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Chapter 65. Guideline-Directed Medical Therapy for Patients with Stable Ischemic Heart Disease

What is the most appropriate initial medical therapy to reduce low-density lipoprotein (LDL) cholesterol in among patients with stable ischemic heart disease (SIHD)?

A. Lowest tolerated dose statin

B. High-intensity statin

C. Ezetimibe

D. Niacin

E. At least 30-60 minutes of moderate-intensity daily aerobic activity

The correct answer is B

Data from randomized clinical trials have demonstrated that lowering of LDL cholesterol is associated with a reduced risk of cardiovascular events and support intensive LDL cholesterol lowering in patients with SIHD. High-intensity statin therapy includes atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily. Compared to lower doses and lower potency statins, randomized trials have demonstrated a consistent benefit in event reduction with use of high-intensity statins.

Which of the following is true for patients with SIHD and a blood pressure (BP) of 140/90 mm Hg or higher?

A. Specific medications used for treatment of high BP should be based on patient characteristics.

B. All patients should be counseled about the need for lifestyle modification.

C. Antihypertensive drug therapy should be instituted for a BP of 140/90 mm Hg or higher in addition to or after a trial of lifestyle modifications.

D. All of the above

The correct answer is D

In many patients with SIHD, the choice of medications is guided by compelling indications for specific classes of drugs, and effective BP lowering is the most important factor in preventing stroke or myocardial infarction. Treatment of high BP should begin with lifestyle measures, as weight loss, diet, reduction in sodium intake, and regular physical activity have all been shown to reduce blood pressure. In addition to lifestyle measures, antihypertensive drug therapy will frequently be needed to reach the currently accepted target of BP <140/90 mm Hg.

What can be expected from intensive glucose control in patients with SIHD?

A. Reduced risk of microvascular disease

B. Reduced risk of myocardial infarction

C. Reduced risk of death

D. Reduced risk of hypoglycemia

E. If achieved with rosiglitazone, risk of cardiovascular complications is reduced

The correct answer is A


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