Primary prevention of CVD

GP Curriculum Homepage

This lecture in long-winded video form. Forgive me, I noob.

Definitions

Primary Prevention = prevention of disease ever happening by reducing risk factors

CVD = Cardio-Vascular Disease = Three Things:

• Coronary Heart Disease (CHD)
• Cerebrovascular Disease (CVD)
• Peripheral Vascular Disease (PVD)

Risk Factors

Modifiable and non-modifiable

Modifiable — things you have and things you do

• Things you have: high BP, high lipids, obesity
• Things you do: smoking, physical inactivity, unhealthy diet, too much EtOH

Change the things you have by changing the things you do

Non-modifiable

• Family history of CVD
• Ethnicity
• Male gender
• Increasing age
• Socioeconomic deprivation

The Healthy Individual

• BP <140/90mmHg
• Total cholesterol <5 mmol/L
• Not overweight
• Nonsmoker
• Physically active: at least 30mins 5x/week
• Healthy diet
• Less than 14U EtOH/week for both males and females
• Normal glucose metabolism
• Avoidance of stress

Risk Assessments

NHS Health Check: offered every 5 years to all aged 40–74 years

Use QRISK tools to assess 10-year risk of CVD except with:

• Established CVD
• At high risk of developing CVD, for example people with familial hyperlipidaemia, T1DM, or CKD
• Over 85 years of age — high risk due to age

Consider testing HbA1c and U&Es if high risk of DM or CKD.

QRISK <10%

• Offer lifestyle advice for the big 3: smoking, hypertension, high lipids
• Re-assess in 5 years

QRISK >10%

Lifestyle modification

If inappropriate, offer statins if:

• Under 85 years old
• CKD
• Type 1 diabetes mellitus (over 40y, DM for >10y, nephropathy, or other CVD risk factors)
• Type 2 diabetes mellitus
• Hypercholesterolaemia