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.

READ ALSO  ANAEMIA, MEGALOBLASTIC
 

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
 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  
 0.9–1.1 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 –3 –1
120–129 2 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  
1.6     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.

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Skip to toolbar