ASSeSSing the risk of fatal cardiovascular disease

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1 ASSeSSing the risk of fatal cardiovascular disease «Systematic Cerebrovascular and coronary Risk Evaluation» think total vascular risk Assess the risk Set the targets Act to get to goal revised; aupril 25 th 2012 Multiple risk factors usually contribute to the atherosclerosis that causes cardiovascular disease. These risk factors interact, sometimes multiplicatively. Manment of the individual components of risk such as smoking, diet, exercise, blood pressure and lipids impacts on total cardiovascular risk. Thus the aim should be to reduce total risk; if a target cannot be reached with one risk factor, total risk can still be reduced by reducing other risk factors. Recommended by Canadian Vascular Coalition 2004

how 1 Find the cell nearest to the person s gender,, total/hdl-chol.

2 This will give you a percent representing the risk of dying from vascular disease in next 10 years.

0 (women); obesity, BMI > 30 Kg/m 2, waist circumference 102 cm or higher in men or 88 cm or higher in women; sedentarity; diabetes: multiply by 3 in men and by 5 in women; very high

Interpretation (Risk level) <1 % 1 % 2 % 3 à 4 % 5 à 9 % 10 à 14% 15 % Low ( <1% ) High ( >5%) Use SCORE unless known cardiovascular disease, diabetes with microalbuminuria, markedly increased

2 how 1 Find the cell nearest to the person s gender,, total/hdl-chol. ratio and systolic blood pressure values, bearing in mind that the risk will be higher as the person approaches the next, cholesterol or blood pressure category. 2 This will give you a percent representing the risk of dying from vascular disease in next 10 years. 3 Risk may be higher than indicated in the chart if: preclinical atherosclerosis already established; family history of premature cardiovascular disease: X 1.7 (men), X 2.0 (women); obesity, BMI > 30 Kg/m 2, waist circumference 102 cm or higher in men or 88 cm or higher in women; sedentarity; diabetes: multiply by 3 in men and by 5 in women; very high triglycerides; high levels of hsc-reactive protein, fibrinogen, homocystein, apoliprotein B or Lp(a). Interpretation (Risk level) <1 % 1 % 2 % 3 à 4 % 5 à 9 % 10 à 14% 15 % Low ( <1% ) High ( >5%) Use SCORE unless known cardiovascular disease, diabetes with microalbuminuria, markedly increased single risk factors or older than 70 years of. The charts should be used in the light of the clinician s knowledge and judgement, especially with regard to local conditions. relative risk chart Use this chart to show younger people, less than 40, at low total risk that, relative to their group, their risk may be many times higher than necessary. This may help to motivate decisions about avoidance of smoking, healty nutrition and exercise, as well as flagging those who may become candidates for medication. Systolic BP < Total cholesterol to HDL-C ratio

ASSeSSing 10 year risk of fatal cardiovascular disease Women Men 5 7 8 10 11 65 10 13 15 18 20 7 9 11 13 14 5 7 8 9 10 9 12 14 17 19 7 9 10 12 14 5 7 8 9 10 65 17 22 26 30 33 13 16 19 22 25 9 12 14

3 ASSeSSing 10 year risk of fatal cardiovascular disease Women Men Systolic blood pressure (mmhg) Systolic blood pressure (mmhg) Total cholesterol to HDL -C ratio Total cholesterol to HDL -C ratio determining vascular Vascular, or the of a person s arteries, is determined by comparing a person's risk with that of an older person having the same risk level but risk factor values situated in an optimal interval. More information can be found on the following website: Vascular Age evaluation table After having used the SCORE chart to calculate the % of risk, use this table to estimate the vascular. SCORE VA women VA men

What are the objectives of vascular prevention?

2 To Obtain the caracteristics of people who tend to stay healthy: 0 No smoking 5 Five portions of fruit and vegetable or more a day and healthy food choices 30 Thirty minutes of physical exercise

BMI under 25 Kg/m 2 and no abdominal obesity 3 To achieve more rigorous risk factor control in high risk subjects, especially those with established vascular disease, diabetes or kidney disease.

minutes 4-7 days/week Dietary patterns DASH diet Smoking cessation Smoke free environnement 2012 Canadian Hypertension Education Program Recommendations Vascular Risk and Target Lipid levels Risk

80 Moderate Clinical judgement Low Clinical judgement Æ LDL-C = LDL-Cholesterol; Apo B = Apolipoprotein B level Adapted from: Can J cardiol.

4 What are the objectives of vascular prevention? 1 To Assist those at low risk of vascular disease to maintain this state lifelong, and to help those at higher increased total vascular risk to reduce it. 2 To Obtain the caracteristics of people who tend to stay healthy: 0 No smoking 5 Five portions of fruit and vegetable or more a day and healthy food choices 30 Thirty minutes of physical exercise (moderate intensity) a day Blood pressure under /90 mmhg 5 Total-cholesterol under 5 mmol/l 3 LDL-cholesterol under 3 mmol/l 0 Zero diabetes ; fasting plasma glucose under 7 mmol/l 0 Zero obesity ; BMI under 25 Kg/m 2 and no abdominal obesity 3 To achieve more rigorous risk factor control in high risk subjects, especially those with established vascular disease, diabetes or kidney disease. Lifestyle Therapies in Hypertensive Adults Intervention Target Limit sodium-added food < 1500 mg/day Weight reduction BMI < 25 kg/m 2 Alcohol restriction < 2 drinks/day Physical activity minutes 4-7 days/week Dietary patterns DASH diet Smoking cessation Smoke free environnement 2012 Canadian Hypertension Education Program Recommendations Vascular Risk and Target Lipid levels Risk Level Primary Targets LDL-C (mmol/l) Apo B (g/l) High < 2.0 ou 50% < 0.80 Moderate Clinical judgement Low Clinical judgement Æ LDL-C = LDL-Cholesterol; Apo B = Apolipoprotein B level Adapted from: Can J cardiol Oct; 25(10): Blood pressure target values for treatment of hypertension Condition Isolated systolic hypertension < Systolic Diastolic hypertension Systolic BP < Diastolic BP < 90 Diabetes Systolic BP < 130 Diastolic BP < Canadian Hypertension Education Program Recommendations 4 To prescribe ASA, statin, ACE-I or ARB in these high risk subjects, especially those with established atherosclerotic disease. 5 To consider pharmacological treatment to control hypertension and/or diabetes. Target SBP and DBP (mm Hg) Recommended targets for glycemic control A1C FPG PG (%) (8h)orpreprandial 2h postprandial (mmol/l) (mmol/l) Diabetes < Type 1 and ( if A1C targets Type 2 not being met) A1C = Glycated hemoglobin; FPG = Fasting plasma glucose; PG = plasma glucose Canadian Diabetes Association 2008 Clinical Practice Guidelines, S30 «Systematic Cerebrovascular and coronary Risk Evaluation» Assessing 10 year risk of fatal cardiovascular disease

Established vascular disease Diabetes Man > 45(years old) Women > 50(years old) Diabetes > 15 years and d

of fruit and vegetable or more a day and varied healthy foods, cereals or whole wheat bread, fish, limit

exercise on most days Reduce weight if BMI > 25 kg/m 2 or waist circumference equal or higher than 88 cm

established vascular disease or diabetes with end organ dam: Consider ASA, Statin, ACE-I or ARB Consider

5 Established vascular disease Diabetes Man > 45(years old) Women > 50(years old) Diabetes > 15 years and d > 30 CV Multi risk Microvascular disease Markedly elevated single risk factor E.g.: LDL-C > 6 mmol/l BP > /110, SCORE Risk > 5 % SCORE Risk < 5 % 0 No smoking recommendations 5 portions of fruit and vegetable or more a day and varied healthy foods, cereals or whole wheat bread, fish, limit salt (sodium) intake Lifestyle advice to maintain low risk status 30 minutes of moderately vigorous exercise on most days Reduce weight if BMI > 25 kg/m 2 or waist circumference equal or higher than 88 cm (women), 102 cm (men) PREVENTION COMBINATION If SCORE risk is equal or exceeds 5 % or if there is established vascular disease or diabetes with end organ dam: Consider ASA, Statin, ACE-I or ARB Consider a pharmacological treatment to control hypertension and/or diabetes. SCORE Canada by René Gagnon M.D., Denis Drouin M.D. and Guy Tremblay M.D. Re-assess total risk every two years Bruno Roy graphiste brgraph@sympatico.ca

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,