How does idraparinux c/w warfarin in treatment of DVT & PE?
Idraparinux not inferior to warfarin in the DVT Study, but it was inferior in the PE Study.
How does dabigatran c/w warfarin for treatment of VTE, after initial parenteral anticoagulation?
Dabigatran is noninferior to warfarin in the prevention of recurrent VTE and PE events.
True or false? Rosuvastatin a/w significant reduction in risk of VTE?
True. In trial with "healthy" ppl, rosuvastatin a/w significant reduction in VTE risk.
Anti-Parkinsonian drugs (dopamine agonists, eg. pergolide / cabergoline) a/w with significant increased risk of what?
Heart-valve regurgitation. People on these meds should get regular TTE follow-up.
What is OMT for severe AS?
Trick question! No effective medical therapy for severe AS; need mechanical correction. Valve replacement definitive management.
What is better in someone with atherosclerotic renovascular disease: OMT, or OMT+endovascular revascularisation?
OMT alone. Revascularization carried substantial risk, and not a/w any benefit in terms of renal function, blood pressure, renal or cardiovascular events, or mortality.
Renal failure patients at risk of CVD events. Does a regular statin (rosuvastatin) decrease CVD events?
No. AURORA trial found rosuvastatin significantly reduced LDL-C and CRP, but was not a/w reduction in MI, stroke, or death from CVD causes.
True or false? Relatively small reduction in LDL-C level sustained over a lifetime markedly reduces incidence of CHD.
Is it worth prescribing statins to men with hypercholesterolemia, who have no PHx of MI?
Yes. Statin treatment for ~5yrs provided an ongoing reduction in the risk of major CVD events for an additional period of up to 10 yrs. Presumably due to stabilisation of existing plaque and a slowing of the progression of CAD.
What antiHTN should be used in patients >80 years?
HYVET (Hypertension in the Very Elderly trial ie >80 years old) showed that indapamide +/- perindopril significantly reduced risk of death from stroke AND death from any other cause in very elderly patients, and reduced heart failure, with target BP
Which patient groups should get diuretics for treatment of pre/HTN?
First-line for HTN with no other comorbidities: thiazide diuretic - effective AND low cost
Which patient groups should get CCB for treatment of pre/HTN?
Elderly at risk of stroke
Which patient groups should get BB for treatment of pre/HTN?
Appropriate first line therapy if patient does not have pre-existing conditions
Which patient groups should get ACEI/ARB for treatment of pre/HTN?
T2DM and/or renal disease
Is medical therapy indicated in people with preHTN and 1+ CVD RF?
Yes. Choose one of: diuretics, BB, ACEI, ARB, CCB.
What lifestyle changes can help treat mildly elevated BP (pre-HTN) (when pt has no other CVD RFs)?
Weight loss, decrease dietary sodium, stop smoking, exercise.
What is more important in terms of RF for CVD and renal disease: elevated SBP or DBP?
What is the BP target for normal ppl? For ppl with DM or renal failure?
How can you differentiate clinically b/w diastolic and systolic HF?
You can't reliably distinguish between these patients.
What proportion of HF patients have diastolic HF?
What is the definition of diastolic HF?
HF with EF > 50%
Which patients do better? Diastolic or systolic HF?
Similar in-hospital complication rates, 1-yr mortality & morbidity.
According to the AHA Science Advisory (2005), who is the optimal candidate for CRT?
Dilated cardiomyopathy (non/ischemic), LVEF 120ms, SR, NYHA class III or IV despite OMT.
Is CRT worthwhile in those with HF class III, EF
There was significant improvement in NYHA class, but no significant improvement in terms of QOL, 6-minute walk test, LV reverse remodelling; ie) not recommended
Is it worthwhile replacing iron in symptomatic, iron deficient, HF patients? Does it matter if they are anaemic or not?
Good to replace iron in iron deficiency: improves symptoms, physical performance, QOL. Benefit in those with and without anaemia.
Is newer LVAD (continuous-flow) superior to older LVAD (pulsatile-flow)?
Yes. Newer LVAD had less device-related problems less hospitalisations improved QOL.
Is CRT+ICD useful in mild HF (class I or II) with reduced EF and wide QRS?
Yes. A/w 34% reduction in risk of death or HF events, and TTE showed improved LVEF after 1yr.
What is superior therapy in symptomatic AF with EF
Pulmonary vein isolation was superior; significant improvements in EF, 6-min walk test.
Which ACEI has been found to have a favourable effect on glucose metabolism in people with DM? (ie. Effects regression to normal glucose levels?)
What is the best approach to preventing CVD morbidity/mortality in T2DM?
Appropriate management of hypertension, dyslipidemia, and other CVD risk factors