Prevention

Question 1

For Framingham 7.5 to 20%, CAC cutoff to recommend statin

Answer 1

> 100 - moderate intensity

If 1-99, favors statin

Question 2

If TG > 400, must make sure what?

Answer 2

Check fasting levels

Question 3

ASCVD.

Events (4)

High risk conditions (8)

Answer 3

ACS < 12 mo ago, h/o MI, h/o ischemic CVA, sx PAD (claudication with ABI < 0.85 or revascularization)

Age > 65, HTN, DM, heterozygous FH, h/o CABG or PCI, CKD, h/o CHF

Question 4

Secondary prevention

For age >18, very high ASCVD risk is…

Mgmt recommendation

Answer 4

2+ events or 1 event and 2+ high risk conditions

Need max tolerated statin

Question 5

For age 20-75, what is LDL cutoff for high intensity statin

Answer 5

190

Question 6

DM prevention

Statin recommendation?

Answer 6

All need mod intensity

If ASCVD > 20%, then high intensity

Question 7

Primary prevention

Age <20
Age 20 - 39

Answer 7

1. Lifestyle changes, can treat if HeFH

2. Calculate lifetime risk…if FH early ASCVD or if LDL > 160, can give statin

Question 8

Risk enhancers

13 (including LDL, TG, hsCRP, LPa, ApoB, and ABI cutoffs)

Answer 8

FH premature ASCVD
South Asian descent
CKD
Metabolic syndrome
Pre-eclampsia
Premature menopause
RA, psoriasis, or HIV
LDL > 160
TG > 175
HsCRP > 2.0
LPa > 50 mg/dL
ApoB > 130
ABI < 0.9

Question 9

If FH premature ASCVD, need to assess what for primary prevention

Answer 9

LP(a)

Question 10

CK cutoff before stopping statin

Answer 10

5x ULN

Question 11

Statin consideration for Asians

Answer 11

Start at 1/4 dose, since myopathy risk is 10%. They achieve lower LDLs with each dose than others

Question 12

BP goals:

based on ASCVD? (AHA guideline)
based on age? (JNC 8)

Answer 12

> 10%. Then <130/80
<10%. 140/90

> 65 <150/90
<65 <140/90

Question 13

Metabolic syndrome definition

Answer 13

Abd obesity > 102 cm men, >88 cm women
TG > 175
HDL < 40 men, <50 women
BP > 130/85
Fasting BG > 100