Management of stable CAD

Question 1

CABG studies vs med rx:

Answer 1

CASS 1975
European Study 1973
VA study 1972

Question 2

BARI study

Answer 2

no sig difference in ptca or cabg in mortality or MI for entire group
dm: cabg superior to ptca mortality
no difference in mortality in nondiabetic

difference: ima graft

Question 3

Stenting vs POBA

Answer 3

no difference in death, mi, emergent cabg
reduced:
angiographic restenosis 48%
coronary revasc 41%

Question 4

cabg vs pci in elderly

Answer 4

reduced mortality

Question 5

COURAGE

Answer 5

opt med rx vs pci and omt
pos stage 1 bruce excluded
results: angina same at 36 mths
chronic stable angina: omt 1st

Question 6

DES vs BMS

Answer 6

meta analysis
no difference in mort, cabg, stent thrombosis (late PES>SES=BMS)
decreased angio restenosis @9-12 mth 9%
less tvr SES<BMS 5-10%

Question 7

SYNTAX

Answer 7

cabg vs des in lmca or 3vd
cabg less endpoint (due to less revascularization)
cva 2.2 vs des 0.6 in cabg vs des

Question 8

HIT study

Answer 8

lowering TG
gemfibrizil 600 bid
lowers all cause mortality

Question 9

Risk stratification (NCEP ATP III)
chd equivalent

Answer 9

chd equiv: 10 yr risk >20%- atherosclerosis (pad,aaa, symp carotid dz, dm, multiple risk factors for chd >20%
framingham 10 yr risk calc

Question 10

goals ncep atpiii

Answer 10

high risk (10yr>20%) 100, rx if >130
moderate high (>2 risk fact, 10 yr risk 10%-20%) 130, rx >130
moderate 160
low 160, >190 consider rx

Question 11

amlodipine/simvastatin

statin contraindicated combos:

Answer 11

do not use 80 simvastatin

cyclosporine, macrolide abx, antifungals

Question 12

lipophilic statin

Answer 12

simvastatin, atorvostatin, fluvastatin, lovastatin

rosuvastatin, pravastatin are not lipophilic

Question 13

statin with ketoconazole or erythomycin

Answer 13

pravastatin ok

Question 14

statin protein binding

Answer 14

fluvastatin, lovastatin, simvastatin, atorvorstatin >95% protein bound
pravastatin 50%
rosuvastatin 88%

Question 15

associated with statin induced myopathy

Answer 15

age, nicotinic acid, fibrate, verapamil, cytochrome p450 3A4 inhibitor

Question 16

myopathy statin and fibrates

Answer 16

lopid (gemfibrozil) risk&raquo_space; than tricor (fenofibrate)

Question 17

Bile Acid Sequestrants

Answer 17

cholestyramine (questran)
Colestipol (Colestid)
colesevelam (Wellchol)
gi side effects
may increase triglycerides

Question 18

Fibrates

Answer 18

gemfibrozil (lopid, gemcor) inhib chol absorpt at brush border
fenofibrate (tricor etc
clofibrate
gallstones, myopathy
used for elevated tg

Question 19

metabolic syndrome criteria

Answer 19

abd obesity: >40” men, >35” women
TG> 150
HDL 130/85
fasting glu >110

Question 20

JNC 7 BP

Answer 20

normal 120/80
pre 139/89
stage1 159/99
stage2 >160/100

Question 21

varenicline contraindication

Answer 21

depression

Chantix

Question 22

ACCORD study:

Answer 22

DM Rx
hga1c < 
also ADVANCE trial
severe hypoglycemia ~ 2x increased
nephropathy decreased - goal 7.0 hga1c