ISCHAEMIC HEART DISEASE AND ATHEROSCLEROSIS, PREVENTION

Major risk factors for ischaemic cardio- and cerebrovascular disease:

» Diabetes mellitus.

» Hypertension.

» Central obesity: waist circumference  102 cm (men) and  88 cm (women). » Smoking.

» Dyslipidaemia:

>     total cholesterol > 5.0 mmol/L, or

>      LDL > 3 mmol/L, or

>    HDL < 1 mmol/L in men and < 1.2 mmol/L in women.

» Family history of premature cardiovascular disease in male relatives < 55 years and in female relatives < 65 years.

» Age: men > 55 years, women > 65 years.

 

GENERAL MEASURES

Lifestyle modification

All persons with risk factors for ischaemic heart disease should be encouraged to make the following lifestyle changes as appropriate:

» Smoking cessation.

» Weight reduction in the overweight patients, i.e. BMI > 25 kg/m2.

» Maintain ideal weight, i.e. BMI < 25 kg/m2.

» Reduce alcohol intake to no more than 2 standard drinks/day

» Follow a prudent eating plan i.e. low saturated fat, high fibre and unrefined carbohydrates, with adequate fresh fruit and vegetables.

» Moderate aerobic exercise, e.g. 30 minutes brisk walking at least 3 times a week.

 

Calculation of risk of developing cardiovascular disease over 10 years (in the absence of cardiovascular disease)

 

To derive the absolute risk as percentage of patients who will have a myocardial infarction over 10 years, add the points for each risk category (Section A). The risk associated with the total points is then derived from Section B.

 

S E C T I O N A

Age

(years)

MEN   WOMEN
30–34    0      0  
35–39    2      2  
40–44    5      4  
45–49

50–54

   6      5  
   8      7  
55–59    10     8  
60–64    11      9  
65–69    12      10  
70–74    14      11  
75–79    15      12  

 

Total cholesterol (mmol/L) MEN WOMEN
< 4.1 0 0
 4.1–5.1 1 1
 5–6.2 2 3
 6.2–7.2 3 4
> 7.2 4 5

 

HDL cholesterol  (mmol/L) MEN   WOMEN
> 1.6   –2     –2  
 1.3–1.5 1   –1
 1.2–1.3 0   0
 0.9–1.1 1   1
< 0.9 2   2

 

  MEN WOMEN
Smoker 4 3
Diabetic* 3 4

*Type 2 diabetics >40 years, qualify for statin therapy irrespective of risk score.

 

 
   

 

  MEN WOMEN
Systolic BP (mmHg) Untreated Treated Untreated Treated
< 120 –2 0 –3 –1
120–129 0 2 0 2
130–139 1 3 1 3
140–149 2 4 2 5
150–159 2 4 4 6
 160 3 5 5 7

 

S E C T I O N B

Total points

10-year risk %   MEN   10-year risk %   WOMEN
  <1      –3     <1      –2  
1.1   –2   1.0   –1
1.4   –1   1.2   0
1.6   0   1.5   1
1.9   1   1.7   2
  2.3     2     2.0     3  
2.8   3   2.4   4
3.3   4   2.8   5
3.9   5   3.3   6
4.7   6   3.9   7
  5.6     7     4.5     8  
6.7   8   5.3   9
7.9   9   6.3   10
9.4   10   7.3   11
11.2   11   8.6   12
  13.2     12     10.0     13  
15.6   13   11.7   14
18.4   14   13.7   15
21.6   15   15.9   16
25.3   16   18.5   17
  29.4     17     21.5     18  
>30   18   24.8   19
      28.5   20
>30   21+

» Established atherosclerotic disease, irrespective of cholesterol or triglyceride plasma concentrations:

>     ischaemic heart disease,

>      peripheral vascular disease, or >     atherothrombotic stroke.

» Type 2 diabetics > 40 years of age.

» Chronic kidney disease (eGFR < 60 mL/minute.)

» A risk of MI of greater than 20% in 10 years (see table above).

Such high-risk patients will benefit from lipid lowering (statin) therapy irrespective of their baseline LDL-C levels.

 

HMGCoA reductase inhibitors (statins) that lower LDL by at least 25%, e.g.:

  • Simvastatin, oral, 10 mg at night.

Note:

When lipid-lowering drugs are used, this is always in conjunction with ongoing lifestyle modification

 

REFERRAL

»     Random cholesterol >7.5 mmol/L.

»     Fasting (14 hours) triglycerides >10 mmol/L.

 

See also  LABORATORY INSTRUMENT AND EQUIPMENT

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