sHow to Prevent Cardiovascular Disease?
There are two methods of preventing cardiovascular disease
These are the primary prevention and secondary prevention.
Primary prevention is for patients who never had cardiovascular disease in the past.
Secondary prevention is for patients who have developed myocardial infarction, angina, transient ischemic attack, stroke or peripheral vascular disease.
The first step in preventing cardiovascular disease as part of the primary or secondary prevention is to optimize modifiable risk factors. These include stop smoking, stop drinking alcohol, advise on diet, weight loss or exercise and optimize the treatment of the co – morbidities such as diabetes.
In term of primary prevention of cardiovascular disease, we need to perform a QRISK 3 score. QRISK 3 score will calculate the percentage risk that a patient will have a myocardial infarction or stroke in the next 10 years.
Statins treatment (atorvastatin 20mg at night) should be started if there is a risk of more than 10% that the patients may develop stroke or heart attack over the next 10 years.
Patients with type 1 diabetes or chronic kidney disease for more than 10 years should be considered 20 mg atorvastatin.
Before starting treatment with statins, patients need to be informed of the side effects such as type 2 diabetes development, muscle weakness or pain / myopathy, or rarely hemorrhagic stroke.
Liver function tests need to be considered within 3 months of starting statin and later at 12 months. This is because statins can cause mild and transient rise in ALT or AST ( liver enzymes) in the first few weeks of use.
In terms of secondary prevention of cardiovascular disease the medications needed include atorvastatin, aspirin, clopidogrel, atenolol or bisoprolol, and ACE inhibitor such as Ramipril.
Lipids level need to be checked at 3 months and the dose of statin need to be increased with the aim to achieve 40% reduction in non –HDL cholesterol.
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