CLS Cardiovascular Risk Assessment & Management 3 — Questions and Answers
Question 1: In the Reynolds Risk Score, which additional biomarker is incorporated compared to the Framingham Risk Score?
- Lipoprotein(a) and homocysteine
- High-sensitivity CRP (hsCRP) and family history of premature MI (Correct answer)
- Apolipoprotein B and fibrinogen
- Ankle-brachial index and microalbuminuria
Correct answer: High-sensitivity CRP (hsCRP) and family history of premature MI
The Reynolds Risk Score adds hsCRP and parental history of premature MI to traditional Framingham variables for improved risk discrimination.
Question 2: Which statement about the ankle-brachial index (ABI) as a cardiovascular risk marker is correct?
- An ABI >1.4 indicates low cardiovascular risk
- An ABI <0.9 is diagnostic of peripheral artery disease and signals elevated ASCVD risk (Correct answer)
- ABI is only validated in women under 60
- ABI replaces stress testing for coronary evaluation
Correct answer: An ABI <0.9 is diagnostic of peripheral artery disease and signals elevated ASCVD risk
An ABI <0.9 indicates peripheral artery disease, which is an ASCVD risk equivalent that increases overall cardiovascular event risk.
Question 3: A 45-year-old woman is classified as intermediate ASCVD risk. Her hsCRP is 4.2 mg/L. According to JUPITER trial evidence, statin therapy is most likely to benefit patients with which profile?
- Normal LDL-C (<100 mg/dL) and hsCRP ≥2 mg/L (Correct answer)
- Elevated LDL-C (>190 mg/dL) and low hsCRP
- Known ASCVD with any hsCRP level
- Triglycerides >500 mg/dL regardless of hsCRP
Correct answer: Normal LDL-C (<100 mg/dL) and hsCRP ≥2 mg/L
The JUPITER trial showed rosuvastatin reduced cardiovascular events in patients with normal LDL-C (<130 mg/dL) but elevated hsCRP (≥2 mg/L).
Question 4: Which cardiovascular risk factor is best addressed by assessing urine albumin-to-creatinine ratio (UACR) in a hypertensive diabetic patient?
- Confirming statin eligibility
- Detecting early chronic kidney disease as an ASCVD risk enhancer (Correct answer)
- Measuring triglyceride-rich lipoprotein clearance
- Identifying familial hypercholesterolemia
Correct answer: Detecting early chronic kidney disease as an ASCVD risk enhancer
Microalbuminuria (UACR 30–300 mg/g) signals early CKD, which is an independent ASCVD risk enhancer beyond traditional risk factors.
Question 5: In secondary prevention, the 2018 ACC/AHA guidelines define 'very high-risk ASCVD' patients as those with major ASCVD events plus which additional criteria?
- Age >75 years only
- Major ASCVD events plus high-risk conditions such as multiple events or diabetes (Correct answer)
- LDL-C >130 mg/dL on statin therapy
- History of statin intolerance
Correct answer: Major ASCVD events plus high-risk conditions such as multiple events or diabetes
Very high-risk ASCVD is defined by multiple major ASCVD events or one major event plus high-risk conditions (e.g., diabetes, CKD, familial hypercholesterolemia, smoking).
Question 6: A non-HDL-C goal is particularly useful compared to LDL-C alone in patients with:
- Isolated hypercholesterolemia and normal triglycerides
- Hypertriglyceridemia, where VLDL-C contribution is significant (Correct answer)
- Patients on niacin monotherapy
- Post-menopausal women with metabolic syndrome
Correct answer: Hypertriglyceridemia, where VLDL-C contribution is significant
Non-HDL-C captures all atherogenic lipoproteins including VLDL-C, making it more informative than LDL-C in hypertriglyceridemic states.
Question 7: What is the primary mechanism by which metabolic syndrome increases cardiovascular risk beyond individual risk factors?
- Exclusive elevation of LDL-C particle size
- Clustering of insulin resistance, dyslipidemia, hypertension, and central obesity causing additive risk (Correct answer)
- Direct myocardial toxicity from hyperglycemia
- Suppression of HDL synthesis in the liver
Correct answer: Clustering of insulin resistance, dyslipidemia, hypertension, and central obesity causing additive risk
Metabolic syndrome's risk stems from clustering of multiple interrelated abnormalities driven by insulin resistance, which additively amplifies ASCVD risk.
CLS Cardiovascular Risk Assessment & Management 3
In the Reynolds Risk Score, which additional biomarker is incorporated compared to the Framingham Risk Score?