Cardiovascular Risk Assessment & Management Flashcards

A 58-year-old man has a 10-year ASCVD risk of 9.8% calculated by the Pooled Cohort Equations. Which category does this place him in?

Answer: Intermediate risk (7.5% to <20%)

A 10-year ASCVD risk of 7.5% to <20% is classified as intermediate risk per the 2018 AHA/ACC cholesterol guidelines.

Which of the following is considered a 'risk-enhancing factor' that may favor initiating statin therapy in a borderline-risk patient?

Answer: Family history of premature ASCVD in a first-degree relative before age 55 (men) or 65 (women)

Family history of premature ASCVD is one of the ACC/AHA risk-enhancing factors that can tip the risk-benefit discussion toward statin initiation.

The coronary artery calcium (CAC) score is best used in clinical practice to:

Answer: Reclassify patients in uncertain risk strata to guide statin decisions

CAC scoring is most valuable for reclassifying patients in borderline or intermediate risk categories when statin benefit is uncertain.

A patient with diabetes mellitus aged 40–75 years and LDL-C 70–189 mg/dL but no other major risk factors should receive which statin intensity?

Answer: Moderate-intensity statin

Per 2018 ACC/AHA guidelines, diabetic patients aged 40–75 with LDL-C 70–189 mg/dL qualify for at least moderate-intensity statin therapy.

Which lipoprotein particle has the strongest independent association with residual cardiovascular risk after LDL-C is controlled?

Answer: Lipoprotein(a) [Lp(a)]

Lp(a) is a genetically determined, causal risk factor for ASCVD that remains elevated despite statin therapy and LDL-C lowering.

According to current guidelines, what is the recommended LDL-C threshold for adding a non-statin agent (ezetimibe or PCSK9 inhibitor) in very high-risk ASCVD patients already on maximally tolerated statin?

Answer: LDL-C ≥70 mg/dL

In very high-risk ASCVD patients, ezetimibe should be considered if LDL-C remains ≥70 mg/dL on maximally tolerated statin therapy.

A CAC score of zero in a low-to-intermediate risk patient most appropriately supports which management decision?

Answer: Withholding statin therapy and reassessing in 5–10 years

A CAC of zero confers a very low near-term event rate, supporting deferral of statin therapy with reassessment in 5–10 years.