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CVD risk assessment and management (Assessment (QRISK 2 or 3) Repeat 5…
CVD risk assessment
and management
Definition
Assessing the risk of a patient experiencing
a CVD event in the next 10 years and
treating prophylactically
Indications
and CIs
Indication
1+ risk factor identified and patient consents
CIs
Known CVD (will need secondary prophylaxis)
T1DM, CKD, familial hypercholesterolaemia, age >85y
Assessment
(QRISK 2 or 3)
Repeat 5 yearly
Medical conditions
HTN/1st degree relative
T2DM, CKD stage 3-5, migraines, ED
Autoimmune disorder e.g. RA, SLE
Severe psychiatric disorder
Clinical parameters
BP, BMI, cholesterol:HDL
Demographics
Age, gender, postcode
Medications
Anti-HTN
Antipsychotics
Steroids
Management
Medical
Indication: QRISK >10%
Lipid-lowering
agent
Statin
Indication: 1L primary prophylaxis
E.g. atorvastatin, simvastatin
MOA: HMG-CoA reductase inhibitor, reducing
cholesterol synthesis in the liver
SEs: myalgia, myositis, abdo pain, deranged LFTs
CI: pregnancy, cholestasis, acute liver disease
Fibrates
Indication: 2L if statin CI/not tolerated
E.g. benzafibrate, ezetimibe
MOA: inhibits cholesterol synthesis
SE: flushes
Conservative
Information and advice
Explain QRISK2 gives estimate of risk over next 10y
Emphasise just an estimate
Support all patients, irrespective of score, to adopt healthier lifestyles
Find out ideas, concerns, expectations
Lifestyle
Diet
Low fat (<30% total intake, saturated <7%), low dairy, low salt (<6g/d), low sugar, fruit/veg (5/d), fish (2/wk), wholegrain cereals/breads (fibre), olive oil/rapeseed > animal fats
Exercise
30m/d brisk aerobic activity e.g. walk
150m/wk moderate intensity aerobic (breathless)
OR
75m/wk vigorous intensity,
OR
mix of both plus muscle strengthening exercises
Bouts of 10m as effective as longer bouts
Weight loss
BMI 20-25
Alcohol
Max 2u/d, or 14u/wk
2+ alcohol free days/wk
Smoking
Cessation