Transcript CVD Risk assessment

CVD risk estimation and prevention: An
overview of SIGN 97
Annual prevalence of CVD
 4.2% men
 3% women
Cardiovascular Disease (CVD)
includes….
 Cerebrovascular disease
 Coronary heart disease
 Peripheral vascular disease
Clinical risk assessment-history
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Age
Sex
Family history
Smoking
Alcohol
Diet
Physical activity
Socioeconomic status
Clinical risk assessment measurements
 Blood pressure
 BMI/waist circumference
 Cholesterol
 Glucose
 Renal function
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
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.
Alcohol
 Brief multi-contact intervention.
 Information about recommended daily limits
 Low to moderate alcohol consumption is
cardio-protective.
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.
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.
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
Lipid lowering in established
CVD
Patients with established CVD should be
considered for intensive statin therapy.
Lipid lowering without
established CVD
Recommended if
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age > 40 years
CVD risk > 20% in 10 years
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.
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.
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).
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
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.
Psychological stress
Depression
Lack of social support
Social isolation