Preventive Cardiology&nbsp;&nbsp;&nbsp;

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?

How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?

4 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

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

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)

4 Answers available

Is there any contraindication to the use of ezetimibe in patients with a history of statin-induced necrotizing myopathy?

5 Answers 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 the patient is compliant with medications?

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?

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 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

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?

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?

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?

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?

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

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?

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

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.

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

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?

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

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

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

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

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?

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

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?

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?

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?

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)?

How frequently and when should lipoprotein A levels be monitored?

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

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?

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?