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Heart disease: patient introduction

Watch Kirstie introduce Steve Park, an overweight 49-year-old with reflux and high blood pressure.
KIRSTIE GALBRAITH: Welcome to this module on heart disease and treatment of high cholesterol with a medicine called atorvastatin. It’s from a group of medicines called statins. This week, we’ll meet Steve Park, an overweight 49-year-old with reflux and high blood pressure. In the following short video, Steve talks about his overall health.
STEVE PARK: Yeah, my health’s OK. No real problems. Bit of high blood pressure, but that’s pretty normal for someone who works hard. The doc keeps an eye on things and has put me on some tablets for it. He tells me to relax, to lose some weight. Just haven’t got time! I used to get a lot of heartburn, so the doc put me on some more medicine. I have one capsule in the morning, when I remember.
Well sometimes, just in case, I’ll also take some indigestion tablets too on those business lunches.
LYN CLEARIHAN: It is estimated that by 2020, heart disease will globally be the most common cause of death and disability. In Australia, heart disease is one of our biggest health problems. Unfortunately, one of the most challenging aspects of heart disease is that when a person dies from heart attack, it may be the first indication that they are suffering with a condition. About 59 Australians die each day from heart disease. That’s one death every 24 minutes. There is 1 in 2 lifetime risk of heart disease for a 40-year-old man and a 1 in 3 lifetime risk for a 40-year-old woman. So Steve Park, our patient, is already in at at-risk group.
From a general practitioner’s perspective, identifying patients at risk of heart disease is key to management, as it provides the opportunity to modify any identifiable risk factors. Modifiable risk factors include high blood pressure, diabetes, obesity, and smoking. Screening patients for risk factors is essential, and assessment tools are available to determine a patient’s risk of heart disease. Multiple risks produce additive effects on a person’s likelihood of having a cardiac event. Preventive strategies focus on decreasing overall risk by improving modifiable risk factors. For heart disease, this includes diet and lifestyle modification with an emphasis on increasing exercise and reducing weight. It also involves stopping smoking and maintaining normal blood pressure with the use of medication if necessary.
In order to minimise a patient’s risk of heart attack, the other crucial factor is to control their cholesterol. Even a small increase in cholesterol significantly increases the risk of heart disease. This is the case even when other risk factors, such as smoking and high blood pressure, are controlled. For patients who have already suffered a cardiac event, maintaining a healthy cholesterol level is one of the mainstays in preventing further cardiac events. This is called secondary prevention, whereas preventing heart disease from occurring in the first instance is called primary prevention. However, lowering cholesterol is not always easy. Especially in primary prevention, as the patient has not yet experienced any symptoms. Management requires ongoing support, counselling, and dietary advice in addition to medication.
Research strongly supports the use of statin drugs for both primary and secondary prevention. But statins have their own problems, and each patient thus needs individualised management. Some of these management issues will be discussed as you work through a detailed exploration of the science of statins and how they might be used in our patient, Steve Park, this week.
KIRSTIE GALBRAITH: So back to Steve. He has a history of being overweight and has high blood pressure. His mum Shirley, who we’ll meet in a later module, has Type II diabetes. If Steve were to develop diabetes, it would be a significant risk factor for development of heart disease. He’s recently been told his cholesterol is high. And since he has other risk factors for a cardiovascular event, his doctor wants to start him on atorvastatin. This week, we’ll be hearing about how atorvastatin works and the science behind this medicine. At the end of the module, we’ll check back with Steve and see how he’s getting on.

Watch Kirstie introduce Steve Park, an overweight 49-year-old with reflux and high blood pressure. Kirstie also reintroduce Steve’s mum, Shirley.

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The Science of Medicines

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