CVD Prevention – Key Questions Answered
Did you attend our virtual event covering Women’s Health, Dermatology and Long Term Conditions from 21 – 23 November 2023? Dr Elizabeth Martin, GPWSI Diabetes, Leeds Community Healthcare NHS Trust answers some of the key questions about CVD Prevention: adding years to life and life to years that we didn’t have time to answer on the day.
CVD Prevention – Key Questions Answered
QRisk2 or Qrisk3?
May 2023 NICE recommended QRisk3 over Qrisk2, as the latter would underestimate the 10 year risk within the next 10 years. Q3 includes risk factors such as SLE, migraine and others, which do not appear in Q2.
Is QRisk3 applicable to someone already on a statin for 1 year prevention?
Not really as the statin they are taking will have already reduced their risk. However, if you did do a QRisk and it still comes back >10% then it definitely supports being on the statin (check that at target on current dose) and needs other management to reduce risk further (BP/ wt).
If QRisk is>25%, and chol raised including HDL significantly, non-smoker, do we still advise lifestyle changes prior to starting statins?
I think its usually worth giving people the understanding of how important lifestyle is and the difference it can make and empower them to be responsible for their condition. I agree that at an increased risk of >25% as a non-smoker, it is very unlikely they will not need a statin but they may be impressed by the difference it makes if they change their diet, loose weight, increase exercise etc. Negotiate a delay in prescribing with patient?
On statin already, how important to optimise statins?
Essential! In a nutshell, aim to reduce non-HDL-c by >40% or aim for LDL-c to be <1.8 or non-HDL <2.5. (1ry and 2ry_ PCCS).
How often should you repeat lipids on a statin for 1yr prevention?
After initiating Rx, check lipid profile at 6/12. If not at target, treat accordingly, continue monitoring every 3/12 until at target. Once at required target, conduct annual review.
Anon: Starting DOAC for new onset AF, already on aspirin for 2 year prevention – add or swap?
Creatinine kinase 4X raised, previous increase from widespread muscle aches for a few years.
All info from: ‘Accelerated Access Collaborative: Statin Intolerance Pathway.’
DO NOT Start Statin if CK>4X Normal. Consider reasons for this increase: MSK conditions, metabolic, inflammatory: PMR, Vitamin D deficiency, check bone profile, CRP etc.
Okon EDEK: Views on Cows milk V vegetable ‘milk’.
In context of CVD protection diet: Semi-skimmed cow milk= 1.1gm/100ml
Oat milk =0.1gm/100ml
Soya milk =0.2gm/100gm
But in normal diet this is unlikely to make any real difference unless drinking large amounts of cows milk.