BCACP Cardiovascular Risk Reduction 3 — Questions and Answers
Question 1: A patient taking rosuvastatin 40 mg develops muscle pain with a CK level 12 times the upper limit of normal. What is the most appropriate action?
- Switch to pravastatin
- Reduce dose to 20 mg
- Discontinue rosuvastatin immediately (Correct answer)
- Add CoQ10 supplementation
Correct answer: Discontinue rosuvastatin immediately
CK >10x ULN with symptoms indicates myopathy requiring immediate statin discontinuation to prevent progression to rhabdomyolysis.
Question 2: Which non-HDL cholesterol target is recommended for very high-risk cardiovascular patients per current guidelines?
- <70 mg/dL
- <100 mg/dL (Correct answer)
- <130 mg/dL
- <55 mg/dL
Correct answer: <100 mg/dL
Non-HDL-C goal for very high-risk patients is <100 mg/dL, which corresponds to an LDL-C goal of <70 mg/dL plus 30 mg/dL.
Question 3: A patient with ASCVD on maximum-tolerated statin therapy has LDL-C of 95 mg/dL. Which add-on therapy has outcomes data showing reduced CV events?
- Omega-3 fatty acids
- Ezetimibe (Correct answer)
- Niacin
- Fibrates
Correct answer: Ezetimibe
The IMPROVE-IT trial demonstrated that adding ezetimibe to statin therapy reduced major cardiovascular events in high-risk patients.
Question 4: In the SPRINT trial, what systolic blood pressure target was associated with reduced cardiovascular events compared to standard control?
- <150 mmHg
- <140 mmHg
- <130 mmHg
- <120 mmHg (Correct answer)
Correct answer: <120 mmHg
SPRINT showed that intensive SBP target of <120 mmHg reduced CV events and all-cause mortality compared to <140 mmHg in high-risk non-diabetic patients.
Question 5: Which smoking cessation pharmacotherapy is CONTRAINDICATED in a patient with a history of seizure disorder?
- Nicotine patch
- Varenicline
- Bupropion (Correct answer)
- Nicotine gum
Correct answer: Bupropion
Bupropion lowers the seizure threshold and is contraindicated in patients with seizure disorders or eating disorders.
Question 6: A patient with type 2 diabetes and established CVD should preferentially receive which GLP-1 receptor agonist with proven CV mortality reduction?
- Exenatide
- Liraglutide (Correct answer)
- Dulaglutide
- Albiglutide
Correct answer: Liraglutide
Liraglutide demonstrated significant reduction in CV death, nonfatal MI, and nonfatal stroke in the LEADER trial for T2D patients with CVD.
Question 7: What is the mechanism by which PCSK9 inhibitors reduce LDL-C levels?
- Block HMG-CoA reductase enzyme
- Inhibit cholesterol absorption in the gut
- Prevent PCSK9 from degrading LDL receptors (Correct answer)
- Activate LPL to clear VLDL particles
Correct answer: Prevent PCSK9 from degrading LDL receptors
PCSK9 inhibitors prevent PCSK9 from binding to and degrading LDL receptors, allowing more receptors to remain on hepatocytes to clear LDL-C.
BCACP Cardiovascular Risk Reduction 3
A patient taking rosuvastatin 40 mg develops muscle pain with a CK level 12 times the upper limit of normal.
What is the most appropriate action?