thera II test I pri. & secon. prevention

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thera II test I pri. & secon. prevention
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thera II test I pri. & secon. prevention
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  1. Three states of CV disease
    • coronary artery disease (coronary heart disease)
    • cerebrovascular disease (stroke)
    • peripheral artery disease
  2. 2 most important risk factors for myocardial infarction
    lipids and smoking
  3. fish oil
    • 1. typical dietary intake <1gram/day
    • 2. we are carrying better and fish oil isn't having a positive effect
    • 3. if you are neglecting treatment fish oil will work
    • 4. eat a diet with 1-2 servings of oily fish per week or 1 gram daily fish oil supplement (200-800mg EPA + DHA). 
  4. 5 CHD risk equivalents
    • 1. diabetes
    • 2. stroke/transient ischemic attack (TIA)
    • 3. peripheral artery disease (PAD)
    • 4. abdominal aortic aneurysm (AAA)
    • 5. calculated 10-year framingham risk for CHD of > 20%
  5. ATP II risk calculations, 5 major risk factors
    • 1. cigarette smoking
    • 2. age (men > 45yo; women >55 yo)
    • 3. hypertension (BP > 140/90 or on antihypertensive medication)
    • 4. low HDL (<40mg/dl
    •        - HDL > 60 mg/dl counts as a"negative" risk factor
    • 5. family history of premature CHD
    •       - CHD in male 1st degree relative < 55 yo
    •       - CHD in female 1st degree relative < 65 yo
    •  
  6. what is the JNC 7 guideline to initiate therapy with 2 agents for high blood pressure
    BP > 20/10
  7. 4 LDL risk factors and goals
    • 1. CHD + risk factors - optional < 70mg/dl
    • 2. CHD or CHD risk equivalent (10-year risk >20%) - < 100mg/dl
    • 3. multiple (2+) risk factors (10year risk < 20%) - < 130mg/dl
    • 4. 0-1 risk factor - < 160 mg/dl
  8. BP targets
    • general CAD prevention - <140/90
    • LVD - <120/80
    • the rest - 130/80
    •   stable angina
    •   UA/NSTEMI
    •   STEMI
  9. When should you recommend someone start taking aspirin for primary prevention of cardiovascular disease?
    Benefit outweighs risk only when risk of CV event begins to exceed 5-10% in 10 years
  10. aspirin for primary prevention of stroke and MI in men and women
    • MEN
    • 32% reduction in MI
    • No effect on stroke
    • WOMEN
    • 17% reduction in stroke
    • No effect on MI
  11. effects of aspirin therapy for primary prevention of MI and stroke among men and women with diabetes
    Aspirin significantly reduced the risk of MI in men by 43%, no benefit seen in women with diabetes
  12. when should aspirin be used for primary prevention of CV event with diabetes
    • Men >50 y/o + additional CHD risk factors (smoking, HTN, dyslipidemia, family history of premature CHD, albuminuria)
    • Women >60 y/o + additional CHD risk factor
  13. secondary prevention of CV event
    Combination of statin + ASA in secondary prevention may yield up to a 50% reduction in CV events
  14. chads2 scores
    • C - heart failure - 1pt
    • H - hypertension - 1pt
    • A - age > 75 years - 1pt
    • D - diabetes - 1pt
    • S - prior TIA or stroke - 2 pts

    predicts risk of stroke in patients with A-fib and determines degree of anticoagulation
  15. recommendations for anticoagulation on CHADS2 scores
    • Score = 0 (Low risk)
    • Aspirin
    • Score = 1-2 (Moderate risk)
    • Aspirin or warfarin
    • Score = 3+ (High risk)
    • Warfarin
  16. Primary prevention
    • avoid or delay the development of disease
    • Most public health promotion activities focus on primary preventative measures
    • immunizations
    • seat belts
    • counseling on healthy lifestyle
  17. Secondary Prevention
    • reduce recurrent events/prevent mortality in patients with disease
    • Interventions are to prevent the progression of disease and the emergence of symptoms
    • lifestyle
    • beta-blocker
    • eye exam for diabetes
  18. Relative Risk
    • Ratio of likelihood of a disease developing
    • Tells you nothing about actual risk
  19. Absolute Risk
    Probability of developing the disease in a finite period (ie within the next 10 years)
  20. Folic acid – Primary prevention
    • Pregnancy
    • Supplementation in pregnancy reduces neural tube defects
  21. Folic acid – Secondary prevention
    4 mg/day for women with previous child with neural tube defect
  22. Vitamin D – dosing recommendations
    • Breast-fed infants should be supplemented with 400 IU daily
    • RDA for children and adults (1 y/o+) = 600 IU daily
    • Adults >70 = 800 IU
    • Patients with known osteoporosis or previous fracture = 800 IU daily
  23. Calcium
    • Recommended for risk of osteoporosis
    • recommend calcium citrate
    • RDA 1000-1300 mg/day
  24. vitamin E
    never
  25. vitamin A
    never
  26. Vitamin B12
    In elderly, gastric atrophy and hypochlorhydra (low stomach acid secretion) result in less gastric acid and less absorption of vitamin B12
  27. Multivitamins
    Generally not beneficial for most adults who eat a balanced diet and get regular sun exposure or consume vitamin D-fortified dairy products
  28. Selenium
    Increased risk of diabetes in selenium group
  29. Dietary fiber
    RDA: 25 grams for women, 30 grams for men
  30. Alcohol
    Meta analysis found no benefit above 0.5 portion/day
  31. Primary Prevention of Diabetes
    who should be screened
    • early detection BMI > 25 +
    • 1. overweight
    • 2. over 45
    • 3. inactive
    • 4. first relative with DM
    • 5. baby weighing over 9 lbs
    • 6. HTN
    • 7. HDL <35 TG > 250
    • 8. History of vascular disease
    • 9. previous test showed glucose tolerance
  32. Secondary Prevention with Diabetes
    • Glucose control
    •    HbA1c <7%
    • Lipid control
    •    LDL <100mg/dL
    • Hypertension
    •    BP <130/80 mmHg
    • Eye exams
    • Foot exams
    • Kidney function monitoring
    • Immunizations
    • Flu, pneumococcal
    • Dental exams

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