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.