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CVD risk estimation and prevention: An overview of SIGN 97 Dr. Rose Rosario GPST3.
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Transcript of CVD risk estimation and prevention: An overview of SIGN 97 Dr. Rose Rosario GPST3.
![Page 1: CVD risk estimation and prevention: An overview of SIGN 97 Dr. Rose Rosario GPST3.](https://reader036.fdocuments.in/reader036/viewer/2022081520/5697bfb51a28abf838c9dde7/html5/thumbnails/1.jpg)
CVD risk estimation and prevention: An overview of SIGN 97
Dr. Rose Rosario
GPST3
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Annual prevalence of CVD
4.2% men 3% women
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Cardiovascular Disease (CVD) includes….
Cerebrovascular disease Coronary heart disease Peripheral vascular disease
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Clinical risk assessment-history
Age Sex Family history Smoking Alcohol Diet Physical activity Socioeconomic status
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Clinical risk assessment - measurements
Blood pressure BMI/waist circumference Cholesterol Glucose Renal function
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Risk scoring systems
Framingham - set up in the US in the 1970s ASSIGN – set up by SIGN to reduce
differences in socio-economic risk. QRISK2 JBS score
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Diet
Reduction of total and saturated dietary fat. Less than 6g of dietary salt per day. Two 140g portions of fish per week one of
which should be fatty fish. Increased intake of fruit and vegetable.
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Alcohol
Brief multi-contact intervention. Information about recommended daily limits Low to moderate alcohol consumption is
cardio-protective.
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Other specific recommendations
Physical activity – moderate intensity. Active smoking- dose related risk and should
be advised to stop and supported in this, especially young and low socio-economic status.
Passive smoking- increases risk of CVD and should be minimised.
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Antiplatelets with established CVD
Aspirin 75mg/day of clear benefit in CHD. Clopidogrel can be used. Individuals with history of stroke or TIA in
sinus rhythm should be considered for aspirin + dipyridamole (or) clopidogrel.
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Antiplatelets without established CVD
In asymptomatic individuals with CVD risk >20% in ten years.
In hypertensives with CVD risk > 20% in 10 years.
In DM, aspirin if over 50 years of age and in younger diabetics with increased CVD risk
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Lipid lowering in established CVD
Patients with established CVD should be considered for intensive statin therapy.
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Lipid lowering without established CVD
Recommended if age > 40 years CVD risk > 20% in 10 years
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Lipid lowering
Reducing LDL by 1.6 mmol/L halves CHD events after 2 years with standard statin doses.
Existing total cholesterol target of < 5mmol/L for established CVD is regarded as the minimum standard of care(NHS Scotland)
Elderly- age alone not a reason. Assess 10 year CVD risk, life expectancy and quality of life.
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Lipid lowering
DM - drug therapy shows statistically significant reduction of relative risk of various endpoints including all cause mortality and fatal/nonfatal MI.
Familial hypercholesterolemia- treat irrespective of risk calculation as cholesterol usually > 8. Might need ezetimibe + statin combination.
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Lipid lowering
Individuals with hypertriglyceridemia (>1.7mmol/L) and/or low HDL(<1mmol/L in men, <1.2mmol/L in women), consider fibrates and nicotinic acid.
Statins are drug of choice in diabetics with combined dyslipidemia and elevated LDL.
Statins and fibrates together- combined dyslipidemia.(caution with statin and gemfibrozil together).
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BP with established CVD
Treat if BP > 140/90mmHg Individuals with DM or chronic renal disease
or target organ damage, treat if BP > 130/80mmHg
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BP without established CVD
If BP > 160/100, drug therapy If CVD risk > 20% over 10 years, treat if BP
> 140/90 If CVD risk < 20%, lifestyle change and
reassess 3-5 years.
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Psychological stress
Depression
Lack of social support
Social isolation
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