Free BCACP Cardiovascular Risk Reduction Questions and Answers — Questions and Answers
Question 1: A 65-year-old male with established coronary artery disease is managed with atorvastatin 80 mg daily. His recent lipid panel shows an LDL-C of 65 mg/dL, HDL-C of 40 mg/dL, and triglycerides of 250 mg/dL. According to the results of the REDUCE-IT trial, which agent is most appropriate to add to further reduce this patient's cardiovascular risk?
- Icosapent ethyl (Correct answer)
- Fenofibrate
- Niacin
- Omega-3-acid ethyl esters
Correct answer: Icosapent ethyl
Based on the REDUCE-IT trial, icosapent ethyl is indicated to reduce the risk of cardiovascular events in adults with elevated triglyceride levels (≥150 mg/dL) and established cardiovascular disease who are on maximally tolerated statin therapy. This patient meets all criteria. Fenofibrate and niacin have not demonstrated a consistent benefit in reducing ASCVD events when added to statin therapy. Standard over-the-counter or prescription omega-3-acid ethyl esters have not shown the same benefit as the purified EPA formulation of icosapent ethyl.
Question 2: A 55-year-old female with no history of ASCVD undergoes a risk assessment. Her calculated 10-year ASCVD risk is 12%. She has no increased risk of bleeding. According to the 2022 United States Preventive Services Task Force (USPSTF) recommendation statement, what is the most appropriate advice regarding the initiation of low-dose aspirin for primary prevention?
- Recommend initiating low-dose aspirin 81 mg daily.
- Recommend against initiating aspirin as the risks outweigh the benefits.
- Recommend initiating aspirin only if her 10-year ASCVD risk was >20%.
- The decision to initiate aspirin should be an individual one after discussing risks and benefits. (Correct answer)
Correct answer: The decision to initiate aspirin should be an individual one after discussing risks and benefits.
The 2022 USPSTF recommends that for adults aged 40 to 59 years with a ≥10% 10-year CVD risk, the decision to initiate low-dose aspirin should be an individual one (Grade C recommendation). This is because the evidence indicates the net benefit is small. Therefore, a discussion with the patient about the potential benefits versus the risks of bleeding is the most appropriate course of action, rather than routinely recommending for or against it.
Question 3: An ambulatory care pharmacist is educating a patient on proper home blood pressure monitoring technique. Which of the following instructions is INACCURATE and could lead to a falsely elevated reading?
- "Rest quietly in a chair for at least 5 minutes before taking a measurement."
- "Sit with your back supported and your feet flat on the floor."
- "Place the cuff over a long-sleeved shirt to ensure it is snug." (Correct answer)
- "Support your arm on a table so the cuff is at the level of your heart."
Correct answer: "Place the cuff over a long-sleeved shirt to ensure it is snug."
Blood pressure cuffs should always be placed on a bare arm, not over clothing. Placing the cuff over a sleeve can interfere with the artery compression and lead to a falsely elevated blood pressure reading. The other options represent correct procedures for accurate measurement according to AHA/ACC guidelines.
Question 4: A 45-year-old patient who smokes one pack per day expresses a desire to quit. His medical history is significant for a well-controlled seizure disorder. Which of the following is the most appropriate first-line pharmacotherapy recommendation?
- Varenicline
- Bupropion SR
- Nortriptyline
- Nicotine patch + nicotine lozenge (Correct answer)
Correct answer: Nicotine patch + nicotine lozenge
Bupropion is contraindicated in patients with a history of a seizure disorder as it can lower the seizure threshold. Varenicline is a first-line option, but combination nicotine replacement therapy (NRT)—such as a nicotine patch for long-acting control plus a lozenge for short-acting craving relief—is a highly effective and safe first-line option that completely avoids the contraindication associated with bupropion. Nortriptyline is considered a second-line agent for smoking cessation.
Question 5: A 70-year-old female with type 2 diabetes and recently diagnosed heart failure with preserved ejection fraction (HFpEF) has an A1c of 7.9%. Her current regimen includes metformin and sitagliptin. Which of the following medications should be added to provide both glycemic improvement and a reduction in heart failure hospitalizations?
- Dapagliflozin (Correct answer)
- Pioglitazone
- Liraglutide
- Glimepiride
Correct answer: Dapagliflozin
SGLT2 inhibitors, such as dapagliflozin and empagliflozin, are recommended in the 2022 AHA/ACC/HFSA heart failure guidelines for patients with HFpEF (Class 2a recommendation) to reduce the risk of heart failure hospitalizations and improve symptoms, regardless of diabetes status. They also provide glycemic control. Pioglitazone can cause fluid retention and should be avoided in heart failure. While liraglutide offers ASCVD benefits, its primary benefit is not in reducing HF hospitalizations in HFpEF. Glimepiride offers no cardiovascular or heart failure benefits.
Question 6: A 68-year-old male diagnosed with symptomatic peripheral artery disease (PAD), confirmed by an ankle-brachial index of 0.75, is not currently on any antiplatelet or anticoagulant therapy. Which of the following is the most appropriate initial agent to reduce his risk of major adverse cardiovascular events?
- Warfarin
- Apixaban
- Aspirin 81 mg plus ticagrelor 90 mg twice daily
- Clopidogrel 75 mg daily (Correct answer)
Correct answer: Clopidogrel 75 mg daily
The 2016 AHA/ACC guidelines recommend antiplatelet therapy for symptomatic PAD to reduce the risk of myocardial infarction, stroke, and vascular death. Aspirin (75-325 mg daily) or clopidogrel (75 mg daily) are both appropriate first-line choices (Class I recommendation). Anticoagulants like warfarin or apixaban are not indicated for PAD risk reduction alone. Dual antiplatelet therapy is not routinely recommended for chronic PAD management without a compelling concurrent indication like a recent coronary stent.
Free BCACP Cardiovascular Risk Reduction Questions and Answers
A 65-year-old male with established coronary artery disease is managed with atorvastatin 80 mg daily.
His recent lipid panel shows an LDL-C of 65 mg/dL, HDL-C of 40 mg/dL, and triglycerides of 250 mg/dL.
According to the results of the REDUCE-IT trial, which agent is most appropriate to add to further reduce this patient's cardiovascular risk?