CVRM
Cardiovasculair risicomanagement
,Inhoud
H1. Anatomie & Fysiologie.....................................................................................................................6
Voorbeelden van HVZ.........................................................................................................................6
Risicofactoren voor HVZ:.................................................................................................................7
Hypertensie........................................................................................................................................9
Het RAASysteem.............................................................................................................................9
Gevolgen van hypertensie............................................................................................................10
Tensiemeting.................................................................................................................................10
Behandeling van hypertensie........................................................................................................11
Medicamenteuze behandeling van hypertensie...........................................................................11
Wanneer is welke behandeling nodig?.............................................................................................11
Stap 1:...........................................................................................................................................11
......................................................................................................................................................12
Stap 2............................................................................................................................................13
Dyslipidemie.....................................................................................................................................13
Functie van cholesterol.................................................................................................................13
Vetsoorten....................................................................................................................................14
Lipoproteïnen...............................................................................................................................14
Psychofysiologie............................................................................................................................15
Cholesterolsyntheseremmers.......................................................................................................15
Behandeling hypercholesterolemie..............................................................................................15
Stappenplan statine......................................................................................................................16
Bijwerkingen statines....................................................................................................................17
Beleid bij statines..........................................................................................................................17
H2. Medicamenteuze behandeling CVRM............................................................................................17
Lipiden..............................................................................................................................................17
Tensie................................................................................................................................................18
Medicatie en het RAASysteem..........................................................................................................18
Bètablokkers.................................................................................................................................18
ACE-remmer.....................................................................................................................................19
Angiotensine-2-receptorblokker (ARB).............................................................................................19
Salicylaten.........................................................................................................................................19
Clopidogrel.......................................................................................................................................19
Statinen............................................................................................................................................19
Calciumantagonisten........................................................................................................................19
,Diuretica...........................................................................................................................................19
Uitwerking medicatie........................................................................................................................20
A.Statinen.....................................................................................................................................20
Atorvastatine................................................................................................................................20
Pravastatine..................................................................................................................................20
Fluvastatine..................................................................................................................................20
Rosuvastatine................................................................................................................................21
Simvastatine.................................................................................................................................21
B.Steroltransportblokker...............................................................................................................21
Ezetimib........................................................................................................................................21
C. PCSK9-remmers........................................................................................................................22
Alirocumab...................................................................................................................................22
Evolocumab..................................................................................................................................22
D. Thiazide-diuretica.....................................................................................................................23
Chloortalidon................................................................................................................................23
Hydrochloorthiazide.....................................................................................................................23
Indapamide...................................................................................................................................24
E. Kaliumsparende diuretica.........................................................................................................24
Eplerenon.....................................................................................................................................25
Finerenon.....................................................................................................................................25
Spironolacton................................................................................................................................25
Triamtereen..................................................................................................................................26
F. Lisdiuretica................................................................................................................................26
Bumetanide..................................................................................................................................26
Furosemide...................................................................................................................................27
G. Bètablokkers.............................................................................................................................27
Acebutolol....................................................................................................................................27
Atenolol........................................................................................................................................28
Bisoprolol......................................................................................................................................29
Carvdilol........................................................................................................................................29
Celiprolol......................................................................................................................................30
Metoprolol....................................................................................................................................30
Propranolol...................................................................................................................................31
Sotalol...........................................................................................................................................31
H. ACE-remmers............................................................................................................................32
Benazepril.....................................................................................................................................32
, Enalapril........................................................................................................................................32
Lisinopril.......................................................................................................................................33
Perindopril....................................................................................................................................33
i.ARBS (Angiotensinereceptorblokkers)........................................................................................33
Candesartan..................................................................................................................................33
Irbersartan....................................................................................................................................34
Losartan........................................................................................................................................34
valsartan.......................................................................................................................................34
J. Salicylaten als trombocytenaggregatieremmers........................................................................34
Acetylsalicylzuur...........................................................................................................................34
k. P2Y12-Remmers........................................................................................................................35
Clopidogrel...................................................................................................................................35
ticagrelor.......................................................................................................................................35
L. Calciumantagonisten.................................................................................................................36
Lercanidipine................................................................................................................................36
Amlodipine...................................................................................................................................36
Diltiazem.......................................................................................................................................36
Verapamil......................................................................................................................................37
M.Anticoagulantia............................................................................................................................37
Apixaban...........................................................................................................................................37
Dabigatran........................................................................................................................................37
Edoxaban..........................................................................................................................................38
Rivaroxaban......................................................................................................................................38
H3. CVRM-NHG standaard....................................................................................................................39
Richtlijnen diagnostiek......................................................................................................................39
Inschatting van risico HVZ.............................................................................................................39
Opstellen van een cardiovasculair risicoprofiel.............................................................................39
Tabel 1. Risicoschatting middels EGFR ACR...................................................................................39
De SCORE-risicotabel (tabel 2)......................................................................................................40
Aanvullende risicofactoren HVZ....................................................................................................40
Niet-medicamenteuze behandeling..................................................................................................41
Leefstijladviezen...........................................................................................................................41
Psychosociale factoren..................................................................................................................41
Sedentaire leefstijl en lichamelijke activiteit.................................................................................41
Roken............................................................................................................................................41
Voeding.........................................................................................................................................41
Cardiovasculair risicomanagement
,Inhoud
H1. Anatomie & Fysiologie.....................................................................................................................6
Voorbeelden van HVZ.........................................................................................................................6
Risicofactoren voor HVZ:.................................................................................................................7
Hypertensie........................................................................................................................................9
Het RAASysteem.............................................................................................................................9
Gevolgen van hypertensie............................................................................................................10
Tensiemeting.................................................................................................................................10
Behandeling van hypertensie........................................................................................................11
Medicamenteuze behandeling van hypertensie...........................................................................11
Wanneer is welke behandeling nodig?.............................................................................................11
Stap 1:...........................................................................................................................................11
......................................................................................................................................................12
Stap 2............................................................................................................................................13
Dyslipidemie.....................................................................................................................................13
Functie van cholesterol.................................................................................................................13
Vetsoorten....................................................................................................................................14
Lipoproteïnen...............................................................................................................................14
Psychofysiologie............................................................................................................................15
Cholesterolsyntheseremmers.......................................................................................................15
Behandeling hypercholesterolemie..............................................................................................15
Stappenplan statine......................................................................................................................16
Bijwerkingen statines....................................................................................................................17
Beleid bij statines..........................................................................................................................17
H2. Medicamenteuze behandeling CVRM............................................................................................17
Lipiden..............................................................................................................................................17
Tensie................................................................................................................................................18
Medicatie en het RAASysteem..........................................................................................................18
Bètablokkers.................................................................................................................................18
ACE-remmer.....................................................................................................................................19
Angiotensine-2-receptorblokker (ARB).............................................................................................19
Salicylaten.........................................................................................................................................19
Clopidogrel.......................................................................................................................................19
Statinen............................................................................................................................................19
Calciumantagonisten........................................................................................................................19
,Diuretica...........................................................................................................................................19
Uitwerking medicatie........................................................................................................................20
A.Statinen.....................................................................................................................................20
Atorvastatine................................................................................................................................20
Pravastatine..................................................................................................................................20
Fluvastatine..................................................................................................................................20
Rosuvastatine................................................................................................................................21
Simvastatine.................................................................................................................................21
B.Steroltransportblokker...............................................................................................................21
Ezetimib........................................................................................................................................21
C. PCSK9-remmers........................................................................................................................22
Alirocumab...................................................................................................................................22
Evolocumab..................................................................................................................................22
D. Thiazide-diuretica.....................................................................................................................23
Chloortalidon................................................................................................................................23
Hydrochloorthiazide.....................................................................................................................23
Indapamide...................................................................................................................................24
E. Kaliumsparende diuretica.........................................................................................................24
Eplerenon.....................................................................................................................................25
Finerenon.....................................................................................................................................25
Spironolacton................................................................................................................................25
Triamtereen..................................................................................................................................26
F. Lisdiuretica................................................................................................................................26
Bumetanide..................................................................................................................................26
Furosemide...................................................................................................................................27
G. Bètablokkers.............................................................................................................................27
Acebutolol....................................................................................................................................27
Atenolol........................................................................................................................................28
Bisoprolol......................................................................................................................................29
Carvdilol........................................................................................................................................29
Celiprolol......................................................................................................................................30
Metoprolol....................................................................................................................................30
Propranolol...................................................................................................................................31
Sotalol...........................................................................................................................................31
H. ACE-remmers............................................................................................................................32
Benazepril.....................................................................................................................................32
, Enalapril........................................................................................................................................32
Lisinopril.......................................................................................................................................33
Perindopril....................................................................................................................................33
i.ARBS (Angiotensinereceptorblokkers)........................................................................................33
Candesartan..................................................................................................................................33
Irbersartan....................................................................................................................................34
Losartan........................................................................................................................................34
valsartan.......................................................................................................................................34
J. Salicylaten als trombocytenaggregatieremmers........................................................................34
Acetylsalicylzuur...........................................................................................................................34
k. P2Y12-Remmers........................................................................................................................35
Clopidogrel...................................................................................................................................35
ticagrelor.......................................................................................................................................35
L. Calciumantagonisten.................................................................................................................36
Lercanidipine................................................................................................................................36
Amlodipine...................................................................................................................................36
Diltiazem.......................................................................................................................................36
Verapamil......................................................................................................................................37
M.Anticoagulantia............................................................................................................................37
Apixaban...........................................................................................................................................37
Dabigatran........................................................................................................................................37
Edoxaban..........................................................................................................................................38
Rivaroxaban......................................................................................................................................38
H3. CVRM-NHG standaard....................................................................................................................39
Richtlijnen diagnostiek......................................................................................................................39
Inschatting van risico HVZ.............................................................................................................39
Opstellen van een cardiovasculair risicoprofiel.............................................................................39
Tabel 1. Risicoschatting middels EGFR ACR...................................................................................39
De SCORE-risicotabel (tabel 2)......................................................................................................40
Aanvullende risicofactoren HVZ....................................................................................................40
Niet-medicamenteuze behandeling..................................................................................................41
Leefstijladviezen...........................................................................................................................41
Psychosociale factoren..................................................................................................................41
Sedentaire leefstijl en lichamelijke activiteit.................................................................................41
Roken............................................................................................................................................41
Voeding.........................................................................................................................................41
