CLS Cardiovascular Risk Assessment & Management 2 — Questions and Answers
Question 1: 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?
- Low risk (<5%)
- Borderline risk (5% to <7.5%)
- Intermediate risk (7.5% to <20%) (Correct answer)
- High risk (≥20%)
Correct 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.
Question 2: Which of the following is considered a 'risk-enhancing factor' that may favor initiating statin therapy in a borderline-risk patient?
- BMI of 27 kg/m²
- LDL-C of 80 mg/dL
- Family history of premature ASCVD in a first-degree relative before age 55 (men) or 65 (women) (Correct answer)
- HDL-C of 55 mg/dL
Correct 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.
Question 3: The coronary artery calcium (CAC) score is best used in clinical practice to:
- Replace the Pooled Cohort Equations entirely
- Reclassify patients in uncertain risk strata to guide statin decisions (Correct answer)
- Monitor response to statin therapy over time
- Diagnose acute coronary syndrome
Correct 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.
Question 4: 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?
- No statin therapy unless ASCVD risk >20%
- Low-intensity statin
- Moderate-intensity statin (Correct answer)
- High-intensity statin plus ezetimibe
Correct 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.
Question 5: Which lipoprotein particle has the strongest independent association with residual cardiovascular risk after LDL-C is controlled?
- HDL-C
- VLDL-C
- Lipoprotein(a) [Lp(a)] (Correct answer)
- Chylomicron remnants
Correct 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.
Question 6: 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?
- LDL-C ≥100 mg/dL
- LDL-C ≥70 mg/dL (Correct answer)
- LDL-C ≥55 mg/dL
- LDL-C ≥130 mg/dL
Correct 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.
Question 7: A CAC score of zero in a low-to-intermediate risk patient most appropriately supports which management decision?
- Immediate high-intensity statin initiation
- Withholding statin therapy and reassessing in 5–10 years (Correct answer)
- Adding PCSK9 inhibitor therapy
- Referral for coronary angiography
Correct 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.
CLS Cardiovascular Risk Assessment & Management 2
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?