Cardiovascular Disease Prevention Strategies

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Questions and Answers

What is the primary objective of primary prevention in cardiovascular health?

To treat existing cardiovascular diseases

To monitor cardiovascular risk factors

To provide rehabilitation for heart patients

To avert the occurrence of disease or injury (correct)

Which of the following substances is NOT typically found in the plaque associated with atherosclerosis?

Fat

Calcium

Glucose (correct)

Cholesterol

Which type of prevention aims to reduce the risk of atherosclerotic cardiovascular disease after it has already developed?

Secondary prevention (correct)

Primary prevention

Tertiary prevention

Quaternary prevention

Atherosclerosis can affect various arteries in the body. Which of the following is NOT affected by atherosclerosis?

Venous arteries Signup and view all the answers

Which of the following diseases is directly linked to atherosclerotic cardiovascular disease?

Peripheral arterial disease Signup and view all the answers

What is the primary intent of primary prevention in cardiovascular disease?

To reduce or eliminate causative risk factors Signup and view all the answers

Which of the following is NOT a common factor that cannot be changed in preventing cardiovascular disease?

Weight management Signup and view all the answers

In secondary prevention, what is the main focus of intervention?

Early identification post-cardiovascular disease onset Signup and view all the answers

What role does patient-centered approaches play in comprehensive ASCVD prevention?

Guiding discussions through shared decision-making Signup and view all the answers

Which group is primarily responsible for initiating aggressive treatment of abnormal risk factors in heart disease prevention?

Primary health care providers Signup and view all the answers

Which factor is an example of a social determinant of health that influences ASCVD risk?

Access to healthy food options Signup and view all the answers

What is the recommended approach for managing risk factors associated with ASCVD?

A collaborative, team-based care approach Signup and view all the answers

What type of patient evaluation should be conducted for those at risk of cardiovascular disease?

Regular assessments and retests at intervals Signup and view all the answers

Which of the following is an example of secondary prevention?

Rehabilitating a patient after a heart attack Signup and view all the answers

What is the first action recommended for primary health care givers in the prevention of heart disease?

Risk assessment Signup and view all the answers

Study Notes

Primary and Secondary Prevention of Cardiovascular Disease

Cardiovascular disease (CVD) prevention involves strategies to reduce risk and manage existing conditions.
Primary prevention aims to prevent CVD before it develops. This includes managing risk factors.
Secondary prevention targets those already diagnosed with CVD. The goal is intervention to slow disease progression and prevent recurrences.

Objectives

Define atherosclerotic disease, primary prevention.
Define atherosclerotic disease, secondary prevention.
Identify ways to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) outcomes.
This includes acute coronary syndromes, myocardial infarction, stable or unstable angina, arterial revascularization, stroke/transient ischemic attacks, and peripheral arterial disease.

Definition of Primary Prevention

US spending in 2017 on healthcare was $3.5 trillion, but only 2.5% was on public health activities towards preventing illness.
Primary prevention aims to avert disease or injury.

Atherosclerotic Cardiovascular Disease

Atherosclerosis is a disease in which plaque builds up in the arteries.
Plaque consists of fat, cholesterol, calcium, and other substances.

Types of Atherosclerosis

Atherosclerosis can impact any artery in the body, including the heart, brain, arms, legs, pelvis, and kidneys.

Ischemic heart disease (IHD) or coronary artery disease (CAD).
Angina
Carotid artery disease
Peripheral artery disease (PAD)
Chronic kidney disease (CKD)

Levels of Prevention

Primary Prevention: An intervention done prior to an event.
- Example: Managing diabetes in people before a heart attack;
Secondary Prevention: An intervention done after an event.
- Example: Treatment for someone post-heart attack to stop future heart attacks.

Preventing Heart Disease

Important for primary caregivers, cardiologists, and pharmacists.
Prevention begins with risk assessments emphasizing lifestyle.
Include attention to weight and physical activity, and aggressively treat abnormal risk factors like hypertension, hyperlipidemia, and diabetes.

Options for Patients Being Evaluated for Primary Prevention

Healthy patients should be followed less frequently than patients with risk factors or pre-existing CVD.
Patients with existing CVD receive more frequent, detailed follow-up, including assessments and treatments.

Primary Prevention of Cardiovascular Disease (Risk Factors)

Modifiable factors: Type 2 diabetes, Smoking, Physical inactivity, Obesity, High blood pressure.
Non-modifiable factors: Age, Genetic factors, Ethnicity.

Recommendations for Assessment of Cardiovascular Risk

Adults 40-75 years old: Routinely assess traditional risk factors and calculate 10-year ASCVD risk.
Adults 20-39 years old: Assess ASCVD risk factors every 4-6 years.
Borderline or intermediate risk patients: Utilize additional risk factors to guide preventative decisions, potentially including statin therapy.

ASCVD Risk Score

Use an online calculator.
Input required factors like age, sex, race, blood pressure, cholesterol, history of diabetes, etc.

Risk Enhancing Factors for Clinician-Patient Risk Discussion

Family history of premature ASCVD
Primary hypercholesterolemia
Chronic kidney disease
Metabolic syndrome
Chronic inflammatory conditions (RA, psoriasis, lupus, HIV)
History of premature menopause
High risk race/ethnicity
Lipid biomarkers

Cardiovascular risk, diet, exercise, physical activity, obesity prevention and management.
Diabetes mellitus and high blood pressure are also addressed.
Tobacco treatment should also be considered.

Modifiable Lifestyle Factors – Diet and Nutrition

Emphasize vegetables, fruits, legumes, nuts, whole grains, and fish.
Replace saturated fat with monounsaturated and polyunsaturated fats.
Minimize processed meats and refined carbohydrates. Reduce intake of sweetened beverages.
Avoid trans fats.

Modifiable Lifestyle Factors - Exercise and Physical Activity

Counsel patients regularly on physical activity, and aim for at least 150 minutes per week of moderate intensity exercise or 75 minutes of vigorous intensity aerobic exercise.
If unable to do above, any exercise is still recommended, including reduced sedentary behavior.

Modifiable Lifestyle Factors – Overweight and Obesity

Weight loss is part of ASCVD risk reduction strategies, including counseling and comprehensive lifestyle interventions.
BMI calculation should be done annually or more frequently as needed; waist circumference may also be used.

Modifiable Lifestyle Factors – Type 2 Diabetes

Tailored nutrition plan focusing on heart healthy dietary patterns. Daily moderate intensity exercise (150 minutes/week).
Metformin or SGLT2 inhibitors and/or GLP-1 agonists can be reasonable additions to the treatment plan.

Interventions for environmental and psychological factors (depression, stress, self-efficacy, social support) should be included in the treatment approach.
Enhance lifestyle factors to improve glycemic control and adherence to treatment.

Moifiable Lifestyle Factors – High Blood Cholesterol

Moderate intensity statin therapy is recommended for intermediate-risk patients.
Adults 40-75 with diabetes: Moderate statin is recommended regardless of the risk score.
Patients with 20-75 with LDL above 190mg/dl: Use maximally tolerated statin
High-intensity statins for adults with diabetes and multiple CVD risk factors; reduce LDL by ≥50%.

Moifiable Lifestyle Factors – High Blood Pressure

Weight loss, heart-healthy diets, dietary potassium supplementation, structured exercise programs are important components for treatment, and alcohol should be limited
For patients > 130/80, BP lowering medications should be considered.

Modifiable Lifestyle Factors – Tobacco

Assess tobacco use and status and address it in each visit, guiding patients to quit.
Combination of behavioral and pharmacotherapy treatment is recommended
Avoid second-hand smoke exposure

Provide social support counseling.

Secondary Prevention – Diabetes (Type 2) Prevention and Treatment

Aim for A1C < 7%.
Lifestyle interventions and antihyperglycemic medications (refer to a nutritionist and physician).
- Metformin is a good first line choice, with Liraglutide or empagliflozin available as second-line options for specific cases.
- Oral agents or insulin may become appropriate.
- ACE or ARB is suitable first line options for hypertension management.
- Cholesterol should be treated, aiming to minimize end-organ damage.

Secondary Prevention – Exercise

Aim for 10,000 steps or appropriate exercise target.
Limit sedentary time.
Cardiac rehabilitation for patients with CVD events or heart failure with reduced ejection fraction.

Cardiac Rehabilitation

Multidisciplinary approach involves structured exercise, coping skills, and medication management support for CVD patients.
Reduces mortality rates significantly over 5 years compared to only medical therapy.

Secondary Prevention – Heart Failure

Lifestyle interventions are important.
Medications (ACE Inhibitors, ARBs, ARNIs, Beta Blockers, etc.)
Assess need for devices such as ICD/CRT-D
Include cardiac rehabilitation, diuretics, and actively manage blood pressure, cholesterol and blood sugar.

Aspirin for Prevention of Cardiovascular Disease

Aspirin has benefits in cardiovascular disease prevention, particularly in patients with specific risk factors and conditions.

Recommendations for Aspirin Use for Primary Prevention

75-100mg daily aspirin is a potential choice in certain high-risk patients (40-70 but not >70).
Not routinely recommended for primary prevention over 70.

Aspirin History

Ancient societies and subsequent civilizations used willow bark remedies, leading to aspirin development
Process to reduce stomach irritation was discovered and further research and trials confirmed its value in CVD prevention.

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Description

This quiz explores the primary and secondary prevention strategies for cardiovascular disease (CVD). It will cover defining atherosclerotic disease, identifying risk reduction methods, and understanding goals for those diagnosed with CVD. Enhance your knowledge on preventing acute coronary syndromes and other related conditions.