GEM - cardiovascular risk cases - answer (2)

(2) A 40 year old woman has recently become a patient at a general practice in Coventry. During her new patient medical she stated that her father had suffered angina in his 60's and had a 'heart attack' at the age of 70 years. She had no significant past medical history of note and was on no regular medication. She has had no symptoms of cardiovascular disease and her blood pressure was 165/100 mmHg. The practice nurse checked her fasting lipids when she was seen for the new patient medical which revealed total cholesterol = 7.1 mmol/l, TG = 3.9, HDL-C 1.2 mmol/l.

i. Can you carry out a cardiovascular risk calculation given that there is only one blood pressure reading on which to base the calculation? Y

ii. What are the groups who are not appropriate for cardiovascular risk estimation according to the Joint British Guidelines? GPN reference click here

iii. Is the history of her father's cardiovascular disease significant to undertaking a cardiovascular risk calculation? No, family history is considered to be significant when a male relative's first CHD event occurred before the age of 55, or a female relative's first CHD event occurred before 65

iv. What is the difference between CHD and cardiovascular risk? GPN reference click here

v. What other significant changes were outlined in BHS guidelines with respect to estimation of cardiovascular risk? as mentioned in reference used for parts i and iv. Also guidance for use of lipid lowering treatment in diabetics below the age of 40 years (GPN reference click here) and provides a factor to increase risk if raised triglycerides (GPN reference click here)

vi. Should this lady be started on an aspirin? yes but her blood pressure needs to be controlled first.

vii. What initial management is suggested by the BHS guidelines for this lady's blood pressure?

screen for secondary causes and undertake an ECG and remeasure blood pressure weekly; if blood pressure remains raised then treat

viii. Whilst taking the blood test for the lipid screen the nurse also ticked the box on the blood form for CK which has revealed a markedly raised (predominantly CK-MM). What is the likely cause of this lady's hyperlipidaemia?

hypothyroidism - may cause a dyslipidaemia (GPN reference click here) and myopathy