Multiple Choice Questions (MCQ)

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Category: Cardiology--->Hyperlipidemia
Page: 7

Question 31# Print Question

In 2012, the FDA issued an alert reporting a relationship between statin use and increase in blood glucose and new incidence of diabetes. Which of the following statements is TRUE?

1. A large meta-analysis has reported an approximate 18% increase in relative risk of developing diabetes on statin therapy.

2. This observation appears to be dose dependent with a meta-analysis of high- versus moderate-dose trials reporting an absolute increase in rate of 0.4%.

3. Increase in blood glucose with statins does not attenuate the CVD reduction benefit of statins.

4. Development of diabetes on statin therapy is independent of risk factors for diabetes

. 5. Reducing the dose of statin should be utilized to avoid diabetes development in those at risk, for example, metabolic syndrome, obesity, and impaired fasting glucose.

A. All of the above
B. 1, 3, and 5
C. 2 and 3
D. 2, 3, and 5
E. None of the above

Question 32# Print Question

Your patient is a 51-year-old man with heterozygous FH with predrug therapy LDL-C of 202 mg/dL who had been tried on atorvastatin, simvastatin, and lovastatin in the past but stopped all three due to complaints of muscle aching, had gastrointestinal complaints with resins, and refused further treatment. He recently had an ST-segment elevation MI treated with direct stenting. He was given a prescription to start atorvastatin again but was hesitant to have it filled and comes to you for advice. He has increased his frequency of aerobic exercise and has been following a low-saturated fat diet. LDL-C measured 2 months after the MI was 188 mg/dL. Appropriate options to consider in managing this patient include:

1. trial of rosuvastatin beginning at 5 mg two to three times a week followed by slow titration.

2. pretreatment with coenzyme Q10 followed by rechallenge with a different statin or lower dose of previously used statin.

3. niacin titrated to highest tolerated dose in combination with ezetimibe.

4. LDL-C apheresis.

5. emphasis on aggressive lifestyle intervention including very low saturated fat to vegetarian diet, plant sterols/stanols, and high dietary and supplementary fiber.

6. mipomersen.

A. All of the above
B. 1, 2, 3, and 5
C. 1, 2, 3, 4, and 5
D. 1, 3, and 5
E. None of the above

Question 33# Print Question

Statements regarding fibrates include all of the following except that:

A. Side effects include gastrointestinal complaints, gallstones, and increase in need for cholecystectomy and elevated hepatic transaminase levels
B. Monotherapy trials have not uniformly demonstrated reductions in CVD risk but subanalysis of groups with a metabolic pattern (elevated TG and low HDL) have been more strongly associated with CVD event reduction
C. Although difficult to demonstrate in individual studies, meta-analysis of fibrate trials has demonstrated reduction in cardiovascular mortality on therapy
D. Myopathy has been reported with both monotherapy and combination therapy with statin
E. Increase in creatinine is more common with gemfibrozil compared with fenofibrate

Question 34# Print Question

The following statements regarding use of niacin are true except that:

A. Possible concerns with niacin use include risk of gout, worsening glucose control, and flushing
B. Combination therapy of statins with niacin has been shown to exert favorable effect on some surrogate markers for CVD outcomes
C. The Coronary Drug Project in the pre-statin era demonstrated a beneficial effect on MI and mortality in secondary prevention patients with coronary disease treated with high-dose niacin
D. Niacin can raise HDL-C from 20% to 25% and lower TGs from 30% to 50% depending on dose and pretreatment TG levels but has little effect on LDL-C
E. To reduce adverse event severity, start niacin at low dose and titrate over weeks, take with a light snack, and take aspirin 30 minutes prior

Category: Cardiology--->Hyperlipidemia
Page: 7 of 7