CC Nov 2015 Screening asymptomatic adults for cardiovascular disease

echoecho's version from 2015-12-25 18:20


Question Answer
Cardiovascular disease is the leading cause of death among adults int he USA and includes a broad spectrum of illness, name these?1) unstable angina 2) myocardial infarction 3) heart failure
Unfortunately many patients are not diagnosed with cardiovascular disease until after what event, when irreparable damage and morbidity may have already occurred?index
List the risk factors that have been identified that contribute to cardiovascular disease?1) HTN 2) DM 3) dyslipidemia 4) tobacco abuse 5) family hx of early cardiovascular disease
If patients at high risk for cardiovascular disease can be identified prior to a clinical event, what is the hope?that steps can be taken to prevent and or mitigate its effects
In 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a guideline on the assessment of cardiovascular risk in adults. How many recommendations are there?three
Describe the first recommendation of these guidelines?1) the race-gender-specific pooled cohort equation ( should be used for non-Hispanic African Americans and non-Hispanic whites (male and females) 40 to 79 years of age to estimate the 10 year risk of a first cardiovascular event (defined as a first nonfatal myocardial infarction, death due to cardiovascular disease or fatal or nonfatal stroke)
*** Pts w/ an elevated 10-year risk (defined in the guidelines as > ___%) should have their risk managed according to the most recent ACC/AHA guidelines or blood cholesterol, obesity and lifestyle management?7.5%
In addition, what 3 things should be controlled?1) HTN 2) glycemic control in DM 3) tobacco cessation
The guidelines do note that "data are sparse on the use and impact of absolute risk scores in clincal practice in primary prevention setting, but gives this a strong what?recommendation
*** What is the 2nd guideline by the ACC/AHA?the race and gender specific pooled cohort equations for non-Hispanic whites may be considered in patients of HIspanic or Asian descent, realizing that may overestimate these patients' risk
What is the 3rd guideline by the ACC/AHA?1) if after a quantitative assessment per the first or second guideline, a risk-based assessment is intermediate, the use of any or all of the following may be considered to inform treatmnet decision making = 1) fm hx of premature cardiovascular disease (1st degree male relative < 55 years of age or 1st degree female relative < 65 years of age) 2) highly sensitive CRP > 2 mg/l 3) coronary artery calcium (CAC) score of > 300 Agatston units 4) ankle-brachial index < 0.9 5) treatment of high-risk patients per this assessment should be the same as in guideline number 1
What is the 4th guideline by the ACC/AHA?1) routine use of carotid intima-media thickeness is NOT recommended in clinical practicde for risk assessment of a first cardiovascular event
What is the 5th guidline by the ACC/AHA?the contribution of the following markers is uncertain at this time (apolipoprotein B, chronic kidney disease, albuminuria and cardiorespiratory fitness)
Aspirin can reduce what in men and what in women?1) MI 2) ischemic strokes
The decision to use ASA depends on what?patient's risk for GI bleeding balanced against the cardiovascular benefits
Is there any single cardiovascular risk cutoff value? no
The final recommendations regarding ASA use by the USPSTF has tables that allow a better assessment of risks and benefits, what is the website?
*** SUMMARY = the race-and-gender specific pooled cohort equation should be used for non-Hispanic African Americans and non-Hispanic whites (male and female) 40-79 years of age to estimate what?the 10-year risk of a first cardiovascular event
*** SUMMARY = the above equation can overestimate the risk for patients of what descent?Hispanic or Asian
*** SUMMARY = the routine use of carotid intima-media thickness is NOT recommended in clinical practice for risk assessment of a first cardiovascular event, true or false?true