Cardiovascular Notes

Non-Modifiable CV Disease Risk Factors

  • Crucial to recognize as they assess overall cardiovascular risk:
    • Age is included in the Aus CVD Risk Calculator for ages 45 to 79.
    • Gender affects definitions of premature CVD:
    • Male relative before 55.
    • Female relative before 65.
    • Family history of premature CVD significantly increases risk:
    • Associated with a 13% increased 5-year risk in men, 4% in women.
    • Family history can influence risk categorization.
    • Indigenous status is linked with increased risk; earlier screening recommended.

Modifiable CV Disease Risk Factors

  • These can be changed through lifestyle and pharmacotherapy:
    • Examples include:
    • Raised blood pressure (hypertension).
    • Dyslipidemia (total cholesterol to HDL-C ratio).
    • Diabetes, with screening at a younger age; HbA1c improves risk estimation.
    • Smoking.
    • Socioeconomic status, inferred from postcodes.
    • Atrial fibrillation.
    • BMI (indicating overweight status).
    • Renal function, especially moderate to severe chronic kidney disease which categorizes high risk.
    • Lifestyle factors (nutrition, physical activity, weight, alcohol intake).

Importance of Smoking Cessation

  • Smoking cessation reduces cardiovascular risk significantly:
    • Pharmacies play a vital role in cessation support.
    • Included in the CV risk calculator for risk assessment.

Benefits of Increased Physical Activity

  • Vital lifestyle modification for managing cardiovascular risk:
    • Improvement in exercise tolerance and overall health.
    • Combined with nutrition and weight management for optimal results.

Aus CVD Risk Calculator

  • New tool for assessing/manage cardiovascular disease risk:
    • Based on PREDICT-1° equation from a NZ cohort; modified for Australia.
    • Estimates risk of CVD events over the next 5 years (e.g. myocardial infarction, stroke).
    • Accounts for age, gender, lipid profiles, diabetes, smoking, and medications.
    • Includes additional factors like socioeconomic status and atrial fibrillation.
    • Risk categories are high (>10%), intermediate (5-9%), low (<5%).
    • Individuals close to risk thresholds are assigned to the higher category:
    • Patients with symptomatic CVD or chronic kidney disease are automatically high risk.

Hypertension

  • Importance of treating high blood pressure:
    • Reduces cardiovascular event risk and target organ damage.
    • Accurate BP measurement is crucial; follow recommended protocols.
    • Classification of hypertension based on BP readings (>140/90 mmHg).
    • Lifestyle changes significant in all hypertension patients:
    • Reducing salt intake, increasing physical activity, and dietary modifications can modestly decrease BP.

Initial Dizziness with Blood Pressure Lowering

  • Temporary dizziness is a common response to BP lowering:
    • Postural hypotension can occur, particularly with selective alpha blockers.

Selection of First-Line Antihypertensives

  • First-line options include:
    • ACE inhibitors, ATII antagonists (ARBs), thiazide diuretics, and dihydropyridine calcium channel blockers.
    • Avoid beta blockers without other comorbidities due to poor tolerance.

Drug Costs and Risks of Antihypertensives

  • Consideration of cost when choosing antihypertensives:
    • Thiazide diuretics are generally cheaper than ACE inhibitors and ARBs.
  • Risks of Thiazides:
    • New-onset diabetes, electrolyte disturbances.
  • Risks of Dihydropyridine Calcium Channel Blockers:
    • Headaches, peripheral edema, postural hypotension.

Hypertensive Crisis Management

  • Chronic vs. hypertensive crisis:
    • Chronic focuses on long-term BP management.
    • Crisis management involves rapid BP reduction based on the severity of symptoms.

Hypertension in Pregnancy

  • Pre-eclampsia is a major concern post 20 weeks gestation:
    • Methyldopa as first-line treatment.
    • Avoid ACE inhibitors in later trimesters due to fetal risk.

Dyslipidaemia Management

  • Initiation of lipid-lowering therapy based on CV risk profiles:
    • Statins as first-line agents.
    • Ezetimibe is used if LDL-C remains high despite statin therapy.
  • PCSK9 inhibitors reserved for specific high-risk populations.

Thrombosis Management

  • Antiplatelet therapy primarily with low-dose aspirin:
    • Risks vs. benefits need careful consideration.
  • Dual Antiplatelet Therapy (DAPT) post-stent insertion is essential.

Anticoagulation in Acute Myocardial Infarction

  • Utilized to prevent thrombus enlargement and intramural thrombus formation.

Secondary Prevention in CAD

  • Beta-blockers, ACE inhibitors, and statins are core medications post-MI.
  • Patient education on lifestyle changes, medication adherence, and recognizing symptoms of deterioration is vital for better outcomes.

Patient Counselling

  • Emphasizing the importance of compliance, education regarding side effects, and monitoring is essential for optimal treatment outcomes.