3- Risk factors, primary and secondary prevention

what is primary prevention

• prevention of CV or cerebrovascular disease in people at risk

• to reduce risk of CV events in people without disease, but who are at risk of developing it

what is used for primary prevention

• lifestyle changes

• CV risk factors profile modification

what is secondary prevention

• manifest PAD, CHD, stroke or TIA → prevention of further cardio cerebrovascular or peripheral vascular events

• slowing progression of established disease

what is used for secondary prevention

• lifestyle change

• CV risk factor profile modifictaion

• drugs

  • statins, antiplatelet, ACEi, ARBs, BB

what are modifiable risk factors

• smoking

• HT

• hyperlipidemia/ dyslipidemia

• T2DM

• obesity

what are non modifiable risk factors

• age

• gender

• family history

what are other risk factors

• alcohol

• exercise

• diet

• uric acid + homocystein levels

what are the CV effects of smoking

• increased HR, BP, LDL, vascular plaque

• decreased HDL

• platelet activation → thromboembolism

• endothelial dysfunction

• coronary artery spasms

what are tehe CV effects of DM

increased coagulation

• decreased fibrinolysis

• platelet hypercoagulability

• increased platelet aggregation and adhesion

what is the SCORE system

• european CV risk factor assessment

• based on gender, age, smoking, systolic BP, cholesterol level

• pts collect score percentage- determines 10 year risk of fatal CV disease

what is low and medium risk SCORE value

• low 1%

• medium 1-5%

what is high risk SCORE value

• one risk factor, but very high levels

• diabetes with no high risk features

• GFR 30-59ml/min

• SCORE 5-10%

what is very high risk SCORE value

• established CV disease diagnosed by clinical and/ or imaging measures

• diabetes with target organ damae or with high BP, high lipids, smoking

• GFR <30

• SCORE >10%

what are the target values in prevention

• LDL value

  • Very high risk: under 1.4 mmol/L or decreased by 50%

  • High risk: under 1.8 mmol/L or decreased by 50%

  • Medium or low risk: under 2 – 6.3 mmol/L

• smoking → no

• diet→ no saturated fats

• exercise

• BMI → 20-25kg/m2

• BP under 140-90

• DM→ HBa1c under 7%

what are antiplatelet drugs used

• clopidogrel, ticagrelor

  • inhibits ADP binding to platelets

• aspirin

  • inhibits COX enzyme

• abciximab

  • inhibits binding of molecules to GPIIb/ IIIa receptor sites

what are the anticoagulants used

• direct FXa inhibitors

  • rivaroxaban

• LMWH/ UFH

  • antithrombin → decreased Xa

• fondaparinux

• bivalirudin, dabigatran

  • direct thrombin inhibitors

what are the CHD secondary prevention targets

• 100mg ASA

• statins

• BB for target HR

• ACEi and ARBs for target BP

• clopidogrel for 1 year after ACS or PCI

• OAC for INR 2-3

• lower salt intake

• more vegeta