Cardiovascular Risk Assessment & Management Flashcards

A 62-year-old woman has an estimated ASCVD risk of 12% and a CAC score of 250 Agatston units. Which management is most appropriate?

Answer: High-intensity statin therapy is favored given very elevated CAC

A CAC ≥100 (or ≥75th percentile) in an intermediate-risk patient supports high-intensity statin therapy due to substantially elevated risk.

Which cardiovascular risk calculator is recommended as the preferred tool by the 2018 ACC/AHA cholesterol guidelines for primary prevention decisions in patients aged 40–79?

Answer: Pooled Cohort Equations (PCE)

The 2018 ACC/AHA guidelines recommend the Pooled Cohort Equations for 10-year ASCVD risk estimation in primary prevention for patients aged 40–79.

Apolipoprotein B (ApoB) measurement is especially valuable in which patient scenario?

Answer: A patient with high triglycerides where LDL-C may be underestimated by Friedewald equation

ApoB directly counts all atherogenic particles and is most useful when LDL-C is underestimated due to hypertriglyceridemia or discordance.

In patients with chronic kidney disease (CKD) stages 3–5 not on dialysis, which lipid-lowering therapy is most supported by evidence?

Answer: Statin or statin/ezetimibe combination based on SHARP trial evidence

The SHARP trial demonstrated that simvastatin/ezetimibe significantly reduced major atherosclerotic events in CKD patients not on dialysis.

Which statement correctly describes the relationship between LDL-C and ASCVD risk?

Answer: Risk is log-linear; lower LDL-C achieved is associated with proportionally lower event rates

Mendelian randomization studies and RCTs confirm a log-linear relationship: each mmol/L reduction in LDL-C yields ~22% relative risk reduction regardless of baseline.

A patient with established ASCVD and LDL-C of 95 mg/dL on high-intensity statin is being considered for ezetimibe. The primary rationale based on IMPROVE-IT trial is:

Answer: Further lowering LDL-C with ezetimibe modestly but significantly reduces cardiovascular events

IMPROVE-IT demonstrated that adding ezetimibe to simvastatin further reduced LDL-C and produced a modest but significant reduction in cardiovascular events.

What is the most appropriate initial management for a patient presenting with triglycerides of 850 mg/dL to prevent acute pancreatitis?

Answer: Strict dietary fat restriction plus fibrate therapy plus omega-3 fatty acids

Severe hypertriglyceridemia (>500 mg/dL) requires urgent dietary fat restriction and fibrate therapy ± omega-3s to reduce pancreatitis risk.