DPCA 2-3_100-110

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CPD module JBS3 Board (2014) Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 100: ii1–1167 Juutilainen A, Kortelainen S, Lehto S et al (2004) Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care 27: 2898–904 Kastelein JJ, van der steeg WA, Holme I et al (2008) Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation 117: 3002–9 Keech A, Simes RJ, Barter P et al; FIELD study investigators (2005) Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. 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CPD module Online CPD activity Visit www.pcdsa.com.au/cpd to record your answers and gain a certificate of participation Participants should read the preceding article before answering the multiple choice questions below. There is ONE correct answer to each question. After submitting your answers online, you will be immediately notified of your score. A pass mark of 70% is required to obtain a certificate of successful participation; however, it is possible to take the test a maximum of three times. A short explanation of the correct answer is provided. Before accessing your certificate, you will be given the opportunity to evaluate the activity and reflect on the module, stating how you will use what you have learnt in practice. The CPD centre keeps a record of your CPD activities and provides the option to add items to an action plan, which will help you to collate evidence for your annual appraisal. 1. According to Boekholdt et al (2012), which combination of LDL cholesterol and non- HDL cholesterol has the HIGHEST hazard ratio for major cardiovascular events? Select ONE option only. LDL cholesterol (mmol/L) Non-HDL cholesterol (mmol/L) A. 4 3 B. 2 4 C. 2 3 D. 3 2 2. When considering the primary prevention of CVD, for which ONE of the following people with diabetes is Australian CVD risk tool inappropriate? Select ONE option only. A. A 30-year-old man with type 1 diabetes B. A 45-year-old woman with type 2 diabetes and familial hypercholesterolaemia C. A 62-year-old man with type 2 diabetes and diabetic nephropathy D. A 77-year-old woman with type 2 diabetes and hypertension E. A 91-year-old man with type 2 diabetes and Parkinson’s disease 3. Which ONE of the following features is found in the JBS3 risk calculator but NOT in the Australian CVD risk assessment tool? Select ONE option only. A. Ability to include diabetes as a risk factor B. Ability to include rheumatoid arthritis as a risk factor C. 5-year risk D. Life years gained E. 10-year risk 4. A 47-year-old man with type 2 diabetes has a 5-year Australian CVD risk score of 16%. Which is the MOST appropriate INITIAL medication, if any, to reduce his cardiovascular risk? Select ONE option only. A. Atorvastatin 20 mg B. Atorvastatin 80 mg C. Simvastatin 40 mg D. Simvastatin 80 mg E. Lifestyle changes alone recommended 5. For which ONE of the following people with type 1 diabetes is a statin as primary prevention of CVD the MOST appropriate? Select ONE option only. A. A 17-year-old male smoker B. A 26-year-old female with a total cholesterol of 6.4 mmol/L C. A 35-year-old male with poor glycaemic control D. A 39-year-old male diagnosed 5 years ago E. A 46-year-old female with CKD stage 3 6. A 59-year-old woman with type 2 diabetes agrees to start high-intensity statin medication today for primary CVD prevention. When is the MOST appropriate time-interval (in months), if any, before remeasuring her lipid profile? Select ONE option only. A. 1 B. 3 C. 6 D. 12 E. No repeat lipid profile required 7. What is the MINIMUM target REDUCTION in non-HDL cholesterol recommended for people with diabetes starting a high-intensity statin? Select ONE option only. A. 10% B. 20% C. 30% D. 40% E. 50% 8. A 61-year-old man with type 2 diabetes is at high risk of CVD. He is intolerant of both atorvastatin and simvastatin due to myalgia. His creatine kinase (CK) was normal at the time of reporting symptoms. Which is the SINGLE MOST appropriate monotherapy to now recommend? Select ONE option only. A. Fenofibrate B. Ezetimibe C. Nicotinic acid D. Omega-3-acid ethyl esters E. Rosuvastatin 9. A 49-year-old man with type 2 diabetes has a 10-year CVD risk score of 32%. Despite good lifestyle modification and concordance with maximal statin dosages, his total and LDL cholesterol remain poorly controlled. Which is the SINGLE MOST appropriate add-on therapy, if any, to recommend as primary prevention? Select ONE option only. A. Fenofibrate B. Bile acid sequestrant C. Co-enzyme Q10 D. Ezetimibe E. No add-on therapy recommended 10. A 65-year-old woman developed muscle pain after starting simvastatin 40 mg. Her CK was elevated at twice the upper limit of normal. According to European Atherosclerosis Society guidance (Stroes et al, 2015), what is the MINIMUM time-interval (in weeks) before a statin re-challenge is recommended? Select ONE option only. A. 1 B. 2 C. 4 D. 8 E. 12 110 Diabetes & Primary Care Australia Vol 2 No 3 2017
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