Cardiovascular Risk Assessment & Management Flashcards

Which patient population is excluded from the Pooled Cohort Equations because the tool was not validated in this group?

Answer: Patients aged 20–39 or >79 years

The Pooled Cohort Equations are validated for adults aged 40–79; alternative approaches are needed for those younger or older.

In a patient with familial hypercholesterolemia (FH) and LDL-C of 210 mg/dL despite maximum statin plus ezetimibe, which is the most appropriate next step?

Answer: Add a PCSK9 inhibitor (evolocumab or alirocumab)

PCSK9 inhibitors are indicated for FH patients who do not achieve adequate LDL-C reduction on maximum statin plus ezetimibe therapy.

The FOURIER trial demonstrated which key finding regarding PCSK9 inhibitor therapy (evolocumab)?

Answer: Evolocumab reduced LDL-C by ~60% and significantly reduced cardiovascular events vs placebo on background statin

FOURIER showed evolocumab reduced LDL-C by ~59% and significantly reduced the composite of CV death, MI, stroke, hospitalization for unstable angina, and coronary revascularization.

A 55-year-old man has an LDL-C of 195 mg/dL on no therapy and no other cardiovascular risk factors. According to ACC/AHA guidelines, what is the most appropriate next step?

Answer: Calculate 10-year ASCVD risk and use risk-benefit discussion to guide statin decision

LDL-C 160–189 mg/dL without other major risk factors requires calculating 10-year ASCVD risk and shared decision-making before statin initiation.

Inclisiran, a small interfering RNA (siRNA) therapy targeting PCSK9, differs from monoclonal antibody PCSK9 inhibitors primarily in:

Answer: Its twice-yearly dosing schedule after initiation doses

Inclisiran is dosed twice yearly (after initial and 3-month doses) due to its siRNA mechanism inhibiting hepatic PCSK9 synthesis, compared to monthly or bimonthly injections for monoclonal antibodies.

Which of the following best describes the mechanism of bempedoic acid's LDL-C lowering effect?

Answer: It inhibits ATP-citrate lyase, reducing hepatic cholesterol synthesis upstream of HMG-CoA reductase

Bempedoic acid inhibits ATP-citrate lyase, an enzyme upstream of HMG-CoA reductase in the cholesterol synthesis pathway, reducing hepatic cholesterol production.

A 70-year-old woman with no prior ASCVD, LDL-C 145 mg/dL, and 10-year PCE risk of 8% declines statin therapy after a risk discussion. Which intervention remains appropriate?

Answer: Therapeutic lifestyle changes including diet, weight management, and physical activity

Regardless of statin decision, therapeutic lifestyle changes (heart-healthy diet, exercise, weight management, smoking cessation) are foundational for ASCVD risk reduction.