Macrovascular

Question 1

What four classes of anti hypertensives are preferred? In no particular order and in patients with no CV disease or CKD.

Answer 1

Thiazides
ACE
ARB
Dihydropyridine Ca blockers. Ie: amlodipine, nifedepine, felodipine

Question 2

If a patient is already on an ACE and needs BP therapy intensified, what is the drug of choice?

Answer 2

CCB rather than thiazides

Question 3

Why should all patients with ACS be screened for diabetes prior to discharge?

Answer 3

More than 2/3 patients with an MI have diabetes or pre-diabetes

Question 4

What particular treatments for ACS are different for people with diabetes?

Answer 4

None. They should be treated the same and have the same interventions as a non-diabetic

Question 5

Which is preferred in diabetic patients with ACS:
Clopidogrel
Ticagrelor (brillinta)
Prasugrel (Effient)

Answer 5

Undergoing PCI:
Ticagrelor or prasugrel Preference to ticagrelor as
Prasugrel only use if 65kg and no Hx of stroke.

Question 6

What are the BP

TARGETS and Thresholds?

Answer 6

Both 130/80

Question 7

Why should patients with stroke be screened for diabetes?

Answer 7

Because men with D have a 2-3 fold increase and women have a 2-5 fold increase of risk of stroke

Question 8

Is diabetes a cause of heart failure or only secondary to Ischemia?

Answer 8

Diabetes can cause HF independent of ischemic heart disease by causing diabetic cardiomyopathy that may manifest with normal or reduced left ventricular ejection fraction.

Question 9

What is the recommendation ace/arb dosing and monitoring in a D patient with heart failure but Also with an eGFR less than 60?

Answer 9

Starting dose of ACE/ARB should be HALVED

Within 7-10 days of initiation or titration of therapy, monitor:
Electrolytes, eGFR, BP, weight and heart failure sx and signs.

Dose up more gradually but target same doses as non diabetics even B Blockers.

Question 10

People with diabetes have a CV age _____ years in advance of their chronological age.

Answer 10

10-15 years

Question 11

Reduced life expectancy is __ years due to CVD.

Answer 11

12

Question 12

ASA for primary prevention?

Answer 12

No reduction of CAD events but increase in bleeding.

MAY be considered if high risk.

Question 13

At what age should an ACE or ARB be started if signs of microv

Answer 13

Age 55

OR younger if clinical macrovascular disease or microvascular disease

Question 14

When should a statin be initiated? 4

Answer 14

Age > 40

Age > 30 if diabetes > 15 years.

Microvascular complications

Framingham high risk.

Question 15

The presence of CAD in type one pts is related to:

Answer 15

Age
Duration of D 
Higher A1C 
Higher albumin excretion 
Traditional factors (smoking, weight, total and LDL cholesterol)

Question 16

Are type 1 diabetics at higher CAD risk than people without D?

Answer 16

Type 1 D is an independent risk factor for premature CV disease and MORTALItY in young adults (20-39)

Question 17

In secondary prevention, what if ASA cannot be tolerated?

Answer 17

Clopidogrel cAn be used

Question 18

What is the most common lipid panel seen when a type 2 is tested?
ALSO, What’s the difference in LDL particles in non-D people and D people?

Answer 18

High TG
Low HDL
Normal LDL-C

Note:the atherogenicity of LDL is increased in D due to glucagon and oxidation!!

LDL particles are smaller and denser

Question 19

If a patient cannot fast for a lipid panel, what markers can be used which are NOT affected by fasting?

Answer 19

Non HDL cholesterol

Apo-B

Question 20

How often should a lipid panel be done in all patients with D?

Answer 20

Upon dx
Then yearly or as clinically indicated.
OR every 3-6 months if treatment is initiated.

Question 21

Which pts are automatically high risk Framingham, Ie: >= 20%

Answer 21

Age > 40
Age > 30 if D more than 15 years
Microvascular disease.

Clinical vascular disease
Abdominal aortic aneurysm
CKD
High risk HTN

Question 22

Low risk Framingham is at what percent?

Answer 22

Less than 10%

Question 23

When should a baseline ECG be done?

How often should it be repeated?

Answer 23

Age > 40
Age greater than 30 if D more than 15 years
Cardiac risk factors such as HTN, proteinuria, reduced pulses or vascular Bruits (sound heard in artery due to narrowing)
Microvascular or macrovascular damage

Every 2 years!

Question 24

What is the initial test for investigation of CAD if indicated ?

Answer 24

Exercise ECG stress testing.

Question 25

Is IFG or IGT more closely associated with CVD outcomes?

Answer 25

IGT

Question 26

When should fibrates and statins for sure not be used together?

Answer 26

CKD. Increased risk of rhabdo

Question 27

Which statins need lower doses in eGFR less than 60?

Answer 27

Atorv

Prava

Question 28

Who should have a stress test done?

Answer 28

Typical or atypical cardiac symptoms. 
PAD
Carotid Bruits
TIA
stroke 
Resting ECG abnormalities.

Question 29

What if a patient CANNOT do an exercise ECG test or if there’s resting ECG abnormalities?

Answer 29

Do pharmacilogic stress echo or nuclear imaging

Question 30

If a patient is on Max statin and still has low HDL AND LDL Is not at target, what should you add?

Answer 30

Can add niacin.

Question 31

If a patient is on Max statin and still LDL Is not at target, what should you add?

Answer 31

Can add ezetrol, fibtraye or niacin.

Question 32

When should non HDL-C be used?

What’s the target?

Answer 32

If patient cannot fast. Should be less than 2.6

Question 33

Resting ECG should be repeated every 3-5 years in what individuals?

Answer 33

Age > 40
Duration of diabetes >15 yrs and older than age 35
End organ danage
One or more CVD risk factor
Age >40 and planning to undertake very vigorous or prolonged exercise.

Question 34

What is the Apolipiprtein B target?

What is the non-HDL cholesterol goal?

Answer 34

0.8

<2.6

Question 35

After initial lipid profile screening is done, hiw often do you retest for
1- patient started on statin
2- patirnt not started on statin

Answer 35

1- wvery 3 to 6 months to verify targets being met

2- wvery 1-3 years depending on risk

Question 36

What drug do you start if TG >10 and need to reduce risk of pancreatitis

Answer 36

Fibrate

Question 37

Albuminuria is an indeoendant risk factir for HF. Increased ACR gives a pt an ____ x increase in Risk of developong HF
AND how can we lower the risk with drugs?

Answer 37

2-4 x

RAAS blockade

Question 38

Do HF patinets with D need to be treated differently than HF pts without D?

Answer 38

No. Same deugs. Eg. Ivabradine is effective regardleas.