Target: Diabetes and Lipids

From "Anti-inflammatory effects of pioglitazone and/or simvastatin in patients
with distinct clinical risk for cardiovascular complication."

Learning objectives

Discuss the complementary effect of thiazolidinediones (TZD) and statin treatment on several cardiovascular risk factors in subjects without diabetes.

Questions

1. The study by Hanefeld et al was a 3-arm, double-blind, randomized trial evaluating the anti-inflammatory effects of monotherapy with simvastatin, monotherapy with the TZD pioglitazone, and the combination of both. Exclusion criteria for prospective study subjects included all but which of the following?
   
   
   1. Statin therapy within the previous 4 weeks before randomization
   2. Chronic inflammatory diseases
   3. Known or newly diagnosed diabetes
   4. Hypertension
   
   
2. The highly sensitive C-reactive protein (hs-CRP) of study subjects was decreased by 19% with simvastatin and by 33% with pioglitazone treatment. One of the most important findings of this study was that the combination of simvastatin and pioglitazone exerted an additive effect, resulting in a decrease in hs-CRP of ______.
   
   
   1. 38%
   2. 43%
   3. 52%
   4. 65%
   
   
3. Pioglitazone significantly reduced _____ in this study, whereas simvastatin alone or combined with pioglitazone had only minor, nonsignificant effects on it (them).
   
   
   1. matrix-degrading matrix metalloproteinases (MMP-9) levels
   2. macrophage chemoattractant protein (MCP)-1 plasma levels
   3. plasminogen activator inhibitor (PAI)-1
   4. body mass index
   
   
4. As expected, simvastatin significantly decreased low-density lipoprotein cholesterol and increased high density lipoprotein cholesterol levels with no add-on effect in combination therapy with pioglitazone. However, only ___ therapy was effective in reducing triglyceride levels.
   
   
   1. simvastatin
   2. pioglitazone
   3. combination
   
   
5. In the majority of study subjects, neither simvastatin nor pioglitazone monotherapy resulted in a target level of hs-CRP below _________.
   
   
   1. 5.0 mg/L
   2. 3.5 mg/L
   3. 2.4 mg/L
   4. 1.0 mg/L
   
   

To take this exam, you can download the CME answer form (PDF) and mail, fax, or email it to address given; or go to the University of Cincinnati's Center for Continuous Professional Development. Cardiology Review materials are posted to that site on a continuous basis (registration required).

Target: CAD and Imaging

From "Myocardial perfusion imaging in identifying a low-risk group after acute MI."

Learning objectives

Describe the use of adenosine myocardial perfusion imaging as an initial noninvasive means of assessing risk and guiding therapy in stable survivors of acute myocardial infarction after hospital admission.

Questions

1. Current practice guidelines for imaging of patients after acute myocardial infarction have been strongly influenced by 2 recent trials that showed superiority of a routine invasive approach compared with 1 of noninvasive ______ with selective angiography in patients hospitalized for acute coronary syndrome.
   
   
   1. 12-lead electrocardiography
   2. treadmill testing
   3. Doppler echocardiography
   4. tilt table testing
   
   
2. The Adenosine Sestamibi SPECT Post-Infarction Evaluation (INSPIRE) trial subject risk and subsequent treatment were prospectively defined based on the perfusion results. Subjects with large (20% or higher) left ventricular perfusion defect size but predominantly nonischemic defects were considered ________ risk.
   
   
   1. high
   2. low
   3. intermediate
   
   
3. The INSPIRE study design also incorporated general treatment guidelines to promote optimal patient care. All subjects routinely received __________ and medical therapy for hyperlipidemia.
   
   
   1. aspirin
   2. beta blockers
   3. angiotensin-converting enzyme inhibitors
   4. warfarin
   
   
4. In the INSPIRE trial, more than half of all subjects at US trial sites were safely imaged with adenosine within _____ of hospital admission to facilitate subsequent patient care and to avoid the pitfalls of earlier trials.
   
   
   1. 12 hours
   2. 1 day
   3. 2 day
   4. 72 hours
   
   
5. INSPIRE demonstrated that low-risk patients (one third of all enrolled subjects) can be managed with a quite acceptable low event rate and at a cost savings approaching ______.
   
   
   1. 45%
   2. 50%
   3. 55%
   4. 65%
   
   

To take this exam, you can download the CME answer form (PDF) and mail, fax, or email it to address given; or go to the University of Cincinnati's Center for Continuous Professional Development. Cardiology Review materials are posted to that site on a continuous basis (registration required).