Aspirin for Primary Prevention
Recommended dose of aspirin for primary prevention
<100 mg (or 81 mg)
Term for office BP >130/80 but <160/100 while daytime ABPM or HBPM <130/80
white coat hypertension
Generally speaking, first line classes of medication when initiating therapy for hypertension (4)
Thiazides
Calcium channel blockers
ACE inhibitors
ARBs
Percent of LDL lowering expected with rosuvastatin 20 mg
>50% from baseline
According to the ACC/AHA Pooled Cohort Equation, the estimated 10-year ASCVD risk that classifies someone as “high risk”
>20%
Blood pressure threshold at which to initiate 2 drug therapy according to ACC/AHA guidelines
>20/10 above goal
Class of medication that is ineffective at GFR<30
Thiazides
According to 2018 AHA/ACC guidelines, this can be assessed if additional information is needed to clarify ASCVD risk (i.e. patients with “intermediate risk” according to PCE)
coronary artery calcium
Based on the ASPREE Trial, patients over this age should NOT receive aspirin on a routine basis for primary prevention
70
Term for elevated blood pressure (>130/80 mm Hg) despite concurrent uses of 3 antihypertensive agents from different classes, including a long-acting CCB, ACEI/ARB, and a diuretic at maximally tolerated doses with appropriate dosing frequency OR controlled blood pressure (<130/80 mm Hg) with the use of four or more antihypertensives
Treatment resistant hypertension
Three preferred antihypertensive agents in pregnancy
Methyldopa
Labetalol
Nifedipine
Based on the results of the REDUCE-IT trial, this medication is now FDA approved as adjunct therapy to statin to reduce CV risk in patients with TG> 150 and established ASCVD, DM, or multiple risk factors for ASCVD
According to ADA Standards of care, consider initiating aspirin for primary prevention for patients with diabetes age >50 who have at least one additional risk factor. Name 4 of the 5 risk factors mentioned.
Family history of premature CVD
Hypertension
Dyslipidemia
Smoking
Albuminuria
Name 3 of the 4 groups of patients that should be initiated on antihypertensive therapy when Stage 1 HTN (130-139/80-89) according to ACC/AHA
Clinical ASCVD
10-year ASCVD risk >10%
Diabetes
CKD
Patients with angioedema with ACE inhibitor can receive an ARB after this length of time once ACE inhibitor has been discontinued
6 weeks
Patient population in the 2018 AHA/ACC cholesterol guidelines that is defined as having a history of multiple major ASCVD events or one major ASCVD event and several high risk conditions
very-high-risk ASCVD
5 factors that put someone at increased risk of bleeding when considering initiation of aspirin for primary prevention
history of GI bleeding/PUD, other history of bleed
Advanced age, Uncontrolled HTN
Thrombocytopenia, coagulopathy, liver disease
Kidney disease
Concurrent use of NSAID or anticoagulants
According to ACP/AAFP guidelines for treatment of hypertension in adult 60 and older, the goal SBP for patients with history of stroke/TIA or at high CV risk
<140
The two classes of antihypertensive agents that should be used along with hydralazine
Beta blocker
Diuretic
Name 3 patient populations that can be considered for PCSK9 inhibitor therapy according to the 2018 ACC/AHA guidelines
Very-high-risk ASCVD if LDL goal not reached on max tolerated statin + ezetimibe
LDL >190 if LDL goal not reached on max tolerated statin + ezetimibe
Heterozygous or homozygous familial hypercholesterolemia, as adjunct to statin
Statin-intolerant patients