CAD/Lipids Flashcards
True or false, heart disease is the leading cause of death in the US?
True.
This is true for BOTH genders.
What racial group has the highest incidence of CAD?
a) whites
b) hispanic
c) blacks
d) asians
Answer: C)blacks
Note: all races have seen declines since the 90’s
Which is not a risk factor for CAD?
a) HTN
b) obesity
c) DM
d) high HDL
e) high cholesterol
Answer: d) high HDL
HDL is the GOOD cholesterol.
High intensity statins include:
a) atorvastatin & simvastatin
b) rosuvastatin & atorvastatin
c) atorvastatin & pravastatin
d) pravastatin & rosuvastatin
Answer: b) Rosuvastatin and atorvastatin (atorvastatin 40-80 mg; Rosuvastatin 20-40 mg)
Statin guidelines recommend secondary prevention patients achieve an LDL of:
a) <100
b) <130
c) <70
Answer: c) <70
Most patients who have difficulty tolerating a statin can be helped with a different statin or some type of lower dosing.
a)True
b) False
c) Research is undecided about this
Answer: a) true
Statins can cause T2DM. However, most of the affected patients had several risk factors for diabetes already in place.
a) True
b) False
Answer: a) true
Patients with an intermediate risk for CVD (7.5% to 19.9%) who have metabolic syndrome may be good candidates for a statin.
a) Yes. A statin can reduce their risk.
b) No, metabolic syndrome has nothing to do with CVD risk.
c) The calculated risk of CVD has to be higher than 20%.
Answer: a) Yes.
Metabolic syndrome is judged by 5 criteria. These criteria do NOT include:
a) decreased HDL and increased Triglycerides
b) elevated BG
c) elevated LDL
d) hypertension
Answer: c) elevated LDL
A family history of premature heart disease should always be elicited and documented in the diagnosis list as it i a significant risk factor for Heart disease. It is defined as:
a) Males 55 or less; females 65 or less
b) males <60; females <70
c) males <45; females <55
Answer: a) males <55and females <65
Patients considered secondary prevention means they have established CVD. What is the recommendation for their use of a statin?
a ) High intensity statin
b) Too late to stop their CVD so no need for prevention
c) Moderate intensity statin
Answer: a) high intensity statin
Patients who are considered primary prevention for CVD and statin use include all EXCEPT:
a) Severe HTN
b) LDL >190
c) Calculated CVD risk score of >7.5%
d) Diabetes
Answer: a) severe HTN
MIs occur due to rupture of plaques in blood vessels that are _____ occluded:
A) >90%
B) <25%
C) >75%
D) <50%
Answer: D) <50%
Note: stress tests do not identify obstruction until 70-75% lesion present
Most MIs occur due to unstable coronary artery plaques. Statins help to harden and stabilize these plaques.
A) False: it’s all about the LDL level not the plaque
B) True: another reason to use statins other than to lower atherogenic particles
B) True.
Put the following races into descending order based on the U.S. age adjusted death rates for Heart Disease:
Black, Hispanic, White, & Asians.
Answer: Black, Whites, Hispanic, Asians
Who should be receiving statin therapy per the 2018 Cholesterol Guidelines? Select the one group for whom statins are NOT indicated.
a) TD2M–dosing depends on calculated risk score
b) LDL >190
c) Clinical ASCVD
d) HTN
Answer: d) HTN
Other individuals also have a recommendation for statin therapy. Select the one group for whom statins are NOT indicated.
A) Individuals with a calculated risk score of >7.5%
B) Individuals should be considered with strong family history or History of premature heart disease, a Coronary Calcium Score (CCS) that is elevated or other Enhanced Risk Factors such as metabolic syndrome, CKD. Please review the other indications.
C) Individuals with an LDL >130
Answer: C) individuals with an LDL>130
Which fact below is true about sudden death (CHD) without any previous symptoms?
A) 50% of men and 10% of women died suddenly of CHD had NO previous symptoms.
B) 50% of men and 64% of women who died suddenly of CHD had NO previous symptoms.
C) 20% of men and 80% of women died suddenly of CHD had NO previous symptoms.
Answer: B) 50% of men and 64% of women who died suddenly of CHD had NO previous symptoms
In 2018, new cholesterol recommendations were added to those of 2013. These recommendations idientified 2 more specific risk groups for drug therapy: High Risk and Very High Risk. The 2 drugs added to statin use for these 2 groups are:
a) double doses of high intensity statins
b) fenofibrates
c) ezetimibe and PCSK9-inhibitors
Answer: c) ezetimibe & PCSK9-inhibitors
Research shows that we need universal screening in children to detect lipid disorders as opposed to only scrreeening those with a + family hisory. Universal non-fasting screening for non-hdl cholesterol level should be done using a lab order for TC and HDL only. Then assess that value against an appropriate chart.
The recommended age levels for universal screening include 2 age groups:
a) ages 6-10 & 15-17
b) ages 9-11 & 17-21
c) ages 5-7 & 10-12
Answer: B
The 5-3-2-1-almost 0 counseling framework for children is an east to use tool in the exam room. Select the correct answer for what it means.
5-servings of fruits and veggies daily
3- structured meals daily
2-hours of screen time or less
1-hour of activity daily
0-sugary sweetened beverages
A child <12 who needs a statin should be referred to a lipid specialist for best management?
a) true
b) false
Answer: a) true
______ is the good lipid and ____ is the “bad” lipid.
HDL is the good lipid & LDL is the bad lipid.
“HDL want high; LDL want low”
What was the biggest change between the 2013 previous methods for looking at global risk of CVD versus the 2018 Guidelines for cholesterol?
a) added very high risk group
b) removed LDL as the guiding criteria for treatment
c) added ASCVD risk enhancers
d) added coronary calcium score (CAC)
Answer: b) removed LDL [this was previously the main guideline for treatment]
What is not a component of managing global CVD?
a) tobacco cessation
b) HTN control
c) stress management
d) LDL goal of <130 if DM
Answer: d) LDL goal of <130 if DM
According to the 2013 AHA guidelines, what group does not REQUIRE a statin?
a) HTN
b) LDL 190+
c) established atherosclerosis
d) ASCVD risk 7.5%+
e) DM
Answer: a) HTN
HTN is not a sign of established CVD (we are talking about plaque)
Note: established atherosclerosis is history of MI/CVA/TIA/CABG/angina
Which patient needs a statin?
a) DM with LDL 130
b) DM with LDL 190+
c) patient with 10-year ASCVD risk 7.5%+
Answer: ALL of the above
Note: all diabetic patients aged 40-75 need statin regardless of LDL levels!!!
Strength of statin will be guided by ASCVD risk
If a patient has a 10-year ASCVD risk of 7.5%+ they need what type of statin:
a) high intensity
b) moderate intensity
c) high intensity only if other comorbidities
d) low intensity
Answer: a) high intensity
Unless ages 75+ (consider moderate)
