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The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Eugenia Gianos.
Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women’s heart disease; she is the director of Women s Heart Health at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health.
The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.
An asymptomatic 55-year-old man with no past medical history presents to clinic after having a cardiac CT as part of an executive physical. His coronary artery calcium (CAC) score was 200 and the coronary CTA demonstrated isolated 70% stenosis of the left circumflex coronary artery. He is asymptomatic and able to jog 2 miles daily without limitation. He was recently started on aspirin 81 mg daily and atorvastatin 40 mg daily by his primary care provider. His LDL is 50 mg/dL, HbA1c is 6.0%. His BP is 108/70. What would you recommend? | |
A | Stop aspirin 81 mg daily as he has not had an ASCVD event or revascularization |
B | Cardiac catheterization and stent placement in the left circumflex |
C | Increase atorvastatin to 80 mg daily |
D | Stress test |
E | No change in management |
Answer choices | A | Stop aspirin 81 mg daily as he has not had an ASCVD event or revascularization |
B | Cardiac catheterization and stent placement in the left circumflex | |
C | Increase atorvastatin to 80 mg daily | |
D | Stress test | |
E | No change in management | |
Explanation | The correct answer is E – no change in management. Though the patient has not had an ASCVD event or revascularization, low-dose aspirin may be considered with definite evidence of CAD on imaging (Class IIb, LOE C). He is asymptomatic and does not have high risk anatomy on CT (i.e., proximal LAD, left main disease, multivessel disease), so percutaneous coronary intervention or stress testing are not indicated. His LDL is well controlled, so increasing atorvastatin would not be appropriate at this time. | |
Main Takeaway | Aspirin 75-100 md daily may be considered in the absence of MI or revascularization when there is definitive evidence of CAD on imaging (Class IIb, LOE C). | |
Guideline Loc. | Section 6.1 | |
