Primary and Secondary Prevention of ASCVD, CAD, Cerebrovascular Accidents

Question 1

When do you beginning screening for CAD/CVA

Answer 1

At age 20 and repeated every 4-6 years in those without established CV or CVD

Question 2

If age 40-79,

Answer 2

use 10 yera Pooled Cohort Risk Equation to estimate short-term ASCVD risk

Question 3

If age 20-39 or low risk (<7.5%) and age 40-79

Answer 3

use 30 yera Framingham score

Question 4

Primary prevention w/o compelling indication =

Answer 4

ACEi/ARB + CCB or Thiazide

Question 5

Coronary artery disease =

Answer 5

BB + ACEi/ARB

Question 6

Recurrent stroke prevention =

Answer 6

Thiazide +/- ACEi

Question 7

CKD or DM =

Answer 7

ACEi/ARB

Question 8

Glycemic control prevents

Answer 8

Progression of microvascular complications (neuropathy, nephropathy, retinipathy)

Question 9

Lifestyle modifiications

Answer 9

Cessation of tobacco and avoid environmental exposure
10% weight loss in 6 months (BMI 18.5-24.9)
30 minutes of moderate intensity activity 3-4 times a week
<1 for women

Question 10

Cardiac rehabilitation

Answer 10

Medically supervised training

Those with a history of CAD esp after MI or Chronic Stable Angina

Question 11

Define atheroembolic event

Answer 11

Plaque rupture has caused a MI or stroke/TIA

Treatment: Antiplatelets

Question 12

Atheroembolic event treatment

Answer 12

Aspirin

Question 13

Define cardioembolic event

Answer 13

Abnormal blood flow, inflamation, or endothelial damage puts you at risk of activation of clotting factors leading to a stroke/TIA
Treatment: Anticoagulants

Question 14

Cardioembolic event treatment

Answer 14

Coumadin

Question 15

Primary Prevention of Atheroembolic process (CAD) and Atheroembolic stroke/TIA

Answer 15

Aspirin 75-162 PO daily IF: high risk of ASCVD and NO peptic ulcer disease

Question 16

Secondary Prevention of Atheroembolic process (CAD)

Answer 16

Silent CAD, Chronic SA, Symptomatic PVD: Aspirin 75-162 mg PO daily or clopidogrel

History of UA/NSTEMI/STEMI: Aspirin + P2Y12 inhibitor for 12 months after initial event (clopidogrel, prasugrel, ticagrelor)

Question 17

Secondary Prevention of Atheroembolic stroke/TIA

Answer 17

Clopidogrel 75 mg QD,
Aggrenox BID OR
Aspirin 5-325 mg QD
- No combos!!

Question 18

Primary and Secondary Prevention of Cardioembolic stroke/TIA (Afib or valve replacement

Answer 18

CHA2DS2Vasc

Question 19

CHA2DS2Vasc Scoring

Answer 19

CHF: 1
HTN: 1
Age greater than 75: 2
65-74: 1
DM: 1
Stroke/TIA: 2
CAD/MI: 1
Female: 1

Question 20

CHA2DS2Vasc Scoring = treatment

Answer 20

0: no antithrombotic therapy
1: aspirin or anticoagulant
>/=2: Anticoagulant

Question 21

Heart valve replacement with mechanical prosthesis treatment

Answer 21

Warfarin +/- aspirin

Question 22

Aggrenox Dosing

Answer 22

200/25 mg ASA

Question 23

Clopidogrel (Plavix) Dosing

Answer 23

75 mg daily

Question 24

Prasegrel (Effient) Dosing

Answer 24

5-10 mg daily

Expensive

Question 25

Ticagrelor (Brilinta) Dosing

Answer 25

90 mg daily | Expensive

Question 26

Dabigatran (Pradaxa) Dosing

Answer 26

75-150mg BID

Question 27

Rivaroxabin (Xarelto) Dosing

Answer 27

15-20 mg QD

Question 28

Apixaban (Eliquis) Dosing

Answer 28

2.5-5 mg BID

Question 29

ASCVD Risk

Answer 29

Green: Sedentary, supoptimal diet, tobacco and EtOH Yellow: Dyslipidemia Red: Excessive weight and HTN

Question 30

Silent ASCVD

Answer 30

>/= obstruction of coronary artery (green) Chronic stable angina (yellow) CAD PAD (yellow)

Question 31

Hard ASCVD

Answer 31

ACS (yellow) | Stroke/TIA (redish)

Question 32

Primary Prevention (Green Zone)

Answer 32

Prevent CAD/CSA/MI/Stroke/TIA by controlling BP, dyslipidemia, tobacco, lifestyle factors, and potentially initiating therapy for high-risk pts

Question 33

Secondary Prevention (Red Zone)

Answer 33

Prevent CAD/CSA/MI/Stroke/TIA by controlling BP, dyslipidemia, tobacco, lifestyle factors, and initiating antithrombotic therapy for all pts without contraindications

Question 34

CV Risk

Answer 34

``` HTN (thumb) Dyslipidemia DM Lifestyle Anti-thrombotics (pinkie) ```

Question 35

Define CAD

Answer 35

Arterial sclerosis leads to plaque rupture Platelets play a large role in treatment and prevention Anti-platelet therapy

Question 36

Define Atheroembolic stroke

Answer 36

Arterial sclerosis leads to plaque rupture Platelets pay a large role in treatment and prevention Anti-platelet therapy

Question 37

Define Cardioembolic Stroke

Answer 37

Abnormal blood flow, inflammation or endothelial damage leads to activation of clotting factors Anticoagulant therapy for Afib

Question 38

MI Therapy

Answer 38

Aspirin +/- Plavix, Effient, Brillinta

Question 39

Atheroembolic stroke Therapy

Answer 39

Plavix Aggrenox Aspirin

Question 40

DVT or PE Treatment

Answer 40

Warfarin | Xarelto

Question 41

Cardioembolic Stroke (Afib or Valve disease)

Answer 41

Anticoagulants (warfarin, Pradaxa, Xarelto, Eliquis

Question 42

Atheroembolic event =

Answer 42

Antiplatelets

Question 43

Thrombo/Cardioembolic Event =

Answer 43

Anticoagulants

Question 44

Someone has MI and was previous taking aspirin and now has an increased risk of bleeding, what do you do?

Answer 44

Keep the aspirin on bc it would be worse without it

Question 45

Men VS Women

Answer 45

``` Men = more MI Women = more Strokes ```