Heart / Stroke Prevention
Adapted from Healthlink 2005.
CVD Risk Factors: Large Potential for Prevention
Cardiovascular Risk Factors
Heart Disease Prevention
Heart disease is the leading cause of death and disability.
The risk of heart disease increases as you age.
There are many things you can do reduce your chances of getting heart disease:-
Regular medical check up is advisable for early detection and control of cardiovascular risk factor.
At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer. (Adapted from WHO cancer control programmes)
What are the major causes of cancer?
Cancer risk can be reduced 60-70% by:-
Less Common Causes of Cancer:-
Specific Cancer Prevention Methods
Mammography annually or biennially
1. Breast self-examination monthly
2. Clinical breast examination annually
1. Annual Pap smear
2. HPV test
1. Carcinoembryonic Antigen (CEA) annually
2. Colonoscopy every 3-5 years
Eradication of Helicobacter pylori
Peripheral blood smear
1. Hepatitis screening
2. Alpha-fetoprotein (AFP)
3. USG abdomen
1. Hepatitis B vaccination
2. Clear fatty liver
1. Chest X-ray
2. CT lung every 3 years
Smoking cessation programme
2. ELISA against EBV specific IgA
1. CA 125 annually
2. Ultrasound Pelvis annually
1. Ultrasound Pelvis annually
2. Prostate Specific Antigen (PSA) annually
1. Ultrasound of thyroid
2. Thyroid scan
Skin examination annually
Precautions in the sun
Preventive recommendations for all cancer types:
Heart Disease Risk Assessment (Annual)
Treatment of Hypertension
Classification and management of blood pressure for adults.
DBP, diastolic blood pressure; SBP, systolic blood pressure.
* Treatment determined by highest BP category.
Table1: Clinical trial and guideline basis for compelling indications for individual drug classes.
* Compelling indications for antihypertensive drugs are based on benefits from outcome studies or existing clinical guidelines;
the compelling indication is managed in parallel with the BP.
Treatment of Hypertension
Goals of Therapy
The ultimate public health goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. Since most persons with hypertension, especially those age >50 years, will reach the DBP goal once SBP is at goal, the primary focus should be on achieving the SBP goal. Treating SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in CVD complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg.
Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hyper-tension. Major lifestyle modifications shown to lower BP include weight reduction in those individuals who are overweight or obese, adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan which is rich in potassium and calcium, dietary sodium reduction, physical activity, and moderation of alcohol consumption. Lifestyle modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk. For example, a 1,600 mg sodium DASH eating plan has effects similar to single drug therapy. Combinations of two (or more) lifestyle modifications can achieve even better results.
There are excellent clinical outcome trial data proving that lowering BP with several classes of drugs, including angiotensin converting enzyme inhibitors(ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and thiazide-type diuretics, will all reduce the complications of hypertension. Thiazide-type diuretics have been the basis of antihypertensive therapy in most outcome trials. In these trials, including the recently published Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial(ALLHAT), diuretics have been virtually unsurpassed in preventing the cardiovascular complications of hypertension. The exception is the Second Australian National Blood Pressure trial which reported slightly better outcomes in White men with a regimen that began with an ACEI compared to one starting with a diuretic. Diuretics enhance the antihypertensive efficacy of multidrug regimens, can be useful in achieving BP control, and are more affordable than other antihypertensive agents. Despite these findings, diuretics remain underutilized.
Thiazide-type diuretics should be used as initial therapy for most patients with hypertension, either alone or in combination with one of the other classes (ACEIs, ARBs, BBs, CCBs) demonstrated to be beneficial in randomized controlled outcome trials. The list of compelling indications requiring the use of other antihypertensive drugs as initial therapy. If a drug is not tolerated or is contraindicated, then one of the other classes proven to reduce cardiovascular events should be used instead.
Lifestyle Modifications to Manage Hypertension
Maintain normal body weight.
(body mass index 18.5−24.9 kg/m2).
5–20 mmHg/10 kg
Adopt DASH eating plan
Consume a diet rich in fruits, vegetables, and lowfat dairy products with a reduced content of saturated and total fat.
Dietary sodium reduction
Reduce dietary sodium intake to no more than 100 mmol per day.
(2.4 g sodium or 6 g sodium chloride).
Engage in regular aerobic physical activity such as brisk walking
(at least 30 min per day, most days of the week).
Moderation of alcohol
Limit consumption to no more than consumption 2 drinks (1 oz or 30 mL ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons.
DASH, Dietary Approaches to Stop Hypertension.
Oral Antihypertensive Drugs
Drug (Trade Name)
Aldosterone receptor blockers
Conbined alpha-and BBs
Angiotensin II antagonists
CCBs − non-dihydropyridines
Diltiazem extended release
Verapamil long acting
CCBs − dihydropyridines Amlodipine
Nicardipine sustained release
Central alpha-2 agonists and other centrally acting drugs
Combination Drugs for Hypertension
Fixed-Dose Combination, mg
ACEIs and diuretics
ARBs and diurectics
BBs and diuretics
Diuretic and diuretic
ARBs and CCBs
* Drug abbreviations:
Alogorithm for Treatment of Hypertension
Treatment of Hyperlipidemia
STEP 1: Determine lipoprotein levels - obtain complete lipoprotein profile after 9- to 12-hour fast.
ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dL)
LDL Cholesterol - Primary Target of Therapy
Near Optimal/Above Optimal
STEP 2: Identify presence of clinical atherosclerotic disease that confers high risk for coronary heart disease (CHD) events (CHD risk equivalent):
STEP 3: Determine presence of major risk factors (other than LDL):
Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals
HDL cholesterol 60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count.
Note: in ATP III, diabetes is regarded as a CHD risk equivalent.
STEP 4: If 2+ risk factors (other than LDL) are present without CHD or CHD risk equivalent, assess 10-year (short-term) CHD risk.
Three levels of 10-year risk:
STEP 5: Determine risk category:
LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories.
LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC)
LDL Level at Which to Consider Drug Therapy
CHD or CHD Risk Equivalents (10-year risk >20%)
≥130 mg/dL (100-129 mg/dL: drug optional)*
2+ Risk Factors (10-year risk ≤20%)
10-year risk 10-20%: ≥130 mg/dL
10-year risk <10%: ≥160 mg/dL
0-1 Risk Factor**
≥190 mg/dL (160-189 mg/dL: LDL-lowering drug optional)
Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory.
Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary.
STEP 6: Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.
STEP 7: Consider adding drug therapy if LDL exceeds levels shown in Step 5 table:
Drugs Affecting Lipoprotein Metabolism.
Agents and Daily Doses
HMG CoA reductase inhibitors (statins)
Lovastatin (20-80 mg)
Pravastatin (20-40 mg)
Simvastatin (20-80 mg)
Fluvastatin (20-80 mg)
Atorvastatin (10-80 mg)
Cerivastatin (0.4-0.8 mg)
Increased liver enzymes.
Bile acid Sequestrants
Bile acid Sequestrants
Cholestyramine (4-16 g)
Colestipol (5-20 g)
Colesevelam (2.6-3.8 g)
TG No change or increase
Decreased absorption of other drugs.
Immediate release (crystalline) nicotinic acid (1.5-3 gm).
Extended release nicotinic acid (Niaspan ®) (1-2 g).
Sustained release nicotinic acid (1-2 g).
Hyperuricemia (or gout).
Upper GI distress.
Gemfibrozil (600 mg BID).
Fenofibrate (200 mg).
Clofibrate (1000 mg BID).
LDL-C 5-20% (may be increased in patients with high TG).
Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution).
STEP 8: Identify metabolic syndrome and treat, if present, after 3 months of TLC.
Clinical Identification of the Metabolic Syndrome - Any 3 of the Following:
>102 cm (>40 in)
>88 cm (>35 in)
Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome.
Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, e.g., 94-102 cm (37-39 in). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from changes in life habits, similarly to men with categorical increases in waist circumference.
Treatment of the metabolic syndrome
STEP 9: Treat elevated triglycerides.
ATP III Classification of Serum Triglycerides (mg/dL).
Treatment of elevated triglycerides (≥150 mg/dL)
Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories.
CHD and CHD Risk Equivalent (10-year risk for CHD >20%)
Multiple (2+) Risk Factors and 10-year risk ≤20%
0-1 Risk Factor
If triglycerides 200-499 mg/dL after LDL goal is reached, consider adding drug if needed to reach non-HDL goal:
If triglycerides ≥500 mg/dL, first lower triglycerides to prevent pancreatitis:
Treatment of low HDL cholesterol (<40 mg/dL)
Treatment of Diabetes Mellitus
Type 1 Diabetes Medication Use Guidelines
Management of Hyperglycemia in Type 2 Diabetes
Treatment of Osteoporosis
Osteoporosis which means 'porous bones' causes bones to become weak and brittle.
Risk factors :
Test and diagnosis - Bone mineral density (BMD)
Treatment and Drugs :
Treatment of osteoporosis are based on a combination of bine mineral density and risk factors of the patient.
Drugs used are :-
Hyperthyroidism and Hypothyroidism
Treatment and Management of Hyperthyroidism and Hypothyroidism
Treatment and Management of Hyperthyroidism
Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine.
Treatment and Management of Hypothyroidism
Hypothyroidism (underactive thyroid) is a condition in which thyroid gland doesn't produce enough of certain important hormones.
Test and Diagnosis :-
Test and Diagnosis :-
Treatments and Drugs :-
Treatments and Drugs :-
The information contained on this site is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. HSC Medical Center accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.