Primary Care

Preventive Cardiology

Questions discussed in this category

What is a reasonable approach to coronary calcification that is incidentally found on CT in a patient who does not have symptoms suggestive of angina?

2 Answers available

How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?

5 Answers available

How do you decide between ordering coronary calcium scoring versus coronary CTA in asymptomatic patients with low to moderate risk for CAD?

6 Answers available

Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?

Ferrell et al., PMID 38448791

6 Answers available

Is it worth getting a calcium score on a patient who is already on statin therapy?

(Since there is some suggestion that stains convert vulnerable plaque to stable calcified plaque and increase calcium score)

3 Answers available

How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long term CVD risk?

1 Answer available

What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?

If the ECG was obtained prior to major orthopedic surgery (such as hip replacement) would that change your approach?

2 Answers available

How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?

Chen & Zhong, AHA/ASA Journals 2024

2 Answers available

Is a daily prophylactic dose of aspirin appropriate for patients with coronary artery calcification by Chest CT or an elevated calcium score?

If so, is there a quantitative calcium score or a reported severity of CT coronary artery calcification that would lead you to start daily aspirin?

8 Answers available

Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?

4 Answers available

Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?

Prattichizzo et al., PMID 39468384

1 Answer available

How would you counsel a patient on the risk/benefit profile of preventive management such as statin initiation if they have an elevated lipoprotein (a) level, markedly elevated LDL > 200 but a CAC score of 0 without other CV risk factors?

2 Answers available

Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?

1 Answer available

For isolated and very high lipoprotein (a) levels (LDL of > 140, has an Lp(a) > 100) in a patient with no cardiac symptoms or risk factors, would you start lipid lowering treatment, such as with a PCSK9i if they develop statin intolerance?

If their calcium score and stress tests are normal, would you still treat?

1 Answer available

How do you counsel patients on wearable heart monitor devices when they ask about specific products and diagnostic accuracy of these devices available on the market?

2 Answers available

Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?

1 Answer available

When would you consider long-term cardiac monitoring to look for atrial fibrillation in patients with mitral stenosis given their baseline elevated risk for atrial fibrillation and thrombosis?

1 Answer available

Would you favor stopping low-dose aspirin and continuing OAC alone in a patient with atrial fibrillation and mild coronary artery calcification seen on routine chest imaging?

2 Answers available

Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?

Cholesterol Treatment Trialists' (CTT) Collaboration

2 Answers available

Do you favor aspirin or P2Y12 inhibitor monotherapy following completion of 12 months of DAPT post-PCI in patients with elevated bleeding risk?

5 Answers available

Would you recommend starting a moderate-intensity statin in a patient under the age of 40 years old with HIV and a 10-year ASCVD risk estimate below 5%?

The REPRIEVE trial included participants who were between 40 and 75 years old.

1 Answer available

If prompted as an outpatient, how do you counsel patients on the rare cardiac complications of vaccinations including myocarditis?

1 Answer available

What is a reasonable way to treat statin-induced myalgia and what statin substitute would you consider using in the event the myalgia is not resolved?

1 Answer available

What is your target or goal lipoprotein (a) level for patients on PCSK9 inhibitors for either primary or secondary prevention?

2 Answers available

When would you consider initiating patients with CAD and aortic stenosis on PCSK9 inhibitors (as an adjunct to statin therapy), given favorable findings in the FOURIER trial?

Sabatine et al., PMID 28304224

3 Answers available

When would you consider initiating GDMT for new onset HF in the geriatric population?

1 Answer available

How do you counsel patients with non-statin associated inflammatory myopathies about statin use?

1 Answer available

When would you consider initiation of low-dose aspirin for primary prevention and/or statin therapy in patients with acceptable bleeding risk and evidence of coronary artery calcification on prior CT chest imaging?

1 Answer available

Would you start ASA and/or statin therapy on an asymptomatic patient noted to have incidental pathologic Q waves on EKG, assuming no prior history of ischemic heart disease?

Would you consider further imaging like coronary calcium scoring or coronary CTA to further risk stratify them?

1 Answer available

What other considerations for hyperlipidemia management would you have for a patient with multiple prior PCIs whose LDL remains above goal on high intensity statin, ezetimibe, and evolocumab (assuming compliant with medications)?

2 Answers available

What is a reasonable surveillance strategy and length of time to maintain patients with thrombosed bioprosthetic valves on systemic anticoagulation?

1 Answer available

When would you consider initiation of bempedoic acid for statin intolerant patients (i.e. LDL threshold, comorbidities)?

How would you assess response to bempedoic acid and its safety on outpatient labs, and how frequently would you have labs monitored?

1 Answer available

When should cardiac MRI be obtained alongside standard echocardiography for outpatient monitoring of the progression of chronic aortic regurgitation?

How often should cardiac MRI be ordered in this context?

1 Answer available

Can DOACs be a reasonable alternative (instead of VKA) for management of LV thrombus post-MI and what is a reasonable follow-up time for surveillance outpatient imaging and subsequent duration of therapy outpatient?

1 Answer available

What are your diagnostic and management approaches beyond statin therapy for hyperlipidemia in young adults with significantly elevated LDL levels in isolation (i.e. reasonable calcium score, normal lipoprotein A levels)?

1 Answer available

How frequently and when should lipoprotein A levels be monitored?

Are there any significant benefits to lowering moderately elevated lipoprotein A levels?

1 Answer available

Should statin initiation be considered in young adult patients with autoimmune disease or chronic inflammatory conditions without an elevated ASCVD risk score given risk of underestimation of underlying CVD?

2 Answers available

For young adults (20-39 years of age) with moderate hypercholesterolemia, should we aim to reduce LDL-C levels by > or equal to 50% and maintain them on long-term statin therapy?

1 Answer available

Papers discussed in this category

J Am Coll Cardiol, 2020 Sep 29

Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk.

N Engl J Med, 2017 Mar 17

Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.

Circulation. Cardiovascular quality and outcomes, 2020 Mar 10

Suboptimal Management of Cardiovascular Risk Factors Among Non-US-Citizen Immigrants: Time to Build a Healthier Immigrant Workforce in the United States.

JAMA cardiology, 2021 Feb 01

Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease.

Lancet (London, England), 2023 Mar 06

Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials.

The British journal of cardiology, 2022 Jul 19

Age and the power of zero CAC in cardiac risk assessment: overview of the literature and a cautionary case.

Journal of clinical lipidology, 2020 Jan 02

Coronary artery disease with normal lipids and low coronary artery calcium in two women with high lipoprotein(a).

Curr Rheumatol Rep, 2020 Aug 26

Lipid-lowering Therapies in Myositis.

The American journal of cardiology, 2004-02-01

Safety and tolerability of simvastatin plus niacin in patients with coronary artery disease and low high-density lipoprotein cholesterol (The HDL Atherosclerosis Treatment Study).

Nature medicine, 2024 Feb 19

A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk.

Journal of clinical lipidology, 2024 Mar 29

A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice.

Journal of the American College of Cardiology, 1986-12

Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin.

The New England journal of medicine, 2011-12-15

Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy.

Current opinion in lipidology, 2007 Aug

Niacin in cardiovascular prevention: mechanisms, efficacy, and safety.

The American journal of cardiology, 2005 Jun 01

Influence of extended-release nicotinic acid on nonesterified fatty acid flux in the metabolic syndrome with atherogenic dyslipidemia.

Trials, 2018 Mar 05

Improved adherence adjustment in the Coronary Drug Project.

The New England journal of medicine, 2014 Jul 17

Effects of extended-release niacin with laropiprant in high-risk patients.

JAMA, 1975 Jan 27

Clofibrate and niacin in coronary heart disease.

Circulation research, 2020 Jun 18

Population-Based Screening for Atrial Fibrillation.

Journal of the American College of Cardiology, 2024 Aug 29

Effect of Screening for Undiagnosed Atrial Fibrillation on Stroke Prevention.

The New England journal of medicine, 2016 Sep 15

Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.

The New England journal of medicine, 2023 Nov 11

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.

The New England journal of medicine, 2022 Apr 21

Calorie Restriction with or without Time-Restricted Eating in Weight Loss.

The lancet. Healthy longevity, 2024 Apr 05

Effects of 3 months of 10-h per-day time-restricted eating and 3 months of follow-up on bodyweight and cardiometabolic health in Danish individuals at high risk of type 2 diabetes: the RESET single-centre, parallel, superiority, open-label, randomised controlled trial.

Diabetes & metabolic syndrome, 2024 Feb 05

Does early time-restricted eating reduce body weight and preserve fat-free mass in adults? A systematic review and meta-analysis of randomized controlled trials.

Journal of clinical lipidology, 2022 Sep 11

Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.

Primary Care

Preventive Cardiology

Questions discussed in this category

Papers discussed in this category

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