BCACP Cardiovascular Risk Reduction 4 — Questions and Answers
Question 1: A 72-year-old woman with hypertension, osteoporosis, and no prior CV events has a 10-year ASCVD risk of 9%. The clinician and patient are uncertain about statin therapy. What is the most appropriate next step?
- Start high-intensity statin immediately
- Use risk-enhancing factors to guide the statin discussion (Correct answer)
- Defer all treatment for 2 years
- Start aspirin therapy instead of statin
Correct answer: Use risk-enhancing factors to guide the statin discussion
For borderline-risk patients (7.5–20%), ACC/AHA guidelines recommend using risk-enhancing factors to refine the statin initiation decision.
Question 2: Which antihypertensive combination is generally AVOIDED due to risk of hyperkalemia, acute kidney injury, and hypotension?
- ACE inhibitor + CCB
- ARB + thiazide diuretic
- ACE inhibitor + ARB (Correct answer)
- Beta-blocker + thiazide
Correct answer: ACE inhibitor + ARB
Dual RAAS blockade combining an ACE inhibitor with an ARB increases risk of hyperkalemia, AKI, and hypotension without additional CV benefit.
Question 3: A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 is started on anticoagulation. Which factor is NOT included in the CHA₂DS₂-VASc score?
- Congestive heart failure
- Hypertension
- Smoking history (Correct answer)
- Age ≥75 years
Correct answer: Smoking history
Smoking history is not a component of the CHA₂DS₂-VASc score; the score includes CHF, HTN, age, diabetes, stroke/TIA, vascular disease, and sex.
Question 4: A patient with hypertriglyceridemia (TG = 680 mg/dL) is at high risk for pancreatitis. Which is the most effective pharmacologic treatment?
- Statins
- Ezetimibe
- Fibrates (Correct answer)
- Bile acid sequestrants
Correct answer: Fibrates
Fibrates are the most effective agents for reducing very high triglycerides and are first-line to prevent pancreatitis in severe hypertriglyceridemia.
Question 5: Which of the following is a contraindication to initiating ACE inhibitor therapy?
- Bilateral renal artery stenosis (Correct answer)
- Proteinuric CKD
- Heart failure with reduced EF
- Microalbuminuria in type 1 diabetes
Correct answer: Bilateral renal artery stenosis
Bilateral renal artery stenosis is a contraindication to ACE inhibitors because they can precipitate acute renal failure in this setting.
Question 6: The FOURIER trial demonstrated cardiovascular benefit for which medication class in patients with established ASCVD on statin therapy?
- SGLT2 inhibitors
- PCSK9 inhibitors (Correct answer)
- Fibrates
- Omega-3 fatty acids
Correct answer: PCSK9 inhibitors
FOURIER showed that evolocumab (a PCSK9 inhibitor) significantly reduced major CV events in patients with ASCVD already on statin therapy.
Question 7: A 48-year-old with metabolic syndrome, LDL-C 135 mg/dL, and no clinical ASCVD has a coronary artery calcium (CAC) score of 0. What is the most appropriate recommendation?
- Start high-intensity statin
- Start low-intensity statin
- Defer statin therapy and reassess in 5–10 years (Correct answer)
- Start aspirin and statin combination
Correct answer: Defer statin therapy and reassess in 5–10 years
A CAC score of 0 in a patient without clinical ASCVD indicates very low near-term CV risk and supports deferring statin therapy with reassessment.
BCACP Cardiovascular Risk Reduction 4
A 72-year-old woman with hypertension, osteoporosis, and no prior CV events has a 10-year ASCVD risk of 9%.
The clinician and patient are uncertain about statin therapy.
What is the most appropriate next step?