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ADA 23 > 10. Cardiovascular Disease 23 > Flashcards

10. Cardiovascular Disease 23 Flashcards

1
Q

Why might patients on SGLT2 inhibitor or GLP-1 receptor agonist therapy need to replace some of their existing medications?

A

To minimize risks of hypoglycemia and adverse side effects, and potentially to minimize medication costs.

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2
Q

Which medication should be considered to improve cardiovascular outcomes and reduce the risk of CKD progression in people with type 2 diabetes and CKD with albuminuria treated with maximum tolerated doses of ACE inhibitor or ARB?

A

Finernone should be considered.

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3
Q

What was the primary outcome observed in patients treated with finerenone?

A

The primary outcome observed in patients treated with finerenone was a 13% reduction in cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization from heart failure.

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4
Q

What is the name of the trial that showed improvement in CKD outcomes with finerenone?

A

The FIDELIO-DKD trial showed improvement in CKD STAGE 3-4 outcomes with finerenone.

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5
Q

What type of medication is finerenone?

A

Finerenone is a selective nonsteroidal mineralocorticoid antagonist.

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6
Q

What is the recommendation for using SGLT2 inhibitors in this HF patient population?

A

SGLT2 inhibitors are recommended to improve symptoms, physical limitations, and quality of life.

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7
Q

What is recommended to reduce the risk of worsening heart failure and cardiovascular death in people with type 2 diabetes and established HFpEF or HFrEF?

A

An SGLT2 inhibitor with proven benefit in this patient population.

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8
Q

Who are recommended to take an SGLT2 inhibitor?

A

People with type 2 diabetes and established HFpEF or HFrEF.

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9
Q

What did the EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and CREDENCE trials suggest about the use of SGLT2 inhibitors?

A

The trials suggested, but did not prove, that SGLT2 inhibitors would be beneficial in the treatment of people with established heart failure.

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10
Q

What were the results of the CREDENCE trial with canagliflozin?

A

The CREDENCE trial with canagliflozin showed a 39% reduction in hospitalization for heart failure, and a 31% reduction in the composite of cardiovascular death or hospitalization for heart failure.

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11
Q

What reduction in hospitalization for heart failure was observed in the EMPA-REG OUTCOME study with the addition of empagliflozin to standard care?

A

A significant 35% reduction in hospitalization for heart failure was observed.

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12
Q

What type of medication was used in the EMPA-REG OUTCOME study to reduce the incidence of heart failure?

A

SGLT2 inhibitors were used to reduce the incidence of heart failure. كلها بدون استثناء

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13
Q

According to the article, have any of GLP-1 receptor agonists identified an increased risk of heart failure hospitalization?

A

No, no increased risk of heart failure hospitalization has been identified in the cardiovascular outcomes trials of the GLP-1 receptor agonists liraglutide, semaglutide, exenatide once-weekly, albiglutide, or dulaglutide

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14
Q

Were patients treated with saxagliptin more likely to be hospitalized for heart failure?

A

Yes, patients treated with saxagliptin were more likely to be hospitalized for heart failure….. other DDP4I. DOSE NOT SHOW ANY RISK….

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15
Q

According to the study, which oral antihyperglycemic agent has better outcomes for people with type 2 diabetes and heart failure?

A

Metformin users have better outcomes than individuals treated with other antihyperglycemic agents.

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16
Q

Which diabetes medication should be avoided in people with symptomatic heart failure?

A

Thiazolidinedione

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17
Q

What percentage of people with type 2 diabetes may develop heart failure?

A

Up to 50% of people with type 2 diabetes may develop heart failure.

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18
Q

What is the study that provides evidence for combination therapy with an SGLT2 inhibitor and a GLP-1 receptor agonist?

A

The study that provides evidence for combination therapy with an SGLT2 inhibitor and a GLP-1 receptor agonist is AMPLITUDE-O.

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19
Q

What are the benefits of SGLT2 inhibitors?

A

SGLT2 inhibitors reduce the risk of heart failure hospitalization and progression of kidney disease in people with established ASCVD, multiple risk factors for ASCVD, or albuminuric kidney disease.

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20
Q

Which SGLT2 inhibitors have reported statistically significant reductions in cardiovascular events?

A

Empagliflozin, Canagliflozin, and Dapagliflozin have reported statistically significant reductions in cardiovascular events….
ertugliflozin» LESSER EFFECT اقل واحد فيهم

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21
Q

Which FDA-approved GLP-1 receptor agonist was removed from the market for business reasons?

A

Albiglutide was removed from the market for business reasons.

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22
Q

Which GLP-1 receptor agonist showed a lower risk of cardiovascular events in a moderate-sized clinical trial, but was not powered as a cardiovascular outcomes trial?

A

Semaglutide showed a lower risk of cardiovascular events in a moderate-sized clinical trial, but it was not powered as a cardiovascular outcomes trial.

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23
Q

What was the purpose of the ELIXA trial?

A

The purpose of the ELIXA trial was to study the cardiovascular outcomes of lixisenatide in people with type 2 diabetes who had a recent acute coronary event…… The ELIXA trial studied the once-daily GLP-1 receptor agonist lixisenatide.

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24
Q

What percentage of participants experienced the primary composite outcome in the dulaglutide treatment group? REWIND

A

12.0% of participants in the dulaglutide treatment group experienced the primary composite outcome.
PLACEPO WAS 13.4%

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25
Q

What was the purpose of the REWIND trial?

A

The purpose of the REWIND trial was to assess the effect of the once-weekly GLP-1 receptor agonist dulaglutide versus placebo on major adverse cardiovascular events.

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26
Q

Was oral semaglutide superior to placebo for the primary composite outcome?

A

No, oral semaglutide was noninferior to placebo for the primary composite outcome.

بمعني انه ينفع

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27
Q

What study assessed the cardiovascular effects of the oral formulation of semaglutide?

A

The study that assessed the cardiovascular effects of the oral formulation of semaglutide is Peptide Innovation for Early Diabetes Treatment (PIONEER) 6.

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28
Q

What was the primary outcome measured in the SUSTAIN-6 trial?

A

The primary outcome measured in the SUSTAIN-6 trial was the first occurrence of cardiovascular death, nonfatal MI, or nonfatal stroke.

The primary outcome (the first occurrence of cardiovascular death, nonfatal MI, or nonfatal stroke) occurred in 108 patients (6.6%) in the semaglutide group vs. 146 patients (8.9%) in the placebo group

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29
Q

What were the treatment options in the SUSTAIN-6 trial?

A

The treatment options in the SUSTAIN-6 trial were once-weekly semaglutide (0.5 mg or 1.0 mg) or placebo.

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30
Q

What was the percentage of deaths from cardiovascular causes in the liraglutide group?

A

4.7% compared with the placebo group (6.0%)

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31
Q

What was the primary composite outcome in the LEADER study?

A

The primary composite outcome in the LEADER study was a combination of myocardial infarction (MI), stroke, or cardiovascular death.

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32
Q

What is the mechanism of action of Sotagliflozin?

A

Sotagliflozin lowers glucose via delayed glucose absorption in the gut and increasing urinary glucose excretion.

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33
Q

What is the name of the trial where Sotagliflozin was evaluated?

A

Sotagliflozin was evaluated in the Effect of Sotagliflozin on Cardiovascular and Renal Events in Patients With Type 2 Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED) trial.

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34
Q

What are the two types of glucose transporters inhibited by Sotagliflozin?

A

Sotagliflozin inhibits SGLT1 and SGLT2 glucose transporters.

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35
Q

Was ertugliflozin superior to placebo for the key secondary outcome of death from cardiovascular causes or hospitalization for heart failure?

A

No, ertugliflozin was not superior to placebo for the key secondary outcome.

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36
Q

What is the name of the trial that evaluated the efficacy and safety of Ertugliflozin?

A

The trial is called the Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial (VERTIS CV).

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37
Q

What were benefits with dapagliflozin therapy compared to placebo? DAPA-CKD?

A

sustained decline in eGFR of at least 50%, endstage kidney disease, or death from renal causes were significantly lower with dapagliflozin therapy compared to placebo.

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38
Q

Were the effects of dapagliflozin similar in individuals with diabetes and without diabetes?

A

Yes, the effects of dapagliflozin therapy were similar in individuals with and without type 2 diabetes.

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39
Q

When compared with placebo, did the DECLARE-TIMI 58 study show a lower rate of major adverse cardiovascular events?

A

No, the study did not show a lower rate of major adverse cardiovascular events when dapagliflozin compared with placebo.
BUT:A lower rate of cardiovascular death or hospitalization for heart failure was noted

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40
Q

What outcome did canagliflozin significantly reduce in the combined analysis of the two trials? CANVAS & CANVAS-RENAL + CREDENCE

A

Canagliflozin significantly reduced the composite outcome of cardiovascular death, MI, or stroke.

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41
Q

What were the outcomes observed in the EMPA-REG OUTCOME trial?

A

The trial showed a 14% reduction in the composite outcome of MI, stroke, and cardiovascular death.

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42
Q

Have DPP-4 inhibitors shown cardiovascular benefits relative to placebo?

A

No, DPP-4 inhibitors have not shown cardiovascular benefits relative to placebo.

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43
Q

According to the content, why is indiscriminate screening not considered cost-effective? In screening CVD?

A

Indiscriminate screening is not considered cost-effective because it may lead to unnecessary tests and treatments for individuals who are not at high risk of cardiovascular disease.

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44
Q

Is routine screening of asymptomatic people with type 2 diabetes and normal ECGs clinically beneficial?

A

No, there is no clinical benefit to routine screening of asymptomatic people with type 2 diabetes and normal ECGs.

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45
Q

What are the two recommended methods for stress testing in individuals unable to exercise?

A

The two recommended methods for stress testing in individuals unable to exercise are pharmacologic stress echocardiography and nuclear imaging.

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46
Q

What type of stress testing should be considered in individuals with diabetes who have resting ECG abnormalities?

A

Pharmacologic stress echocardiography or nuclear imaging should be considered.

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47
Q

What is the purpose of pharmacologic stress echocardiography or nuclear imaging in individuals with diabetes and resting ECG abnormalities?

A

To assess cardiovascular function and risk in individuals who cannot undergo exercise stress testing due to ECG abnormalities.

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48
Q

For which age group is measuring coronary artery calcium reasonable for cardiovascular risk assessment?

A

adults with diabetes ≥40 years of age

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49
Q

Who are the candidates for advanced or invasive cardiac testing?

A

The candidates for advanced or invasive cardiac testing are those with typical or atypical cardiac symptoms and an abnormal resting electrocardiogram (ECG).

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50
Q

What initial tests can be used for candidates for cardiac testing?

A

Exercise ECG testing without or with echocardiography may be used as the initial test.

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51
Q

In people with type 2 diabetes and stable heart failure, can metformin be continued for glucose lowering?

A

Yes, metformin may be continued for glucose lowering if estimated glomerular filtration rate remains >30 mL/min/1.73 m2.

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52
Q

Should metformin be avoided in unstable or hospitalized individuals with heart failure?

A

Yes, metformin should be avoided in unstable or hospitalized individuals with heart failure.

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53
Q

What type of medication should be included in the treatment of individuals with heart failure with reduced ejection fraction?

A

A β-blocker with proven cardiovascular outcomes benefit.

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54
Q

When should a β-blocker be included in the treatment of individuals with heart failure with reduced ejection fraction?

A

A β-blocker should be included unless otherwise contraindicated.

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55
Q

How long should β-blockers be continued after a prior myocardial infarction?

A

β-blockers should be continued for 3 years after the event.

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56
Q

What therapy is recommended to reduce the risk of cardiovascular events in people with known atherosclerotic cardiovascular disease, particularly coronary artery disease?

A

ACE inhibitor or angiotensin receptor blocker therapy.

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57
Q

In which population is ACE inhibitor or angiotensin receptor blocker therapy recommended to reduce the risk of cardiovascular events?

A

People with known atherosclerotic cardiovascular disease, particularly coronary artery disease.

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58
Q

What is the recommended addition for people with type 2 diabetes and chronic kidney disease with albuminuria treated with maximum tolerated doses of ACE inhibitor or angiotensin receptor blocker?

A

The recommended addition is finerenone.

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59
Q

What are the benefits of adding finerenone for people with type 2 diabetes and chronic kidney disease with albuminuria?

A

The benefits of adding finerenone include improving cardiovascular outcomes and reducing the risk of chronic kidney disease progression.

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60
Q

In people with type 2 diabetes and established heart failure, which medication is recommended to improve symptoms, physical limitations, and quality of life?

A

A sodium-glucose cotransporter 2 inhibitor with proven benefit in this patient population.

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61
Q

Which patient population is recommended to use a sodium-glucose cotransporter 2 inhibitor in people with type 2 diabetes and established heart failure?

A

Patients with either preserved or reduced ejection fraction.

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62
Q

Which patient population is recommended to use a sodium-glucose cotransporter 2 inhibitor?

A

People with type 2 diabetes and established heart failure with either preserved or reduced ejection fraction

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63
Q

What type of therapy may be considered for additive reduction in the risk of adverse cardiovascular and kidney events in people with type 2 diabetes?

A

Combined therapy with a sodium–glucose cotransporter 2 inhibitor and a glucagon-like peptide 1 receptor agonist.

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64
Q

Which group of individuals may consider combined therapy with a sodium–glucose cotransporter 2 inhibitor and a glucagon-like peptide 1 receptor agonist for cardiovascular risk reduction?

A

People with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors for atherosclerotic cardiovascular disease.

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65
Q

What is the purpose of combined therapy with a sodium–glucose cotransporter 2 inhibitor and a glucagon-like peptide 1 receptor agonist in people with type 2 diabetes and cardiovascular risk factors?

A

To achieve additive reduction in the risk of adverse cardiovascular and kidney events.

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66
Q

What is recommended to reduce the risk of major adverse cardiovascular events in people with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors for atherosclerotic cardiovascular disease?

A

A glucagon-like peptide 1 receptor agonist with demonstrated cardiovascular benefit.

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67
Q

Who are the individuals that should consider taking a glucagon-like peptide 1 receptor agonist to reduce the risk of major adverse cardiovascular events?

A

People with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors for atherosclerotic cardiovascular disease.

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68
Q

According to the article, what is recommended to reduce the risk of major adverse cardiovascular events and/or heart failure hospitalization in people with type 2 diabetes and established atherosclerotic cardiovascular disease?

A

A sodium-glucose cotransporter 2 inhibitor with demonstrated cardiovascular benefit is recommended.

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69
Q

Who might benefit from the recommended treatment for reducing the risk of major adverse cardiovascular events and/or heart failure hospitalization?

A

People with type 2 diabetes and established atherosclerotic cardiovascular disease, multiple atherosclerotic cardiovascular disease risk factors, or diabetic kidney disease.

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70
Q

According to the article, what type of medication is recommended for people with type 2 diabetes and established atherosclerotic cardiovascular disease or established kidney disease?

A

A sodium–glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist with demonstrated cardiovascular disease benefit.

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71
Q

When should investigations for coronary artery disease be considered?

A

Investigations for coronary artery disease should be considered in the presence of atypical cardiac symptoms, signs or symptoms of associated vascular disease, or electrocardiogram abnormalities.

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72
Q

What are examples of atypical cardiac symptoms that warrant investigations for coronary artery disease?

A

Examples of atypical cardiac symptoms include unexplained dyspnea and chest discomfort.

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73
Q

Why is routine screening for coronary artery disease not recommended in asymptomatic individuals?

A

Routine screening for coronary artery disease is not recommended in asymptomatic individuals because it does not improve outcomes as long as atherosclerotic cardiovascular disease risk factors are treated.

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74
Q

What should be done instead of routine screening for coronary artery disease in asymptomatic individuals?

A

Instead of routine screening for coronary artery disease, atherosclerotic cardiovascular disease risk factors should be treated.

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75
Q

What was the superior treatment for individuals with established coronary artery disease and/or peripheral artery disease?

A

Aspirin plus rivaroxaban 2.5 mg twice daily was superior to aspirin plus placebo.

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76
Q

What is the potential benefit of early aspirin discontinuation compared to continued dual antiplatelet therapy after coronary stenting?

A

Early aspirin discontinuation may reduce the risk of bleeding without increasing the risks of mortality and ischemic events…. TWILIGHT trial

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77
Q

What was noted with dual antiplatelet therapy?

A

A higher incidence of major bleeding, including intracranial hemorrhage, was noted.

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78
Q

What is the effect of adding ticagrelor to aspirin in terms of reducing the risk of recurrent ischemic events?

A

Adding ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events including cardiovascular and CHD death.

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79
Q

What are the potential benefits of using a P2Y12 receptor antagonist in combination with aspirin beyond 1 year in patients following an ACS?

A

Using a P2Y12 receptor antagonist in combination with aspirin may have benefits beyond 1 year in patients following an ACS…

ticagrelor or clopidogrel

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80
Q

According to the study, what were the findings regarding the differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily?

A

There were no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily.

It appears that 75–162 mg/day is optimal.

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81
Q

What is the primary reason why aspirin use is generally contraindicated in patients aged <21 years?

A

The primary reason for the contraindication of aspirin use in patients aged <21 years is the associated risk of Reye syndrome.

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82
Q

Who is aspirin not recommended for?

A

Aspirin is not recommended for those at low risk of ASCVD (such as men and women aged <50 years with diabetes with no other major ASCVD risk factors).

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83
Q

What is ASCVD?

A

ASCVD stands for Atherosclerotic Cardiovascular Disease.

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84
Q

What is the recommended use of aspirin for secondary prevention in people with documented ASCVD?

A

For people with documented ASCVD, the use of aspirin for secondary prevention has far greater benefit than risk, therefore, aspirin is still recommended.

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85
Q

What does ASCVD stand for?

A

ASCVD stands for atherosclerotic cardiovascular disease.

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86
Q

In what context may aspirin be considered?

A

Aspirin may be considered in the context of high cardiovascular risk with low bleeding risk, but generally not in older adults.

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87
Q

Should the use of aspirin be recommended for primary prevention?

A

No, the use of aspirin may generally not be recommended for primary prevention.

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88
Q

Which age group is recommended to use aspirin as primary prevention?

A

Men and women aged ≥50 years with diabetes and at least one additional major risk factor.
Family history of premature ASCVD, hypertension, dyslipidemia, smoking, or CKD/albuminuria.
who are not at increased risk of bleeding (e.g., older age, anemia, renal disease)

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89
Q

For adults with ASCVD risk greater than what percentage per year, will the number of ASCVD events prevented be similar to the number of induced bleeding episodes?

A

For adults with ASCVD risk greater than 1% per year, the number of ASCVD events prevented will be similar to the number of induced bleeding episodes.

بمعني فوق ١ في المية خطوره فايدة الاسبرين اعلي من المضاعفات

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90
Q

What were the two large randomized trials of aspirin for primary prevention mentioned in the article?

A

The two large randomized trials of aspirin for primary prevention mentioned in the article were ARRIVE and ASPREE IN ELDERLY.

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91
Q

By what percentage did aspirin reduce the risk of serious vascular events? ASCEND TRIAL

A

12%

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92
Q

IS ASA BENEFICIAL FOR 1RY PREVENTION FOR CVD?

A

no previous cardiovascular events, its net benefit is more controversial

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93
Q

In which patients is aspirin shown to be effective in reducing cardiovascular morbidity and mortality?

A

Aspirin is shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with previous MI or stroke (secondary prevention).

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94
Q

What is the recommended use of aspirin in high-risk patients with previous MI or stroke?

A

Aspirin is strongly recommended in high-risk patients with previous MI or stroke for reducing cardiovascular morbidity and mortality.

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95
Q

What is the recommended dosage for aspirin therapy as a primary prevention strategy for those with diabetes?

A

The recommended dosage for aspirin therapy as a primary prevention strategy for those with diabetes is 75-162 mg/day.

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96
Q

When can aspirin therapy be considered as a primary prevention strategy for those with diabetes?

A

Aspirin therapy can be considered as a primary prevention strategy for those with diabetes who are at increased cardiovascular risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding.

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97
Q

For whom should combination therapy with aspirin plus low-dose rivaroxaban be considered?

A

Combination therapy with aspirin plus low-dose rivaroxaban should be considered for individuals with stable coronary and/or peripheral artery disease and low bleeding risk.

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98
Q

What is the goal of combination therapy with aspirin plus low-dose rivaroxaban?

A

The goal of combination therapy with aspirin plus low-dose rivaroxaban is to prevent major adverse limb and cardiovascular events.

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99
Q

Which individuals should consider long-term treatment with dual antiplatelet therapy?

A

Individuals with prior coronary intervention, high ischemic risk, and low bleeding risk should consider long-term treatment with dual antiplatelet therapy.

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100
Q

What is the purpose of long-term dual antiplatelet therapy?

A

The purpose of long-term dual antiplatelet therapy is to prevent major adverse cardiovascular events for individuals with prior coronary intervention, high ischemic risk, and low bleeding risk.

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101
Q

How long is it reasonable to continue dual antiplatelet therapy after an acute coronary syndrome?

A

It is reasonable to continue dual antiplatelet therapy for a year after an acute coronary syndrome.

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102
Q

What is the recommended dual antiplatelet therapy for a year after an acute coronary syndrome?

A

The recommended dual antiplatelet therapy includes low-dose aspirin and a P2Y12 inhibitor.

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103
Q

What medication should be used for individuals with atherosclerotic cardiovascular disease and documented aspirin allergy?

A

Clopidogrel (75 mg/day) should be used.

104
Q

What is the recommended dose range for aspirin therapy as a secondary prevention strategy?

A

The recommended dose range for aspirin therapy as a secondary prevention strategy is 75-162 mg/day.

105
Q

In which patient population should aspirin therapy be used as a secondary prevention strategy?

A

Aspirin therapy should be used as a secondary prevention strategy in those with diabetes and a history of atherosclerotic cardiovascular disease.

106
Q

Is there evidence to support the concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia?

A

No, the concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia is not currently supported by evidence.

107
Q

Should the concern about cognitive dysfunction or dementia deter the use of statins or other lipid-lowering agents in individuals with diabetes at high risk for ASCVD?

A

No, the concern about cognitive dysfunction or dementia should not deter the use of statins or other lipid-lowering agents in individuals with diabetes at high risk for ASCVD.

108
Q

Has the addition of ezetimibe or PCSK9 inhibitors TO STATINS in studies reported any change in cognitive function?

A

No, no change in cognitive function has been reported in studies with the addition of ezetimibe or PCSK9 inhibitors

109
Q

What is the result of large randomized trials comparing statin to placebo in terms of cognitive differences?

A

No differences were seen between statin and placebo.

110
Q

What is the relationship between statin use and incident diabetes?

A

Several studies have reported a modestly increased risk of incident diabetes with statin use.

111
Q

Did the combination of fenofibrate and simvastatin reduce the rate of fatal cardiovascular events in the ACCORD study?

A

No, the combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events in the ACCORD study.

112
Q

Does statin plus niacin combination therapy provide additional cardiovascular benefit above statin therapy alone?

A

No, statin plus niacin combination therapy has not been shown to provide additional cardiovascular benefit above statin therapy alone.

113
Q

What is the risk associated with statin plus niacin combination therapy?

A

The risk of stroke may increase with statin plus niacin combination therapy, along with additional side effects.

114
Q

Is the combination therapy of statin and fibrate recommended for improving atherosclerotic cardiovascular disease outcomes?

A

No, the combination therapy of statin and fibrate is generally not recommended for improving atherosclerotic cardiovascular disease outcomes.

115
Q

Has the combination therapy of statin and fibrate been shown to improve atherosclerotic cardiovascular disease outcomes?

A

No, the combination therapy of statin and fibrate has not been shown to improve atherosclerotic cardiovascular disease outcomes.

116
Q

What is the most prevalent pattern of dyslipidemia in people with type 2 diabetes?

A

Low levels of HDL cholesterol, often associated with elevated triglyceride levels.

LOW HDL MOST COMMON FORM OF DLD IN T2DM

117
Q

What was the purpose of the REDUCE-IT trial?

A

The purpose of the REDUCE-IT trial was to investigate the reduction of cardiovascular events with Icosapent Ethyl intervention in adults receiving statin therapy with moderately elevated triglycerides.

The trial met its primary end point, demonstrating a 25% relative risk reduction (P < 0.001) for the primary end point composite of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina. This reduction in risk was seen in people with or without diabetes at baseline.

118
Q

Did the addition of omega-3 CA, compared with corn oil, result in a significant difference in major adverse cardiovascular events?

A

No, the addition of omega-3 CA did not result in a significant difference in major adverse cardiovascular events.

119
Q

What are the criteria for considering the addition of icosapent ethyl to reduce cardiovascular risk?

A

The addition of icosapent ethyl is considered when individuals have atherosclerotic cardiovascular disease or other cardiovascular risk factors, are on a statin with controlled LDL cholesterol, but have elevated triglycerides (135–499 mg/dL).

120
Q

What factors should clinicians address and treat in individuals with moderate hypertriglyceridemia?

A

Clinicians should address and treat lifestyle factors (obesity and metabolic syndrome), secondary factors (diabetes, chronic liver or kidney disease and/or nephrotic syndrome, hypothyroidism), and medications that raise triglycerides.

121
Q

What is considered as moderate hypertriglyceridemia?

A

Moderate hypertriglyceridemia is defined as fasting or nonfasting triglycerides ranging from 175 to 499 mg/dL.

122
Q

What fasting triglyceride level should prompt evaluation for secondary causes of hypertriglyceridemia and consideration of medical therapy?

A

Fasting triglyceride levels ≥500 mg/dL

123
Q

What is the purpose of evaluating for secondary causes of hypertriglyceridemia in individuals with fasting triglyceride levels ≥500 mg/dL?

A

To identify the underlying causes of hypertriglyceridemia and determine appropriate medical therapy to reduce the risk of pancreatitis.

124
Q

According to the article, what is the approximate reduction in LDL cholesterol levels when using bempedoic acid therapy compared to placebo?

A

Bempedoic acid therapy lowers LDL cholesterol levels by about 23% compared with placebo.

125
Q

What is the indication for bempedoic acid?

A

Bempedoic acid is indicated as an adjunct to diet and maximum tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia or established ASCVD who require additional lowering of LDL cholesterol.

126
Q

What is the purpose of the ORION-10 study?

A

The purpose of the ORION-10 study is to evaluate the effectiveness of Inclisiran in participants with atherosclerotic cardiovascular disease and elevated low-density lipoprotein cholesterol.

127
Q

WHAT ARE FINDING OF ODYSSEY OUTCOMES trial? كلها عن Alirocumab

A
  • Among patients who had a previous acute coronary syndrome and who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab.
    -produced about twice the absolute reduction in cardiovascular events among patients with diabetes as in those without diabetes. Alirocumab treatment did not increase the risk of new-onset diabetes.
128
Q

What is the percentage reduction in LDL cholesterol achieved by subcutaneous injections of evolocumab? (FOURIER) trial

A

subcutaneous injections of evolocumab (either 140 mg every 2 weeks or 420 mg every month based on patient preference) versus placebo. Evolocumab reduced LDL cholesterol by 59%…
combined end point of cardiovascular death, MI, or stroke was reduced by 20%

129
Q

Has any cardiovascular outcome trial assessed the reduction of ASCVD event rates with PCSK9 inhibitor therapy in individuals without established cardiovascular disease?

A

No, no cardiovascular outcome trials have been performed to assess whether PCSK9 inhibitor therapy reduces ASCVD event rates in individuals without established cardiovascular disease (primary prevention).

130
Q

What was the average reduction in LDL cholesterol observed in the placebo-controlled trials ON Evolocumab and alirocumab are PCSK9 inhibitors?

A

The average reduction in LDL cholesterol ranged from 36 to 59%.

131
Q

What was the absolute risk reduction in major adverse cardiovascular events with the combination of medications? IMPROVE-IT TRIAL

A

The absolute risk reduction in major adverse cardiovascular events with the combination of medications was 5%.

The relative risk reduction with the combination of medications was 14%.

The combination of medications used in the study was moderate-intensity simvastatin (40 mg) and ezetimibe (10 mg).

132
Q

What did the Cholesterol Treatment Trialists’ Collaboration find regarding high-intensity versus moderate-intensity statins? مهمة

A

The Cholesterol Treatment Trialists’ Collaboration found a 21% reduction in major cardiovascular events in people with diabetes for every 39 mg/dL of LDL cholesterol lowering.

irrespective of baseline LDL cholesterol

133
Q

According to the article, which individuals should similar statin treatment approaches be considered for?

A

Similar statin treatment approaches should be considered for people with type 1 or type 2 diabetes.

134
Q

What are two possible therapies that can be added to maximum tolerated statin therapy to reduce LDL cholesterol levels?

A

Two possible therapies that can be added are ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy.

135
Q

What is the recommended focus for LDL cholesterol target level?

A

The recommended focus for LDL cholesterol target level is <70 mg/dL…. rather than the percent reduction in LDL !!!!

136
Q

Is low-dose statin therapy generally recommended for people with diabetes?

A

No, low-dose statin therapy is generally not recommended for people with diabetes.

137
Q

What is the exception for recommending low-dose statin therapy in people with diabetes?

A

Sometimes low-dose statin therapy is the only dose of statin that a patient can tolerate.

138
Q

What percentage reduction in LDL cholesterol can be achieved with high-intensity statin therapy?

A

Approximately a ≥50% reduction in LDL cholesterol can be achieved with high-intensity statin therapy.

139
Q

What percentage reduction in LDL cholesterol can be achieved with moderate-intensity statin regimens?

A

Moderate-intensity statin regimens can achieve 30–49% reductions in LDL cholesterol.

140
Q

What is the proportional reduction in all-cause mortality for each 1 mmol/L reduction in LDL cholesterol according to the META ANALYSIS study?

A

The study demonstrates a 9% proportional reduction in all-cause mortality for each 1 mmol/L reduction in LDL cholesterol.

The study demonstrates a 13% reduction in vascular mortality for each 1 mmol/L reduction in LDL cholesterol.

141
Q

What should be done for individuals who do not tolerate the intended intensity of statins?

A

The maximum tolerated statin dose should be used.

142
Q

What is the LDL cholesterol goal for people with diabetes and atherosclerotic cardiovascular disease? 2NDRY PREVENTION

A

LDL cholesterol reduction of ≥50% from baseline and an LDL cholesterol goal of <55 mg/dL…

143
Q

What is the recommended course of action if the LDL cholesterol goal is not achieved on maximum tolerated statin therapy for people with diabetes and atherosclerotic cardiovascular disease? 2NDRY PREVENTION

A

Addition of ezetimibe or a PCSK9 inhibitor with proven benefit in this population is recommended

144
Q

What therapy should be added to lifestyle therapy for people with diabetes and atherosclerotic cardiovascular disease? 2NDRY PREVENTION

A

High-intensity statin therapy

145
Q

Is statin therapy recommended during pregnancy?

A

No, statin therapy is contraindicated in pregnancy.

146
Q

When may it be reasonable to initiate moderate-intensity statin therapy in adults with diabetes aged over 75 years?

A

It may be reasonable to initiate moderate-intensity statin therapy after discussion of potential benefits and risks.

147
Q

What is the recommended intensity of statin therapy for adults with diabetes aged over 75 years? 1RY PREVENTION

A

The recommended intensity of statin therapy is moderate.

148
Q

Is it reasonable to continue statin treatment in adults with diabetes aged >75 years who are already on statin therapy? 1RY PREVENTION

A

Yes, it is reasonable to continue statin treatment in adults with diabetes aged >75 years who are already on statin therapy.

149
Q

What is a possible treatment option for people with diabetes aged 40-75 years at higher cardiovascular risk? 1RY PREVENTION

A

It may be reasonable to add ezetimibe or a PCSK9 inhibitor to maximum tolerated statin therapy.

150
Q

What are the criteria for considering ezetimibe or a PCSK9 inhibitor as a treatment? 1RY PREVENTION

A

For people with diabetes aged 40–75 years at higher cardiovascular risk, especially those with multiple atherosclerotic cardiovascular disease risk factors and an LDL cholesterol ≥70 mg/dL.

151
Q

What is the recommended therapy for people with diabetes aged 40–75 at higher cardiovascular risk? 1RY PREVENTION

A

It is recommended to use high-intensity statin therapy.

152
Q

What is the LDL cholesterol goal for people with diabetes aged 40–75 at higher cardiovascular risk?

A

reduce LDL cholesterol by ≥50% of baseline
The TARGET LDL cholesterol goal is <70 mg/dL.

153
Q

When is it reasonable to initiate statin therapy for people with diabetes aged 20-39 years with additional atherosclerotic cardiovascular disease risk factors? 1RY PREVENTION

A

It may be reasonable to initiate statin therapy in addition to lifestyle therapy.

154
Q

Who should consider initiating statin therapy in addition to lifestyle therapy for atherosclerotic cardiovascular disease risk factors? 1RY PREVENTION

A

People with diabetes aged 20-39 years with additional risk factors.

155
Q

What type of therapy should be used in addition to lifestyle therapy for people with diabetes aged 40-75 years without atherosclerotic cardiovascular disease? 1RY PREVENTION

A

Moderate-intensity statin therapy.

156
Q

Is there evidence for benefit from extremely low, less than daily statin doses?

A

Yes, there is evidence for benefit from even extremely low, less than daily statin doses.
LIKE ROSUVASTATIN 5MG OD

157
Q

What is recommended if LDL cholesterol levels are not responding to medication?

A

Clinical judgment is recommended to determine the need for and timing of lipid panels.

158
Q

Why is the highly variable LDL cholesterol-lowering response seen with statins poorly understood?

A

The reason for the highly variable LDL cholesterol-lowering response seen with statins is poorly understood.

159
Q

When should a lipid panel be obtained before initiating statin therapy?

A

A lipid panel should be obtained immediately before initiating statin therapy.

160
Q

When should LDL cholesterol levels be assessed after initiation of statin therapy?

A

LDL cholesterol levels should be assessed 4-12 weeks after initiation of statin therapy.

161
Q

When should a lipid profile be obtained in adults with diabetes?

A

A lipid profile should be obtained at the time of diagnosis, at the initial medical evaluation, and at least every 5 years thereafter in patients <40 years of age.

162
Q

What components are included in a lipid profile?

A

A lipid profile includes total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

163
Q

When should a lipid profile be obtained in adults not taking statins or other lipid-lowering therapy?

A

A lipid profile should be obtained at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter if under the age of 40 years, or more frequently if indicated.

164
Q

How does glycemic control affect plasma lipid levels in patients with very high triglycerides and poor glycemic control?

A

Glycemic control may beneficially modify plasma lipid levels in patients with very high triglycerides and poor glycemic control.

165
Q

What are the recommended interventions for patients with elevated triglyceride levels and/or low HDL cholesterol?

A

Intensify lifestyle therapy and optimize glycemic control.

166
Q

What are the specific triglyceride and HDL cholesterol levels used as thresholds for intervention in patients?

A

Triglyceride levels ≥150 mg/dL [1.7 mmol/L], and HDL cholesterol levels <40 mg/dL [1.0 mmol/L] for men and <50 mg/dL [1.3 mmol/L] for women.

167
Q

What lifestyle modifications should be recommended to improve the lipid profile and reduce the risk of developing atherosclerotic cardiovascular disease in people with diabetes?

A

Lifestyle modification recommendations include focusing on weight loss (if indicated), following a Mediterranean or Dietary Approaches to Stop Hypertension (DASH) eating pattern, reducing saturated fat and trans fat intake, increasing dietary n-3 fatty acids, viscous fiber, and plant stanols/sterols intake, and increasing physical activity.

168
Q

What are the key components of lifestyle modification recommendations for lipid management in people with diabetes?

A

The key components of lifestyle modification recommendations for lipid management in people with diabetes include weight loss (if indicated), following a Mediterranean or DASH eating pattern, reducing saturated and trans fat intake, increasing dietary n-3 fatty acids, viscous fiber, and plant stanols/sterols intake, and increasing physical activity.

169
Q

What are the dietary recommendations for improving lipid profile and reducing the risk of developing atherosclerotic cardiovascular disease in people with diabetes?

A

The dietary recommendations include following a Mediterranean or DASH eating pattern, reducing saturated fat and trans fat intake, and increasing dietary intake of n-3 fatty acids, viscous fiber, and plant stanols/sterols.

170
Q

What should be monitored when adding a mineralocorticoid receptor antagonist to a regimen including an ACE inhibitor or ARB?

A

When adding a mineralocorticoid receptor antagonist to a regimen including an ACE inhibitor or ARB, serum creatinine and potassium levels should be monitored regularly.

171
Q

What effect do mineralocorticoid receptor antagonists have on albuminuria in people with diabetic nephropathy?

A

Mineralocorticoid receptor antagonists reduce albuminuria in people with diabetic nephropathy.

172
Q

What type of medication is effective for management of resistant hypertension in people with type 2 diabetes?

A

Mineralocorticoid receptor antagonists, including spironolactone and eplerenone.

173
Q

CAN WE USE mineralocorticoid receptor antagonists WITH OTHER HTN MEDS?

A

YES,ACE inhibitor or ARB, thiazide-like diuretic, or dihydropyridine calcium channel blocker.

174
Q

How is resistant hypertension defined?

A

Resistant hypertension is defined as blood pressure ≥140/90 mmHg despite a therapeutic strategy that includes appropriate lifestyle management plus a diuretic and two other antihypertensive drugs with complementary mechanisms of action at adequate doses.

175
Q

What therapy should individuals with hypertension who are not meeting blood pressure targets on three classes of antihypertensive medications be considered for?

A

They should be considered for mineralocorticoid receptor antagonist therapy.

176
Q

Why should serum creatinine and potassium be monitored during treatment with an ACE inhibitor, ARB, or diuretic?

A

They should be monitored, particularly among patients with reduced glomerular filtration who are at increased risk of hyperkalemia and AKI.

177
Q

What are the risks associated with AKI and hyperkalemia?

A

AKI and hyperkalemia each increase the risks of cardiovascular events and death.

178
Q

What are the potential side effects of treatment with ACE inhibitors or ARBs?

A

Treatment with ACE inhibitors or ARBs can cause AKI and hyperkalemia.

179
Q

What are the potential side effects of treatment with diuretics?

A

Diuretics can cause AKI and either hypokalemia or hyperkalemia, depending on the mechanism of action.

180
Q

Is the preferential use of antihypertensives at bedtime recommended?

A

No, the preferential use of antihypertensives at bedtime is not recommended. IN MEDS WITH ONE DOSE ONLY

181
Q

Why is the combination of ACE inhibitors, ARBs, and direct renin inhibitors contraindicated?

A

The combination is contraindicated due to the lack of added ASCVD benefit and the increased risk of adverse events such as hyperkalemia, syncope, and acute kidney injury (AKI).

182
Q

In the absence of albuminuria , IS ACEI/ARBS SUPERIOR ON OTHER CLASSESS?

A

ACE inhibitors and ARBs have not been found to afford superior cardioprotection compared to thiazide-like diuretics or dihydropyridine calcium channel blockers.

183
Q

What is the risk of progressive kidney disease in the absence of albuminuria?

A

The risk of progressive kidney disease is low in the absence of albuminuria.

184
Q

What is the recommended continuation of ACE inhibitor or ARB therapy as kidney function declines?

A

Continuation of ACE inhibitor or ARB therapy as kidney function declines to eGFR <30 mL/min/1.73 m2 may provide cardiovascular benefit without significantly increasing the risk of end-stage kidney disease.

185
Q

What is the recommended initial treatment for patients with albuminuria?

A

For patients with albuminuria (urine albumin-to-creatinine ratio [UACR] ≥30 mg/g), initial treatment should include an ACE inhibitor or ARB to reduce the risk of progressive kidney disease

186
Q

What is the purpose of using an ACE inhibitor or ARB for patients with albuminuria?

A

The purpose of using an ACE inhibitor or ARB for patients with albuminuria is to reduce the risk of progressive kidney disease.

187
Q

How often should serum creatinine/estimated glomerular filtration rate and serum potassium levels be monitored for patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic?

A

At least annually.

188
Q

What is the recommended first-line treatment for hypertension in people with diabetes and urinary albumin-to-creatinine ratio ≥300 mg/g creatinine A or 30–299 mg/g creatinine?

A

The recommended first-line treatment for hypertension in people with diabetes and urinary albumin-to-creatinine ratio ≥300 mg/g creatinine A or 30–299 mg/g creatinine is an ACE inhibitor or angiotensin receptor blocker at the maximum tolerated dose indicated for blood pressure treatment.

189
Q

What is the recommended treatment dose of ACE inhibitor or angiotensin receptor blocker for hypertension in people with diabetes and urinary albumin-to-creatinine ratio ≥300 mg/g creatinine A or 30–299 mg/g creatinine?

A

The recommended treatment dose of ACE inhibitor or angiotensin receptor blocker for hypertension in people with diabetes and urinary albumin-to-creatinine ratio ≥300 mg/g creatinine A or 30–299 mg/g creatinine is the maximum tolerated dose indicated for blood pressure treatment.

190
Q

What is the recommendation regarding combinations of ACE inhibitors and angiotensin receptor blockers?

A

Combinations of ACE inhibitors and angiotensin receptor blockers should not be used.

191
Q

What are the recommended first-line therapies for hypertension in people with diabetes and coronary artery disease?

A

ACE inhibitors or angiotensin receptor blockers

192
Q

What is the recommended course of action for individuals with confirmed office-based blood pressure ≥160/100 mmHg?

A

In addition to lifestyle therapy, individuals with confirmed office-based blood pressure ≥160/100 mmHg should have prompt initiation and timely titration of two drugs or a single-pill combination of drugs shown to reduce cardiovascular events in people with diabetes.

193
Q

What blood pressure qualifies individuals for initiation and titration of pharmacologic therapy?

A

Individuals with confirmed office-based blood pressure ≥130/80 mmHg qualify for initiation and titration of pharmacologic therapy.

194
Q

What is one of the recommendations for managing cardiovascular risk according to the article?

A

One of the recommendations is restricting sodium intake to less than 2,300 mg per day.

195
Q

According to the article, what are the recommended daily servings of fruits and vegetables?

A

The recommended daily servings of fruits and vegetables are 8-10 servings per day.

196
Q

What lifestyle interventions are recommended for people with blood pressure >120/80 mmHg?

A

Weight loss when indicated, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity.

197
Q

How long should postpartum individuals with gestational hypertension, preeclampsia, and superimposed preeclampsia have their blood pressures observed in the hospital?

A

Postpartum individuals with gestational hypertension, preeclampsia, and superimposed preeclampsia should have their blood pressures observed for 72 hours in the hospital…. and for 7–10 days postpartum.

198
Q

Are diuretics recommended for blood pressure control during pregnancy?

A

No, diuretics are not recommended for blood pressure control during pregnancy.

199
Q

Which antihypertensive drugs are considered effective and safe in pregnancy?

A

Methyldopa, labetalol, and long-acting nifedipine are considered effective and safe in pregnancy.

200
Q

In what situations may hydralazine be considered in the management of hypertension in pregnancy?

A

Hydralazine may be considered in the acute management of hypertension in pregnancy or severe preeclampsia.

201
Q

What should people intending to become pregnant do if they are currently taking an ACE inhibitor/ARB or spironolactone?

A

They should switch to an alternative antihypertensive medication approved during pregnancy.

202
Q

Why are treatment with ACE inhibitors, angiotensin receptor blockers (ARBs), and spironolactone contraindicated during pregnancy?

A

Treatment with ACE inhibitors, angiotensin receptor blockers (ARBs), and spironolactone are contraindicated during pregnancy as they may cause fetal damage.

203
Q

What blood pressure range supports reducing the risk of accelerated maternal hypertension and minimizing impairment of fetal growth?

A

110–135/85 mmHg.

204
Q

What blood pressure goal was targeted in the active treatment group of the CHAP trial?

A

The blood pressure goal targeted was <140/90 mmHg. CONTROL GROUB TAKE MED ONLY IF SBP>160 DBP>105…… RESULTS: COMPLICATIONS occurred in 30.2% of female participants in the active treatment group vs. 37.0% in the control group

205
Q

What was the target diastolic blood pressure in the CHIPS study during pregnancy?

A

The target diastolic blood pressure in the CHIPS study during pregnancy was 85 mmHg.
was associated with reduced likelihood of developing accelerated maternal hypertension.no demonstrable adverse outcome for infants

206
Q

What are potential adverse effects of antihypertensive therapy?

A

Potential adverse effects of antihypertensive therapy include hypotension, syncope, falls, acute kidney injury, and electrolyte abnormalities.

207
Q

Is low diastolic blood pressure a contraindication to more intensive blood pressure management?

A

No, the presence of low diastolic blood pressure is not necessarily a contraindication to more intensive blood pressure management.

208
Q

In what context is low diastolic blood pressure not a contraindication?

A

Low diastolic blood pressure is not necessarily a contraindication in the context of otherwise standard care.

209
Q

According to META ANALYSIS study, when is antihypertensive treatment most beneficial?

A

Antihypertensive treatment appears to be most beneficial when mean baseline blood pressure is ≥140/90 mmHg.

210
Q

What cardiovascular event showed a further reduction with more intensive reduction to <130 mmHg? META ANALYSIS

A

Stroke….. but not other cardiovascular events.

211
Q

What was the effect of tighter blood pressure control on the risk of stroke? META ANALYSIS

A

Tighter blood pressure control reduced the risk of stroke by 31%…..
but did not reduce the risk of MI

212
Q

What was the primary end point in the ADVANCE study?

A

A composite of cardiovascular death, nonfatal stroke infarction, or worsening renal or diabetic eye disease…
was reduced by 9% in the combination treatment fixed combination perindopril/indapamide

213
Q

By how much was the primary composite outcome reduced in the intensive treatment group? STEP TRIAL( ضغط الشيبان)?

A

The primary composite outcome was reduced by 26% in the intensive treatment group.

214
Q

What was the primary composite cardiovascular endpoint in the ACCORD BP trial?

A

The primary composite cardiovascular endpoint in the ACCORD BP trial was nonsignificantly reduced.

215
Q

What was the target systolic blood pressure in the SPRINT AND ACCORD BP trial?

A

The target systolic blood pressure in the SPRINT trial was <120 mmHg.

216
Q

Why was ACCORD BP viewed as underpowered?

A

ACCORD BP was viewed as underpowered due to the composite primary endpoint being less sensitive to blood pressure regulation.

217
Q

Was the primary composite outcome significantly reduced in the intensive treatment group BP <120 CONTROL GROUP <140? ACCORD BP TRIAL

A

No, the primary composite outcome of nonfatal MI, nonfatal stroke, or death from cardiovascular causes was not significantly
reduced in the intensive treatment group.

علي العكس ……The prespecified secondary outcome of stroke was significantly reduced by 41% in the intensive treatment group

218
Q

What study provides the strongest direct assessment of the benefits and risks of intensive blood pressure control in people with type 2 diabetes?

A

ACCORD BP.

219
Q

By what percentage was the primary composite outcome reduced in the intensive treatment group? SPRINT TRIAL

A

The primary composite outcome of myocardial infarction (MI), coronary syndromes, stroke, heart failure, or death from cardiovascular causes was reduced by 25% in the intensive treatment group.

220
Q

Which trial provides the strongest evidence to support lower blood pressure goals in patients at increased cardiovascular risk?

A

SPRINT provides the strongest evidence to support lower blood pressure goals in patients at increased cardiovascular risk.

SPRINT TRIAL : DM PT NOT INCLUDED

221
Q

According to the article, should treatment for blood pressure be targeted to less than 120/80 mmHg?

A

No, treatment should not be targeted to less than 120/80 mmHg.
s associated with adverse events.

222
Q

In the ADVANCE trial, what was the achieved systolic blood pressure for the treatment group?

A

The achieved systolic blood pressure for the treatment group in the ADVANCE trial was approximately 135 mmHg.

treatment with perindopril/indapamide

223
Q

What was the primary outcome of the ACCORD BP trial?

A

The primary outcome of the ACCORD BP trial was not confirmed.
ماحددت systolic BP رقم معين

224
Q

What was the effect of intensive treatment on stroke in the ACCORD BP trial?

A

Intensive treatment reduced stroke by 41% in the ACCORD BP trial.

225
Q

In the STEP trial, what percentage of people with diabetes were included?

A

Nearly 20%

226
Q

What was the blood pressure target in the STEP trial for treatment of hypertension?

A

<130 mmHg

227
Q

According to the SPRINT trial, by how much did treatment to a target systolic blood pressure of <120 mmHg decrease cardiovascular event rates in high-risk patients?

A

Treatment to a target systolic blood pressure of <120 mmHg decreased cardiovascular event rates by 25%.

228
Q

What blood pressure threshold for initiation or titration of therapy is associated with better pregnancy outcomes in pregnant individuals with diabetes and chronic hypertension?

A

A blood pressure threshold of 140/90 mmHg

229
Q

What is the suggested blood pressure target in pregnant individuals with diabetes and chronic hypertension to reduce the risk for accelerated maternal hypertension?

A

A blood pressure target of 110-135/85 mmHg

230
Q

What should be the lower limit for therapy in pregnant individuals with diabetes and chronic hypertension?

A

Therapy should be lessened for blood pressure <90/60 mmHg

231
Q

According to the article, what is the blood pressure threshold for qualifying for antihypertensive drug therapy for people with diabetes and hypertension?

A

≥130/80 mmHg.

232
Q

What is the target blood pressure goal for people with diabetes and hypertension undergoing antihypertensive drug therapy?

A

<130/80 mmHg, if it can be safely attained.

233
Q

How should blood pressure targets be determined for people with diabetes and hypertension?

A

Blood pressure targets should be individualized through a shared decision-making process that considers cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences.

234
Q

What can home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring provide evidence of?

A

Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring can provide evidence of white coat hypertension, masked hypertension, or other discrepancies between office and ‘true’ blood pressure.

235
Q

What may be evidence of autonomic neuropathy?

A

Postural changes in blood pressure and pulse.

236
Q

When should orthostatic blood pressure measurements be checked?

A

On initial visit and as indicated.

237
Q

Why should people with hypertension and diabetes monitor their blood pressure at home?

A

People with hypertension and diabetes should monitor their blood pressure at home to keep track of their blood pressure levels on a regular basis and detect any fluctuations or abnormalities early. This can help in managing their condition effectively and prevent complications related to cardiovascular disease.

238
Q

How should blood pressure be measured at routine clinical visits?

A

Blood pressure should be measured at every routine clinical visit.

239
Q

How is hypertension defined?

A

Hypertension is defined as a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥80 mmHg based on an average of ≥2 measurements obtained on ≥2 occasions.

EVEN THOSE BORDERLINE SHOUD BE MEASURED 2 TIMES.

240
Q

At what blood pressure level could individuals with cardiovascular disease be diagnosed with hypertension at a single visit?

A

Individuals with blood pressure ≥180/110 mmHg and cardiovascular disease could be diagnosed with hypertension at a single visit.

241
Q

What are some benefits of antihypertensive therapy?

A

Antihypertensive therapy has been shown to reduce ASCVD events, heart failure, and microvascular complications.

242
Q

What is a major risk factor for both ASCVD and microvascular complications?

A

Hypertension

243
Q

How is hypertension defined?AHA

A

Hypertension is defined as a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥80 mmHg.

244
Q

Why is it important to assess the 10-year risk of a first ASCVD event?

A

Assessing the 10-year risk helps to stratify ASCVD risk and guide therapy.

245
Q

What is the basis for the recommendations on cardiovascular risk factor modification for people with type 1 diabetes?

A

The recommendations are based on data obtained in people with type 2 diabetes, as there have been no specific trials for type 1 diabetes.

246
Q

What does extrapolation mean in the context of cardiovascular risk factor modification recommendations for people with type 1 diabetes?

A

Extrapolation means that the recommendations are inferred or extended from data obtained in people with type 2 diabetes to apply to people with type 1 diabetes.

247
Q

What are some risk factors for cardiovascular disease in individuals with diabetes?

A

Some risk factors for cardiovascular disease in individuals with diabetes include duration of diabetes, obesity/overweight, hypertension, dyslipidemia, smoking, a family history of premature coronary disease, chronic kidney disease (CKD), and the presence of albuminuria.

248
Q

What does a recent meta-analysis indicate about the effect of SGLT2 inhibitors on heart failure hospitalization?

A

A recent meta-analysis indicated that SGLT2 inhibitors reduce the risk of heart failure hospitalization.

249
Q

What is a common precursor of heart failure?OR ASCVD?

A

Hypertension is often a precursor of heart failure.

250
Q

According to recent studies, what is the rate of heart failure hospitalization in people with diabetes compared to those without?

A

The rate of heart failure hospitalization in people with diabetes is twofold higher compared to those without.

251
Q

What are some common conditions that coexist with type 2 diabetes?

A

Hypertension and dyslipidemia are common conditions that often coexist with type 2 diabetes( INDEPENDANT)

252
Q

What is Atherosclerotic Cardiovascular Disease (ASCVD)?

A

Atherosclerotic Cardiovascular Disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin.

253
Q

ALGORITHM HTN

A
254
Q

TABLE STATINS

A
255
Q

GLP1 RA LANDMARK TRIAL

A
256
Q

SGLT2I LANDMARK TRIALS

A
257
Q

ALGORITHM SELECTING MEDS ACCORDING TO COMORBIDITIES

A

ADA 23 (9 decks)

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