CAD

Question 1

1. What is the first-line antiplatelet for stable CAD?

Answer 1

Aspirin 75–100 mg once daily

If aspirin-intolerant, consider clopidogrel 75 mg daily.

Question 2

2. What is dual antiplatelet therapy (DAPT) and when is it used in CAD?

Answer 2

DAPT = Aspirin + P2Y12 inhibitor (e.g., clopidogrel, ticagrelor, prasugrel)

Used in ACS (acute coronary syndrome) and post-PCI with stenting (duration guided by bleeding risk and stent type)

Question 3

3. What statin intensity is recommended for CAD patients?

Answer 3

High-intensity statin (e.g., Atorvastatin 40–80 mg or Rosuvastatin 20–40 mg)
Goal: Reduce LDL by ≥50%; target LDL-C <1.4 mmol/L (per ESC)

Question 4

11. When to consider coronary revascularization in stable CAD?

Answer 4

Persistent angina despite optimal medical therapy
High-risk anatomy (e.g., left main disease, multivessel disease with diabetes)
Significant ischemia on testing

Question 5

12. What vaccinations are recommended for CAD patients?

Answer 5

Annual influenza vaccine

COVID-19 vaccine

Pneumococcal vaccine (for those with comorbidities)

Question 6

8. What is the role of ACE inhibitors in CAD?

Answer 6

Indicated in patients with:
CAD + hypertension, diabetes, CKD, or LV dysfunction
Post-MI
Reduce mortality and prevent remodeling

Question 7

10. What are contraindicated drugs in CAD?

Answer 7

NSAIDs (except low-dose aspirin) – increase CV risk

Immediate-release nifedipine – reflex tachycardia

Avoid combining non-DHP CCBs (e.g., verapamil) with beta-blockers due to bradycardia risk

Question 8

9. What is the blood pressure target in CAD patients?

Answer 8

Answer:
<140/90 mmHg (general target)
<130/80 mmHg may be considered in high-risk patients if tolerated (per ESC)

Question 9

5. When should beta-blockers be used in CAD?

Answer 9

In patients with previous MI or reduced LVEF

Consider long-term in all symptomatic CAD (e.g., angina)

Question 10

4. What are the lifestyle recommendations for secondary prevention in CAD?

Answer 10

Smoking cessation
Regular physical activity (≥150 min/week moderate)
Heart-healthy diet (low sat. fat, high fiber)
Weight control (BMI 20–25 kg/m²)
Limit alcohol

Question 11

6. Which medications improve mortality in CAD with LV dysfunction?

Answer 11

Answer:

Beta-blockers

ACE inhibitors or ARBs

Mineralocorticoid receptor antagonists (e.g., eplerenone)

Question 12

7. What are anti-anginal options in stable CAD?

Answer 12

Answer:

First-line: Beta-blockers or calcium channel blockers

Alternatives: Nitrates, nicorandil, ivabradine, ranolazine