Cardiovascular disease prevention

1. Question

When is systematic global cardiovascular disease (CVD) risk assessment recommended?

1. Only in individuals with a family history of premature CVD
2. Only in individuals with arterial hypertension
3. Only in individuals with raised lipid levels
4. In individuals with any major vascular risk factor, such as family history of premature CVD, smoking, arterial hypertension, DM, raised lipid levels, obesity, or comorbidities increasing CVD risk*
5. Only in individuals with diabetes mellitus (DM)

2. Question

In which population may systematic or opportunistic cardiovascular risk assessment be considered, according to the guideline recommendation?

1. Men >30 years of age and women >40 years of age with no known ASCVD risk factors
2. Men >50 years of age and women >60 years of age or postmenopausal with known ASCVD risk factors
3. Men >40 years of age and women >50 years of age or postmenopausal with no known ASCVD risk factors*
4. Men >40 years of age and women >50 years of age with known ASCVD risk factors
5. Men >30 years of age and women >40 years of age or postmenopausal with no known ASCVD risk factors

3. Question

In individuals who have undergone CVD risk assessment in the context of opportunistic screening, after how many years is it recommended to consider repeating the screening?

1. 2 years
2. 3 years
3. 4 years
4. 5 years*
5. 6 years

4. Question

When should opportunistic screening of blood pressure (BP) be considered in adults?

1. Only in adults with a known history of cardiovascular disease.
2. In all adults regardless of risk factors.
3. In adults at risk for the development of hypertension, such as those who are overweight or with a known family history of hypertension.*
4. Only in adults under the age of 40.
5. In adults with no known risk factors for hypertension.

5. Question

When is systematic cardiovascular disease (CVD) risk assessment not recommended according to the guidelines?

1. In men <30 years of age and women <40 years of age with known CV risk factors
2. In men <40 years of age and women <50 years of age with no known CV risk factors*
3. In men <50 years of age and women <60 years of age with known CV risk factors
4. In men <40 years of age and women <50 years of age with known CV risk factors
5. In men <30 years of age and women <40 years of age with no known CV risk factors

6. Question

In apparently healthy people under 70 years without established ASCVD, DM, CKD, genetic/rarer lipid or BP disorders, which tool is recommended for the estimation of 10-year fatal and non-fatal CVD risk?

1. Framingham Risk Score
2. QRISK3
3. ASCVD Risk Calculator
4. SCORE2*
5. Reynolds Risk Score

7. Question

In apparently healthy people aged 70 years or older without established ASCVD, DM, CKD, genetic/rarer lipid or BP disorders, which risk estimation tool is recommended for estimating 10-year fatal and non-fatal CVD risk?

1. Framingham Risk Score
2. Reynolds Risk Score
3. SCORE2-OP*
4. ASCVD Risk Estimator
5. QRISK3

8. Question

In apparently healthy people, what factors should be considered after estimation of 10-year fatal and non-fatal cardiovascular disease (CVD) risk?

1. Blood pressure and cholesterol levels
2. Lifestyle and diet
3. Lifetime risk and treatment benefit, risk modifiers, frailty, polypharmacy, and patient preferences*
4. Family history and genetic predisposition
5. Exercise and physical activity levels

9. Question

Which of the following patient conditions would be considered at high or very high cardiovascular disease (CVD) risk according to the guidelines?

1. Established cardiovascular disease (CVD)
2. Diabetes mellitus (DM)
3. Moderate-to-severe renal disease
4. Genetic or rarer lipid or blood pressure (BP) disorders
5. All of the above*

10. Question

What is the recommended approach for treating apparently healthy people at high or very high CVD risk, as well as patients with established ASCVD and/or DM?

1. A one-time intensive treatment for all risk factors
2. A stepwise treatment-intensification approach aiming at intensive risk factor treatment*
3. A treatment approach focusing only on patient preferences
4. A treatment approach that ignores comorbidities and risk modifiers
5. A gradual treatment approach with minimal consideration of risk factors

11. Question

In apparently healthy individuals without diabetes mellitus (DM), chronic kidney disease (CKD), or genetic/rare lipid or blood pressure (BP) disorders, at what SCORE2 risk percentage is treatment of ASCVD risk factors recommended for those aged 50-69 years?

1. SCORE2 5%
2. SCORE2 7.5%
3. SCORE2 10%*
4. SCORE2 12.5%
5. SCORE2 15%

12. Question

In apparently healthy people without DM, CKD, genetic/rarer lipid, or BP disorders, at what SCORE2 risk percentages should treatment of ASCVD risk factors be considered for those under 50 years of age?

1. SCORE2 1 to <5%
2. SCORE2 2.5 to <7.5%*
3. SCORE2 5 to <10%
4. SCORE2 7.5 to <15%
5. SCORE2 10 to <20%

13. Question

In the context of cardiovascular disease risk estimation, what is recommended regarding discussions about CVD risk and treatment benefits?

1. A general discussion about CVD risk and treatment benefits is recommended.
2. An informed discussion about CVD risk and treatment benefits tailored to the needs of a patient is recommended.*
3. A discussion about CVD risk and treatment benefits should be avoided unless the patient asks for it.
4. A brief discussion about CVD risk without focusing on treatment benefits is recommended.
5. An informed discussion about CVD risk and treatment benefits should be provided only to high-risk patients.

14. Question

Which of the following statements is recommended regarding the assessment of cardiovascular disease (CVD) risk according to clinical practice guidelines?

1. Assessment of dietary habits should be considered.
2. Assessment of physical activity should be prioritized.
3. Stress symptoms and psychosocial stressors modify CVD risk. Assessment of these stressors should be considered.*
4. Genetic testing for all patients should be mandatory.
5. Regular alcohol consumption should be recommended to reduce CVD risk.

15. Question

What method may be considered to improve cardiovascular disease risk classification around treatment decision thresholds, and what is an alternative when this method is unavailable or not feasible?

1. Stress testing; CT angiography
2. Echocardiography; MRI
3. CAC scoring; carotid ultrasound*
4. Holter monitoring; stress echocardiography
5. Genetic testing; PET scan

16. Question

When estimating cardiovascular disease risk, what should be considered for specific ethnic subgroups?

1. Calculation of risk without adjustment
2. Addition of a fixed percentage to the calculated risk
3. Multiplication of calculated risk by RR for specific ethnic subgroups*
4. Averaging the risk across different ethnic subgroups
5. Using a universal risk factor for all ethnic subgroups

17. Question

Which of the following is NOT recommended for routine collection in cardiovascular disease risk estimation?

1. Genetic risk scores
2. Circulating biomarkers
3. Urinary biomarkers
4. Vascular tests or imaging methods (other than CAC scoring or carotid ultrasound for plaque determination)
5. All of the above*

18. Question

Which of the following recommendations is given for patients at (very) high risk for cardiovascular disease (CVD)?

1. They should be encouraged to increase their physical activity.
2. They should be advised to follow a strict low-fat diet.
3. They may be encouraged to avoid long-term exposure to regions with high air pollution.*
4. They should be recommended to take daily aspirin.
5. They should be advised to drink more water.

19. Question

In regions where people have long-term exposure to high levels of air pollution, what action may be considered according to the guidelines for cardiovascular disease risk estimation?

1. Mandatory CVD risk screening programmes
2. Voluntary CVD risk screening programmes
3. (Opportunistic) CVD risk screening programmes*
4. Annual health check-ups
5. Regular exercise programmes

20. Question

In all CKD patients, with or without DM, what is recommended for appropriate screening?

1. Monitoring changes in albuminuria
2. Screening for ASCVD and kidney disease progression
3. Both monitoring changes in albuminuria and screening for ASCVD and kidney disease progression*
4. Only screening for ASCVD
5. Only screening for kidney disease progression

21. Question

What is recommended for monitoring cardiac dysfunction in patients undergoing cancer treatment?

1. Only use imaging techniques before cancer treatment.
2. Monitor cardiac dysfunction using circulating biomarkers only after cancer treatment.
3. It is recommended to monitor cardiac dysfunction using imaging techniques and circulating biomarkers before, periodically during, and after cancer treatment.*
4. Use imaging techniques only during and after cancer treatment.
5. Monitor cardiac dysfunction using circulating biomarkers before and during cancer treatment, but not after.

22. Question

In patients receiving anthracycline chemotherapy, which of the following measures may be considered for the prevention of LV dysfunction in high-risk patients?

1. Routine use of diuretics
2. Cardioprotection in high- risk patients (those receiving high cumulative doses or combined radiotherapy)*
3. Daily exercise regimen
4. Increased dietary potassium
5. Regular echocardiograms

23. Question

What is recommended for patients undergoing treatment for cancer regarding cardiovascular disease assessment?

1. Routine echocardiography every 6 months
2. Screening for ASCVD risk factors and optimization of the CV risk profile*
3. Monthly lipid panel checks
4. Annual stress testing
5. Daily blood pressure monitoring

24. Question

According to clinical practice guidelines, what is recommended for all COPD patients regarding ASCVD?

1. They should be investigated for ASCVD only if they have a family history.
2. It is recommended that all COPD patients be investigated for ASCVD and ASCVD risk factors.*
3. Only patients with severe COPD need to be checked for ASCVD.
4. COPD patients should be treated for ASCVD without prior investigation.
5. Investigation for ASCVD in COPD patients is optional and based on physician discretion.

25. Question

In adults with chronic inflammatory conditions, what may be considered in assessing cardiovascular disease (CVD) risk?

1. Regular exercise regimen
2. Dietary modifications
3. Assessment of total CVD risk*
4. Surgical interventions
5. Genetic screening

26. Question

In adults with rheumatoid arthritis, what adjustment should be considered for the calculated total cardiovascular disease (CVD) risk?

1. Multiplication of calculated total CVD risk by a factor of 2
2. Reduction of calculated total CVD risk by a factor of 0.5
3. Multiplication of calculated total CVD risk by a factor of 1.5*
4. No adjustment to the calculated total CVD risk
5. Division of calculated total CVD risk by a factor of 1.5

27. Question

In the context of cardiovascular disease (CVD) risk assessment, which of the following should be considered?

1. Presence of migraine with aura
2. Presence of tension-type headache
3. Frequency of cluster headaches
4. Severity of chronic migraines
5. Duration of headache episodes

28. Question

In women with migraine with aura, which of the following may be considered according to the guidelines for cardiovascular disease assessment in specific clinical conditions?

1. Use of combined hormonal contraceptives
2. Avoidance of combined hormonal contraceptives*
3. Increased dosage of combined hormonal contraceptives
4. Switching to non-hormonal contraceptives
5. Avoidance of non-hormonal contraceptives

29. Question

In patients with ASCVD, obesity, and hypertension, what type of screening is indicated for non-restorative sleep?

1. Regular screening for sleep apnea using polysomnography.
2. Regular screening for non-restorative sleep using a question about daytime sleepiness.
3. Regular screening for insomnia with a sleep diary.
4. Regular screening for non-restorative sleep using a question about trouble falling or staying asleep, or sleeping too much.*
5. Regular screening for restless leg syndrome symptoms.

30. Question

What is the recommended action if significant sleep problems do not respond within 4 weeks to sleep hygiene?

1. Increase the dosage of sleep medication
2. Implement additional sleep hygiene techniques
3. Refer to a specialist*
4. Monitor the patient for another 4 weeks
5. Discontinue sleep hygiene practices

31. Question

In patients with mental disorders, what factor should be considered as influencing total cardiovascular disease (CVD) risk according to the guideline recommendation?

1. Presence of significant functional impairment or decreased use of healthcare systems*
2. Age and gender of the patient
3. Type of medication used for the mental disorder
4. Duration of the mental disorder
5. Family history of cardiovascular disease

32. Question

In women with a history of preeclampsia and/or pregnancy-induced hypertension, which of the following should be considered?

1. Annual screening for cardiovascular disease
2. Periodic screening for hypertension and diabetes mellitus*
3. Monthly screening for renal function
4. Continuous monitoring of cholesterol levels
5. Biannual screening for thyroid function

33. Question

In women with a history of polycystic ovary syndrome or gestational diabetes mellitus (DM), what is recommended regarding periodic screening?

1. It should be avoided.
2. It should be considered.*
3. It should be mandatory.
4. It should be done annually.
5. It should be done biannually.

34. Question

In women with a history of premature or stillbirth, which of the following may be considered for periodic screening?

1. Hyperlipidemia and thyroid disorders
2. Hypertension and diabetes mellitus*
3. Heart failure and arrhythmias
4. Anemia and electrolyte imbalance
5. Lung function and renal function

35. Question

Quiz Question: According to clinical practice guidelines, assessment of cardiovascular disease (CVD) risk should be considered in which of the following patient groups?

1. Women with osteoporosis
2. Men with erectile dysfunction (ED)*
3. Adolescents with obesity
4. Postmenopausal women with hot flashes
5. Elderly individuals with dementia

36. Question

How many minutes of moderate-intensity aerobic physical activity per week are recommended for adults of all ages to reduce all-cause mortality, cardiovascular mortality, and morbidity?

1. 100-200 minutes
2. 150-300 minutes*
3. 200-350 minutes
4. 75-150 minutes
5. 300-450 minutes

37. Question

According to clinical practice guidelines, what is recommended for adults who cannot perform 150 minutes of moderate-intensity physical activity (PA) a week?

1. They should not engage in any physical activity.
2. They should perform at least 100 minutes of high-intensity exercise weekly.
3. They should stay as active as their abilities and health condition allow.*
4. They should only focus on strength training exercises.
5. They should engage in 30 minutes of moderate-intensity PA daily.

38. Question

What is recommended to reduce all-cause and cardiovascular mortality and morbidity according to the guidelines for physical activity and exercise?

1. Engage in high-intensity exercise for at least one hour daily
2. Reduce sedentary time to engage in at least light activity throughout the day*
3. Participate in moderate to vigorous physical activity every other day
4. Limit physical activity to weekends only
5. Engage in strength training exercises exclusively

39. Question

According to clinical practice guidelines, how often should resistance exercise be performed in addition to aerobic activity to reduce all-cause mortality?

1. 1 day per week
2. 2 or more days per week *
3. 3 days per week
4. 4 or more days per week
5. 5 days per week

40. Question

Which of the following lifestyle interventions should be considered to increase physical activity (PA) participation according to the clinical practice guidelines?

1. Regular use of medication to enhance physical endurance
2. Lifestyle interventions such as group or individual education, behaviour-change techniques, telephone counselling, and use of consumer-based wearable activity trackers*
3. Strict dietary restrictions to enhance physical performance
4. Participation in high-intensity interval training (HIIT) exclusively
5. Enrolling in professional athletic training programs

41. Question

Which of the following is recommended as a cornerstone of cardiovascular disease (CVD) prevention in all individuals?

1. Regular physical exercise
2. A healthy diet*
3. Smoking cessation
4. Stress management
5. Medication adherence

42. Question

Which diet is recommended to lower the risk of cardiovascular disease (CVD)?

1. Ketogenic diet
2. Mediterranean diet*
3. Paleo diet
4. Atkins diet
5. South Beach diet

43. Question

What dietary change is recommended to lower the risk of cardiovascular disease (CVD)?

1. Increase the intake of saturated fats
2. Increase the intake of trans fats
3. Replace unsaturated fats with saturated fats
4. Replace saturated fats with unsaturated fats*
5. Reduce the intake of all types of fats

44. Question

What is recommended to lower BP and risk of CVD according to the clinical practice guidelines?

1. Increase fiber intake
2. Reduce salt intake*
3. Increase protein intake
4. Reduce sugar intake
5. Increase water consumption

45. Question

What type of food pattern is recommended for better nutrition according to the clinical practice guidelines?

1. A diet high in animal proteins and fats
2. A plant-based food pattern, rich in fibre, that includes whole grains, fruits, vegetables, pulses, and nuts*
3. A diet primarily consisting of dairy and meat products
4. A low-carb diet with minimal fibre intake
5. A high-sugar diet with processed foods

46. Question

What is the recommended maximum weekly alcohol consumption according to the clinical practice guidelines for nutrition and alcohol?

1. 50 g per week
2. 75 g per week
3. 100 g per week*
4. 150 g per week
5. 200 g per week

47. Question

According to the clinical practice guidelines, which dietary recommendation is suggested for cardiovascular health?

1. Eat fish, preferably fatty, at least once a week and restrict (processed) meat.*
2. Consume red meat daily and avoid all types of fish.
3. Increase the intake of processed meats and limit fish consumption.
4. Eat fish, preferably lean, three times a week and include more processed meats.
5. Avoid all types of fish and meat entirely.

48. Question

According to clinical practice guidelines, to what maximum percentage of energy intake should free sugar consumption, particularly from sugar-sweetened beverages, be restricted?

1. 5%
2. 10%*
3. 15%
4. 20%
5. 25%

49. Question

What is recommended for overweight and obese people to improve their cardiovascular disease (CVD) risk profile?

1. Increase their physical activity without focusing on weight reduction.
2. Aim for a reduction in weight to reduce blood pressure (BP), dyslipidaemia, and risk of type 2 diabetes mellitus (DM).*
3. Maintain their current weight and focus on dietary changes alone.
4. Use medication to manage dyslipidaemia and BP without weight reduction.
5. Focus solely on reducing salt intake to manage BP and CVD risk.

50. Question

What is the recommendation for maintaining a healthy diet in relation to CVD risk over time?

1. Follow a strict low-carb diet exclusively.
2. Adhere to a Mediterranean diet without exceptions.
3. Maintain a healthy diet in regard to CVD risk over time.*
4. Switch to a vegan diet for the best outcomes.
5. Focus solely on reducing calories, regardless of diet quality.

51. Question

When should bariatric surgery be considered for obese high-risk individuals?

1. When initial diagnosis of obesity is made.
2. When lifestyle changes result in immediate weight loss.
3. When lifestyle changes do not result in maintained weight loss.*
4. When medications fail to reduce body weight.
5. When BMI exceeds 25.

52. Question

According to clinical practice guidelines, what is recommended for patients with mental disorders to improve adherence to lifestyle changes and drug treatment?

1. Reduced attention and support
2. Standard attention and support
3. Minimal attention and support
4. Intensified attention and support*
5. No attention and support

53. Question

In ASCVD patients with mental disorders, what is recommended for their mental healthcare?

1. Alternative therapies without interdisciplinary cooperation
2. Evidence-based mental healthcare without interdisciplinary cooperation
3. Evidence-based mental healthcare and interdisciplinary cooperation*
4. Mental healthcare based on patient preference alone
5. Interdisciplinary cooperation without evidence-based mental healthcare

54. Question

According to clinical practice guidelines, what should be considered for ASCVD patients with stress to improve cardiovascular outcomes and reduce stress symptoms?

1. Medication adjustment
2. Dietary modification
3. Referral to psychotherapeutic stress management*
4. Increased physical exercise
5. Surgical intervention

55. Question

According to clinical practice guidelines, what is recommended for patients with coronary heart disease (CHD) and moderate- to-severe major depression?

1. They should be considered for cognitive-behavioral therapy.
2. They should be considered for an antidepressant treatment with a tricyclic antidepressant.
3. They should be considered for an antidepressant treatment with an SSRI.*
4. They should be considered for electroconvulsive therapy.
5. They should be considered for psychotherapy only.

56. Question

In patients with heart failure (HF) and major depression, which of the following classes of medications are not recommended?

1. Selective serotonin reuptake inhibitors (SSRIs)
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
3. Tricyclic antidepressants
4. Monoamine oxidase inhibitors (MAOIs)
5. All of the above*

57. Question

According to clinical practice guidelines, what action should be taken regarding the use of tobacco due to its strong and independent causal relationship with ASCVD?

1. Reduce tobacco use to a minimal level.
2. All smoking of tobacco should be stopped.*
3. Smoke only filtered cigarettes.
4. Use tobacco only in non-smoking areas.
5. Switch to smokeless tobacco products.

58. Question

Which of the following interventions should be considered for smokers according to the clinical practice guidelines?

1. Only nicotine replacement therapy
2. Follow-up support and nicotine replacement therapy
3. Varenicline and bupropion in combination
4. Follow-up support, nicotine replacement therapy, varenicline, and bupropion individually or in combination*
5. Only varenicline and bupropion

59. Question

In the context of smoking intervention, which of the following statements is true regarding smoking cessation and weight gain?

1. Smoking cessation is not recommended if weight gain is expected.
2. Weight gain after smoking cessation negates the cardiovascular benefits of quitting.
3. Smoking cessation is recommended only if there is no anticipated weight gain.
4. Smoking cessation is recommended regardless of weight gain, as weight gain does not lessen the cardiovascular disease benefits of cessation.*
5. Weight gain should be monitored closely, and smoking cessation should be reconsidered if significant weight gain occurs.

60. Question

What approach is recommended for apparently healthy people at high or very high CVD risk, as well as patients with established ASCVD and/or DM?

1. Immediate high-dose medication initiation
2. Stepwise treatment-intensification approach*
3. Lifestyle changes only
4. Surgical intervention
5. No treatment required

61. Question

What is recommended for patients under the age of 70 to lower low-density lipoprotein cholesterol (LDL-C) levels?

1. Prescribing a low-intensity statin at any dose
2. Prescribing a medium-intensity statin only if lifestyle changes fail
3. Prescribing a high-intensity statin up to the highest tolerated dose to reach specific LDL-C goals*
4. Avoiding statin therapy and focusing on diet and exercise alone
5. Prescribing a high-intensity statin regardless of the patient's risk group

62. Question

What is the recommended LDL-C goal for apparently healthy persons under 70 years of age at very high risk?

1. An ultimate LDL-C goal of 30% reduction vs baseline and an LDL-C of <1.4 mmol/L (<55 mg/dL)
2. An ultimate LDL-C goal of 50% reduction vs baseline and an LDL-C of <1.4 mmol/L (<55 mg/dL)*
3. An ultimate LDL-C goal of 50% reduction vs baseline and an LDL-C of <2.0 mmol/L (<77 mg/dL)
4. An ultimate LDL-C goal of 40% reduction vs baseline and an LDL-C of <1.8 mmol/L (<70 mg/dL)
5. An ultimate LDL-C goal of 30% reduction vs baseline and an LDL-C of <1.8 mmol/L (<70 mg/dL)

63. Question

What is the ultimate LDL-C goal recommended for apparently healthy persons under 70 years of age at high risk?

1. 50% reduction vs baseline and an LDL-C of <1.8 mmol/L (<70 mg/dL)*
2. 30% reduction vs baseline and an LDL-C of <2.5 mmol/L (<100 mg/dL)
3. 40% reduction vs baseline and an LDL-C of <2.0 mmol/L (<80 mg/dL)
4. 60% reduction vs baseline and an LDL-C of <1.5 mmol/L (<60 mg/dL)
5. 20% reduction vs baseline and an LDL-C of <3.0 mmol/L (<115 mg/dL)

64. Question

In patients with established ASCVD, what is the recommended ultimate LDL-C goal for lipid-lowering treatment?

1. 30% reduction vs baseline and an LDL-C of <2.0 mmol/L (<75 mg/dL)
2. 40% reduction vs baseline and an LDL-C of <1.8 mmol/L (<70 mg/dL)
3. 50% reduction vs baseline and an LDL-C of <1.4 mmol/L (<55 mg/dL)*
4. 60% reduction vs baseline and an LDL-C of <1.2 mmol/L (<45 mg/dL)
5. 70% reduction vs baseline and an LDL-C of <1.0 mmol/L (<40 mg/dL)

65. Question

If the goals are not achieved with the maximum tolerated dose of a statin, which additional medication is recommended for lowering low-density lipoprotein cholesterol (LDL-C) in individuals under 70 years of age?

1. Niacin
2. Fibrate
3. Bile acid sequestrant
4. Ezetimibe*
5. Omega-3 fatty acids

66. Question

For primary prevention patients at very high risk, but without familial hypercholesterolemia (FH), if the LDL-C goal is not achieved on a maximum tolerated dose of a statin and ezetimibe, what additional therapy may be considered?

1. Fibrate therapy
2. Bile acid sequestrant
3. PCSK9 inhibitor*
4. Niacin
5. Omega-3 fatty acids

67. Question

For secondary prevention patients not achieving their goals on a maximum tolerated dose of a statin and ezetimibe, what is recommended?

1. Discontinue all medications
2. Increase the dose of statin beyond the maximum tolerated dose
3. Switch from statin to ezetimibe monotherapy
4. Combination therapy including a PCSK9 inhibitor
5. Use of a bile acid sequestrant

68. Question

For very-high-risk FH patients who do not achieve their cholesterol goals on a maximum tolerated dose of a statin and ezetimibe, what is recommended?

1. Increasing the dose of ezetimibe
2. Switching to a different statin
3. Adding a bile acid sequestrant
4. Combination therapy including a PCSK9 inhibitor*
5. Adding niacin

69. Question

What should be considered if a statin-based regimen is not tolerated at any dosage, even after rechallenge?

1. Increase the statin dosage
2. Switch to a different statin
3. Discontinue lipid-lowering therapy
4. Introduce ezetimibe*
5. Use a fibrate

70. Question

In patients under 70 years of age who cannot tolerate a statin-based regimen at any dosage, what alternative treatment may be considered for lowering low-density lipoprotein cholesterol (LDL-C)?

1. Ezetimibe alone
2. PCSK9 inhibitor alone
3. Fibrate combined with ezetimibe
4. PCSK9 inhibitor added to ezetimibe*
5. Bile acid sequestrant combined with ezetimibe

71. Question

What treatment option may be considered if the goal of low-density lipoprotein cholesterol lowering is not achieved in patients under 70 years of age?

1. Statin monotherapy
2. Statin combination with a bile acid sequestrant*
3. Ezetimibe monotherapy
4. PCSK9 inhibitors
5. Lifestyle modification alone

72. Question

In the context of pharmacological low-density lipoprotein cholesterol lowering for individuals under 70 years of age, which of the following patient groups is statin therapy not recommended for?

1. Male patients with a family history of hypercholesterolemia
2. Postmenopausal female patients
3. Premenopausal female patients who are considering pregnancy or are not using adequate contraception*
4. Patients with a history of liver disease
5. Patients currently undergoing chemotherapy

73. Question

What is the first drug of choice recommended for reducing cardiovascular disease (CVD) risk in high-risk individuals with hypertriglyceridaemia (triglycerides >2.3 mmol/L [200 mg/dL])?

1. Fibrates
2. Niacin
3. Omega-3 fatty acids
4. Ezetimibe
5. Statins*

74. Question

In patients taking statins who are at LDL-C goal with triglycerides >2.3 mmol/L (200 mg/dL), which of the following treatments may be considered?

1. Niacin
2. Omega-3 fatty acids
3. Fenofibrate*
4. Ezetimibe
5. PCSK9 inhibitors

75. Question

In high-risk (or above) patients with triglycerides >1.5 mmol/L (135 mg/dL) despite statin treatment and lifestyle measures, which additional treatment may be considered in combination with a statin?

1. Fibrates
2. Niacin
3. Bile acid sequestrants
4. Ezetimibe
5. n-3 PUFAs (icosapent ethyl 2 x 2 g/day)*

76. Question

In the treatment of dyslipidaemias in older people (70 years), how should treatment with statins be approached for those with ASCVD?

1. Treatment with statins is not recommended for older people with ASCVD.
2. Treatment with statins should be initiated only for older people with a history of myocardial infarction.
3. Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients.*
4. Treatment with statins should be considered only if lifestyle modifications fail.
5. Treatment with statins is recommended for older people with ASCVD but at a lower dose than for younger patients.

77. Question

In the treatment of dyslipidaemias in older people (70 years), when may the initiation of statin treatment for primary prevention be considered?

1. For all individuals aged 70 regardless of risk factors
2. Only for individuals aged 75
3. Only for individuals with existing cardiovascular disease
4. If the individual is at high risk or above*
5. Only if lifestyle modifications have failed

78. Question

In the treatment of dyslipidaemias in older people (70 years), it is recommended to start a statin at a low dose under which of the following conditions?

1. When the patient has a history of cardiovascular disease
2. If there is significant renal impairment and/or the potential for drug interactions*
3. Only if the patient is diabetic
4. When the patient's cholesterol levels are extremely high
5. If the patient has no previous history of statin use

79. Question

In patients with type 2 diabetes mellitus at very high risk, what is the recommended target for LDL-C reduction?

1. 30% LDL-C reduction and an LDL-C of <2.0 mmol/L (77 mg/dL)
2. 40% LDL-C reduction and an LDL-C of <1.8 mmol/L (70 mg/dL)
3. 50% LDL-C reduction and an LDL-C of <1.4 mmol/L (55 mg/dL)*
4. 60% LDL-C reduction and an LDL-C of <1.2 mmol/L (46 mg/dL)
5. 70% LDL-C reduction and an LDL-C of <1.0 mmol/L (39 mg/dL)

80. Question

In patients with type 2 diabetes mellitus (DM) over 40 years at high risk, what is the recommended ultimate LDL-C goal for lipid-lowering treatment?

1. 50% LDL-C reduction and an LDL-C of <3.0 mmol/L (115 mg/dL)
2. 30% LDL-C reduction and an LDL-C of <2.5 mmol/L (100 mg/dL)
3. 40% LDL-C reduction and an LDL-C of <2.0 mmol/L (80 mg/dL)
4. 50% LDL-C reduction and an LDL-C of <1.8 mmol/L (70 mg/dL)*
5. 60% LDL-C reduction and an LDL-C of <1.5 mmol/L (60 mg/dL)

81. Question

In which of the following scenarios may statin therapy be considered for individuals aged 40 years with type 1 or type 2 diabetes mellitus?

1. Evidence of target organ damage and/or an LDL-C level >2.6 mmol/L (100 mg/dL), as long as pregnancy is not being planned.*
2. Only if the individual has no evidence of target organ damage and an LDL-C level <2.6 mmol/L (100 mg/dL).
3. Individuals aged >40 years with type 1 or type 2 diabetes mellitus, regardless of LDL-C level.
4. Any person with type 1 or type 2 diabetes mellitus, irrespective of age or LDL-C level.
5. Only if the individual is planning for pregnancy and has an LDL-C level >2.6 mmol/L (100 mg/dL).

82. Question

What is recommended if the LDL-C goal is not reached in the treatment of dyslipidaemia in diabetes mellitus?

1. Increase the dose of statin
2. Add a fibrate to the treatment plan
3. Switch to a different statin
4. Consider statin combination with ezetimibe*
5. Discontinue statin therapy

83. Question

In patients with non-dialysis-dependent, stage 35 CKD, what therapy is recommended for lipid management?

1. The use of statins alone
2. The use of fibrates
3. The use of niacin
4. The use of statins or statin/ezetimibe combination*
5. The use of omega-3 fatty acids

84. Question

In patients with moderate-to-severe chronic kidney disease (Kidney Disease Outcomes Quality Initiative stages 35), what should be considered regarding the continuation of statins, ezetimibe, or a statin/ezetimibe combination at the time of dialysis initiation, particularly in patients with ASCVD?

1. Discontinuation of these drugs should be considered for all patients.
2. Continuation of these drugs should be considered for all patients.
3. Continuation of these drugs should be considered, particularly for patients with ASCVD.*
4. Switching to a different class of lipid-lowering drugs should be considered.
5. None of the above.

85. Question

In patients with dialysis-dependent chronic kidney disease (CKD) who are free of atherosclerotic cardiovascular disease (ASCVD), which of the following is recommended regarding statin therapy?

1. Commencing statin therapy
2. Increasing the dose of existing statin therapy
3. Discontinuing statin therapy
4. Monitoring lipid levels more frequently
5. Commencing statin therapy is not recommended*

86. Question

How should blood pressure (BP) be classified according to office BP?

1. Only as normal or hypertensive
2. As optimal, normal, high-normal, or grades 13 hypertension*
3. As low, medium, or high
4. As pre-hypertension or hypertension
5. As ideal, acceptable, or concerning

87. Question

In the clinical management of hypertension, how is the diagnosis of hypertension recommended to be made when feasible?

1. Based on in-office BP measurement alone.
2. Based on a single BP measurement.
3. Based on out-of-office BP measurement with ABPM and/or HBPM.*
4. Based on patient-reported symptoms.
5. Based on family history of hypertension.

88. Question

In the clinical management of hypertension, what is recommended for the diagnosis of hypertension?

1. To base the diagnosis on a single office BP measurement.
2. To base the diagnosis on repeated office BP measurements, on more than one visit, except when hypertension is severe (e.g. grade 3 and especially in high-risk patients).*
3. To base the diagnosis on home BP measurements only.
4. To base the diagnosis on a single office BP measurement if the patient is high-risk.
5. To avoid using BP measurements for diagnosis and rely solely on symptoms.

89. Question

To evaluate for the presence of hypertensive-mediated organ damage (HMOD), which of the following assessments is recommended for all patients?

1. Measurement of serum creatinine, eGFR, electrolytes, and ACR; a 12-lead ECG
2. Measurement of serum creatinine, eGFR, electrolytes, and ACR; an echocardiography
3. Measurement of serum creatinine, eGFR, electrolytes, and ACR; fundoscopy or retinal imaging
4. Measurement of serum creatinine, eGFR, electrolytes, and ACR; a stress test
5. Measurement of serum creatinine, eGFR, electrolytes, and ACR; an MRI

90. Question

For patients with grade 1 hypertension, what factors should be considered for the initiation of drug treatment?

1. Age and gender
2. Absolute cardiovascular disease (CVD) risk, estimated lifetime benefit, and the presence of hypertension-mediated organ damage (HMOD) *
3. Dietary habits and physical activity levels
4. Family history of hypertension and genetic predisposition
5. Serum cholesterol levels and smoking status

91. Question

In the clinical management of hypertension, for which group of patients is drug treatment recommended?

1. Patients with grade 1 hypertension
2. Patients with prehypertension
3. Patients with grade 2 hypertension or higher*
4. Patients with normal blood pressure
5. Patients with borderline hypertension

92. Question

What is the first objective of treatment for hypertension according to the clinical practice guidelines?

1. Lower BP to <130/80 mmHg in all patients
2. Lower BP to <150/90 mmHg in all patients
3. Lower BP to <140/90 mmHg in all patients*
4. Tailor BP targets to age and specific comorbidities as the first step
5. Maintain BP at current levels while monitoring

93. Question

In treated patients aged 1869 years, to what target range should systolic blood pressure (SBP) ultimately be lowered?

1. 110120 mmHg
2. 120130 mmHg*
3. 130140 mmHg
4. 140150 mmHg
5. 150160 mmHg

94. Question

In treated patients aged 70 years, what is the recommended systolic blood pressure (SBP) target if tolerated?

1. SBP should generally be targeted to <150 mmHg
2. SBP should generally be targeted to <140 mmHg and down to 130 mmHg if tolerated*
3. SBP should generally be targeted to <130 mmHg
4. SBP should generally be targeted to <120 mmHg
5. SBP should generally be targeted to <160 mmHg

95. Question

In the clinical management of hypertension, what is the recommended target for diastolic blood pressure (DBP) in all treated patients?

1. <70 mmHg
2. <75 mmHg
3. <80 mmHg*
4. <85 mmHg
5. <90 mmHg

96. Question

What is recommended for people with high-normal blood pressure (BP) or higher?

1. Medication therapy
2. Lifestyle interventions*
3. Surgical procedures
4. No treatment necessary
5. Regular blood transfusions

97. Question

In the clinical management of hypertension, what is the recommended initial treatment strategy for most patients?

1. Initiate antihypertensive treatment with a single drug.
2. Initiate antihypertensive treatment with lifestyle modifications only.
3. Initiate antihypertensive treatment with a two-drug combination, preferably as a single-pill combination.*
4. Initiate antihypertensive treatment only for patients with SBP >160 mmHg.
5. Initiate antihypertensive treatment with a three-drug combination.

98. Question

What are the preferred combinations for the treatment of hypertension according to the clinical guidelines?

1. A CCB with a beta-blocker
2. An ACE inhibitor or ARB with a CCB or diuretic*
3. A beta-blocker with a diuretic
4. An ACE inhibitor with a beta-blocker
5. An ARB with a thiazide/thiazide-like diuretic

99. Question

What is recommended if blood pressure remains uncontrolled with a two-drug combination?

1. Increasing treatment to a three-drug combination, usually a RAS blocker with a CCB and a diuretic, preferably as a single-pill combination.*
2. Reducing treatment to a single-drug combination, usually a RAS blocker.
3. Increasing treatment to a four-drug combination, including beta-blockers.
4. Maintaining the two-drug combination but increasing the dosage.
5. Switching to a different two-drug combination without increasing the number of drugs.

100. Question

If blood pressure (BP) is not controlled by a three-drug combination in the treatment of hypertension, which of the following is recommended to be added to the treatment?

1. Calcium channel blocker
2. Spironolactone*
3. ACE inhibitor
4. Angiotensin II receptor blocker
5. Direct renin inhibitor

101. Question

In the clinical management of hypertension, which of the following treatment approaches is not recommended?

1. Combining a beta-blocker with a calcium channel blocker
2. Combining a thiazide diuretic with an ACE inhibitor
3. Combining two RAS blockers*
4. Combining an ARB with a calcium channel blocker
5. Combining a beta-blocker with a thiazide diuretic

102. Question

Which of the following is recommended for many patients with hypertension according to clinical practice guidelines?

1. Statin therapy
2. Antiplatelet therapy for primary prevention
3. Antiplatelet therapy for secondary prevention
4. Statin therapy and antiplatelet therapy for primary prevention
5. Statin therapy and antiplatelet therapy for secondary prevention*

103. Question

When screening for diabetes mellitus (DM) in individuals with or without atherosclerotic cardiovascular disease (ASCVD), which of the following assessments should be considered?

1. Oral glucose tolerance test
2. HbA1c (which can be done non-fasting) or fasting blood glucose*
3. Random blood glucose test
4. C-peptide level
5. Fructosamine test

104. Question

Which of the following lifestyle changes is recommended for patients with diabetes according to the clinical practice guidelines?

1. High saturated fat diet
2. Low-fibre diet
3. Strength training*
4. Smoking
5. Sedentary lifestyle

105. Question

What is recommended to patients with diabetes to help achieve lower body weight or prevent or slow weight gain?

1. Increase in energy intake
2. Reduction in energy intake*
3. Maintenance of current energy intake
4. Increase in physical activity only
5. Increase in protein intake

106. Question

What is recommended for those motivated to achieve diabetes remission early after diagnosis?

1. Immediate insulin therapy
2. Considerable weight loss with use of low-calorie diets followed by food reintroduction and weight-maintenance phases*
3. Increased physical activity without dietary changes
4. Exclusive use of oral hypoglycemic agents
5. Gradual weight loss over several years without specific dietary plans

107. Question

What is the recommended target HbA1c level to reduce CVD risk and microvascular complications in the majority of adults with either type 1 or type 2 diabetes mellitus?

1. <6.0% (42 mmol/mol)
2. <6.5% (48 mmol/mol)
3. <7.0% (53 mmol/mol)*
4. <7.5% (58 mmol/mol)
5. <8.0% (64 mmol/mol)

108. Question

For patients with a long duration of diabetes mellitus (DM) and in old or frail adults, what should be considered regarding HbA1c targets?

1. Maintaining strict HbA1c targets
2. Relaxing HbA1c targets (i.e. less stringent)*
3. Ignoring HbA1c targets
4. Increasing HbA1c targets beyond normal levels
5. No change in HbA1c targets

109. Question

What target HbA1c level should be considered at diagnosis or early in the course of type 2 diabetes mellitus in persons who are not frail and do not have atherosclerotic cardiovascular disease (ASCVD)?

1. 7.0% (53 mmol/mol)
2. 6.0% (42 mmol/mol)
3. 6.5% (48 mmol/mol)*
4. 7.5% (58 mmol/mol)
5. 8.0% (64 mmol/mol)

110. Question

Which medication is recommended as first-line therapy for the majority of patients without previous ASCVD, CKD, or HF, following evaluation of renal function?

1. Insulin
2. Sulfonylureas
3. Metformin*
4. GLP-1 receptor agonists
5. SGLT2 inhibitors

111. Question

In persons with type 2 DM with ASCVD, which medication should be considered unless contraindications are present?

1. Insulin
2. Sulfonylureas
3. Metformin*
4. Thiazolidinediones
5. DPP-4 inhibitors

112. Question

According to the clinical practice guidelines, what should be considered in the treatment of hyperglycemia and ASCVD/cardiorenal risks in patients with diabetes?

1. Increasing insulin dosage
2. Avoidance of hypoglycemia and excessive weight gain*
3. Reduction of carbohydrate intake
4. Increasing physical activity
5. Use of beta-blockers

113. Question

In persons with type 2 diabetes mellitus and atherosclerotic cardiovascular disease (ASCVD), which class of medication is recommended to reduce cardiovascular and/or cardiorenal outcomes?

1. ACE inhibitors
2. Beta-blockers
3. Calcium channel blockers
4. GLP-1 receptor agonists or SGLT2 inhibitors*
5. Statins

114. Question

In patients with type 2 DM and TOD, which of the following treatments may be considered to reduce future cardiovascular and total mortality?

1. ACE inhibitors
2. Beta-blockers
3. SGLT2 inhibitors*
4. Thiazide diuretics
5. Statins

115. Question

In patients with type 2 DM and CKD, which treatment is recommended to improve ASCVD and/or cardiorenal outcomes?

1. Metformin
2. DPP-4 inhibitor
3. SGLT2 inhibitor*
4. Insulin
5. GLP-1 receptor agonist

116. Question

In patients with type 2 DM and HFrEF, which class of medication is recommended to lessen HF hospitalizations and CV death?

1. ACE inhibitors
2. Beta-blockers
3. SGLT2 inhibitors*
4. Calcium channel blockers
5. Thiazide diuretics

117. Question

In patients with type 2 DM without ASCVD, HF, or CKD, what should be considered for use based on estimated future risks for adverse ASCVD or cardiorenal outcomes from risk factor profiles?

1. Use of an SGLT2 inhibitor or GLP-1RA*
2. Use of a beta-blocker or ACE inhibitor
3. Use of metformin or sulfonylurea
4. Use of a thiazolidinedione or DPP-4 inhibitor
5. Use of insulin or meglitinide

118. Question

What is the recommended daily dose of aspirin for secondary prevention of cardiovascular disease (CVD)?

1. 50-75 mg
2. 75-100 mg*
3. 100-125 mg
4. 125-150 mg
5. 150-175 mg

119. Question

In the context of secondary prevention in patients intolerant to aspirin, which medication is recommended as an alternative at a daily dose of 75 mg?

1. Warfarin
2. Dabigatran
3. Clopidogrel*
4. Rivaroxaban
5. Apixaban

120. Question

In patients with established ASCVD, which antithrombotic therapy may be considered in preference to aspirin?

1. Warfarin
2. Heparin
3. Clopidogrel 75 mg daily*
4. Dabigatran
5. Rivaroxaban

121. Question

In patients receiving antiplatelet therapy, what is recommended for those at high risk of gastrointestinal bleeding?

1. Concomitant use of beta-blockers
2. Concomitant use of anticoagulants
3. Concomitant use of a proton pump inhibitor*
4. Concomitant use of diuretics
5. Concomitant use of statins

122. Question

In patients with diabetes mellitus (DM) at high or very high cardiovascular disease (CVD) risk, what may be considered for primary prevention in the absence of clear contraindications?

1. High-dose aspirin
2. Low-dose aspirin*
3. Warfarin
4. Clopidogrel
5. Low molecular weight heparin

123. Question

In individuals with low to moderate cardiovascular (CV) risk, what is the recommendation regarding antiplatelet therapy due to the associated risks?

1. It is recommended to initiate antiplatelet therapy to reduce CV events.
2. Antiplatelet therapy is recommended only if the patient has a history of bleeding.
3. Antiplatelet therapy is not recommended due to the increased risk of major bleeding.*
4. It is recommended to use antiplatelet therapy along with anticoagulants.
5. Antiplatelet therapy is recommended for all individuals regardless of CV risk.

124. Question

In the context of secondary prevention of cardiovascular disease (CVD), when is low-dose colchicine (0.5 mg o.d.) recommended?

1. As a first-line treatment for all patients with CVD
2. Only for patients with no other risk factors
3. For primary prevention of CVD
4. For secondary prevention of CVD, particularly if other risk factors are insufficiently controlled or if recurrent CVD events occur under optimal therapy*
5. As an alternative to lifestyle modifications

125. Question

Which of the following is recommended to improve patient outcomes for patients after ASCVD events, revascularization, or with HF (mainly HFrEF)?

1. Participation in a medically supervised, structured, comprehensive, multidisciplinary EBCR and prevention programme
2. Self-directed exercise routines without medical supervision
3. Participation in a diet-only intervention programme
4. Use of medication without any form of physical rehabilitation
5. Regular monitoring without any structured rehabilitation programme

126. Question

What methods should be considered to increase CR and prevention referral and uptake according to the clinical practice guidelines?

1. Only electronic prompts or automatic referrals
2. Referral and liaison visits only
3. Structured follow-up by nurses or health professionals only
4. Early programme initiation after discharge only
5. Electronic prompts or automatic referrals, referral and liaison visits, structured follow-up by nurses or health professionals, and early programme initiation after discharge*

127. Question

Which of the following interventions may be considered to increase patient participation and long-term adherence to healthy behaviors in cardiac rehabilitation?

1. Home-based CR
2. Telehealth
3. mHealth interventions
4. All of the above*
5. None of the above

128. Question

Which of the following measures is recommended to reduce cardiovascular disease (CVD) mortality and morbidity according to the guideline on policy interventions at the population level?

1. Increasing the use of fossil fuels
2. Reducing the use of fossil fuels*
3. Increasing PM emission and gaseous pollutants
4. Encouraging higher carbon dioxide emissions
5. Implementing measures to increase air pollution