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Flashcards in Primary CVD Prevention Deck (12)
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1
Q

Primary goals in CVD prevention

A

-Blood pressure control and lipid control account for 40% decline in CVD mortality in the last decade -Other risk factors that need to be controlled: smoking and diabetes -Focus on primary prevention, not curing the problem that already exists.

2
Q

Tools in CVD prevention

A

-exercise, weight loss, limiting salt/EtOH. -multi-drug therapy and JNC-7 guidelines -community health workers to reach at-risk communities -policy changes

3
Q

Public health benefits of BP control

A

-by lowering BP we can reduce heart failure and reduce the risk of stroke, MI and CV death at any age -tight systolic BP control leads to reduced risk of microvascular endpoints, fatal/non-fatal strokes, heart failure and fatal/non-fatal MIs -reduction in these outcomes = fewer hospitalizations/costly interventions = better overall health

4
Q

Barriers to CVD risk reduction

A
  • Compliance: poor therapy regimen compliance with blood pressure therapy
    • High risk hypertensive patients require multiple drugs (at least 3) and still don’t achieve SBP goals.
    • Only 20% of patients achieve greater than 80% adherence
  • Also, keep in mind that patients who have depression may have lower compliance
  • patients are individuals w/unique communities & unique challenges
5
Q

Major reasons cited for non-adherence to BP meds (6)

A
  • patients forget (55%)
  • don’t think it is necessary (14%)
  • hate taking meds (7%)
  • don’t like being dependent on meds (7%)
  • side effects of drugs (6%)
  • too expensive (2%).
6
Q

JNC-7 guidelines in HTN

A
  • start 2 drugs simultaneously if systolic
    • BP is > 20 mm Hg or
    • diastolic > 10 mm Hg above goal
7
Q

Major myths in primary CVD precention

A
  1. raising HDLs w/drugs saves lives
  2. tight glycemic control in diabetics improves CV outcomes
  3. “an aspirin a day keeps the doctor away”
8
Q

Summary of research regarding “HDL-raising” myth

A
  • Bad of statins: increased blood sugar andglycosylated hemoglobin (HbA1c) levels
  • Good of statins: removal of routine monitoring of liver enzymes from drug labels
  • Bad of statins: potential for generally non-serious and reversible cognitive side effects
  • overall: benefits outweigh risk, but primary prevention evidence is slightly less compelling
9
Q

Summary of research regarding “tight glycemic control” myth

A
  • Higher glucose = higher risk
  • However, aggressive glucose control may lead to an increase in mortality
10
Q

Summary of research regarding “asprin/day” myth

A
  • Works in CAD, and stroke patients
  • Recent randomized trials in DM- no benefit
  • Benefits in primary prevention are small & offset by risks of major bleeding
  • ASA remains recommended in multiple guidelines, but not FDA approved in primary prevention
11
Q

Conclusions regarding CVD prevention

A
  • Assess global risk in all your patients and treat patients holistically
  • Start a statin in high-risk patients with elevated LDL-cholesterol
  • Gain patient buy-in and incorporate tools to improve adherence:
  • Health care delivery alone is not enough
    • ​Community-based programs are beneficial…
12
Q

Tools to improve adherence

A

– Frequent visits and encouragement,

– Once daily or combination drugs,

– Assess for depression & co-factors (alcohol, drugs, etc.)