of the following =metabolic syndrome Blood pressure ≥130/85 mmHg Blood sugar ≥100 mg/dL Large waist circumference Men - ≥40in Women - ≥35in Low HDL cholesterol: Men - <40 mg/dL Women - < 50 mg/dL Triglycerides ≥150 mg/dL | having 3 or more of the conditions listed on other slide equals having metabolic syndrome
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| what condition has been established as a strong, consistent risk factor for coronary atherosclerosis | Hypercholesterolemia
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| What drug has been proven to reduce the risk of death and nonfatal cardiovascular events associated with hypercholesterolemia | statins (HMG-CoA-reductase)
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| what are some secondary causes of dyslipidemia | diabetes
hypothyroidism
obstructive liver disease
chronic renal failure
drugs that raise LDL cholesterol and lower HDL cholesterol (progestins, anabolic steroids, corticosteroids)
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| What is the LDL cholesterol goal in LDL lowering therapy with statins and other drugs | get LDL <100mg/dl
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| What are the two A recomendations for screening for CVD | measure annual blood pressure, weight, height and BMI in pts older than 18
Measure cholesterol in M>35 and F>45 and every 5 yrs after
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| What are the three therapeutic lifestyle changes you need to stress every visit | smoking cessation
exercise-30minutes daily
increase fruits and veggies at leasts 9 servings daily
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| What medical interventions might you perscribe or suggest for reducing risk of CVD | lipid lowering agents (statins)
HTN management
Low Dose Aspirin
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| HOw can you increase adherence to prevention and tx for CVD | simplify medication regimens
provide explicit instruction and use good couseling techniques
use prompts to help patient remember tx
get family support
reward adherence
increase visits for pt not adhering
involve pt in care and self monitoring
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