secondary prevention of coronary artery disease

Question 1

What is the main goal of secondary prevention of coronary artery disease

Answer 1

Stablize existing plaques (to prevent rupture) and prevent future plaques from forming

Question 2

What are the classifications and levels of evidence assigned to guidelines

Answer 2

Classification: I – Should do it, IIa – Reasonable, IIb – Might be considered, III – Don’t do it. Levels of evidence: A – Several randomized trials, B – Observational studies, case reports, C – Expert opinion

Question 3

What are the pharmacologic CAD secondary prevention guidelines? General

Answer 3

anti-platelets, Beta blockers, RAAS inhibitors

Question 4

What are the pharmacologic and lifestyle CAD secondary prevention guidelines? General

Answer 4

BP control, lipid management, diabetes control, depression treatment, smoking cessation

Question 5

What are the lifestyle CAD secondary prevention guidelines? General

Answer 5

Weight management, physical activity

Question 6

Which antiplatelets are used in CAD secondary prevention and how do they work

Answer 6

Aspirin reduces platelet activation by blocking cyclooxygenase and thromboxane A2 (a vasoconstrictor) production. Thienopyridines ((clopidogrel, ticlodipine, prasugrel, and ticagrelor) block P2Y12 and inhibits adenosine diphosphate (ADP) production and platelet aggregation
Aspirin reduces platelet activation by blocking cyclooxygenase and thromboxane A2 (a vasoconstrictor) production. Thienopyridines ((clopidogrel, ticlodipine, prasugrel, and ticagrelor) block P2Y12 and inhibits adenosine diphosphate (ADP) production and platelet aggregation

Question 7

Class I beta blocker guidelines

Answer 7

•Beta-blockers in all with Left ventricular systolic dysfunction (ejection fraction <40%) and heart failure symptoms or MI/ACS in the prior 3 years

Question 8

Class Iia beta blocker guidelines

Answer 8

•Beta-blockers in all with Left ventricular systolic dysfunction (ejection fraction <40%) even in the absence of heart failure symptoms. Beta-blockers in all with any history of MI/ACS

Question 9

How does RAAS blockade affect the CV system

Answer 9

Vasodilation, natriuresis, decreased SNS activity,reduces cardiac remodeling

Question 10

Class 1 RAAS inhibition guidelines

Answer 10

ACEIs: All with Left Ventricular Systolic Dysfunction (ejection fraction <40%) who are receiving therapeutic doses of BB and ACEI/ARB and have heart failure or diabetes

Question 11

What is the recommended BP to prevent cardiac events

Answer 11

< 140/90 if less than 60yrs. <150/90 if greater than 60 yrs

Question 12

Interventions used to lower BP

Answer 12

lifestyle, RAAS inhibitors (ACEIs, ARBs), Beta-blockers, Diuretics, Calcium channel blockers, Direct vasodilators
lifestyle, RAAS inhibitors (ACEIs, ARBs), Beta-blockers, Diuretics, Calcium channel blockers, Direct vasodilators

Question 13

class I lipid guidelines

Answer 13

Statins in all CAD patients. High dose if 75yrs. No need to titrate to LDL, no non-statins,

Question 14

Does glycemic control affect MI outcomes?

Answer 14

No

Question 15

Class I diabetes guidelines

Answer 15

•Lifestyle modifications and coordination with the patient’s primary care physician should occur

Question 16

Class Iia diabetes guidelines

Answer 16

•Metformin should be a first-line pharmacologic therapy

Question 17

Class Iib diabetes guidelines

Answer 17

•HbA1c <7% can be considered

Question 18

Class Iia and Iib depression guidelines

Answer 18

Iia- assessment of depression. Iib- treatment of depression does not appear to improve cardiac outcomes, but is beneficial for overall mental health

Question 19

How does smoking promote atherosclerosis

Answer 19

oxidizes LDL, inflammatory, decreaes LDL, causes endothelial dysfunction and reductions in NO

Question 20

Goal BMI and waist circumference

Answer 20

BMI btw 18.5-24.9. Waist <35inches for women

Question 21

Class I physical activity guidelines

Answer 21

•Moderate to high-intensity exercise for 30-60 minutes/day, At least 5, and ideally 7, days a week