Preventive Cardiology and Cardiovascular Risk Assessment
Core concepts
Preventive cardiology requires estimating ASCVD risk, modifying lifestyle, and choosing evidence-based pharmacotherapy. Statin intensity is matched to risk and LDL reduction. Diabetes, CKD, familial hypercholesterolemia, and inflammatory disease are risk enhancers. Blood pressure control, smoking cessation, physical activity, weight management, and diet are foundational. Aspirin is used for secondary prevention but not routinely for primary prevention. Lipoprotein(a) and coronary artery calcium can refine selected intermediate-risk decisions. Vaccination and screening for social determinants also support prevention.
Question traps
Do not calculate risk in patients with established ASCVD; they need secondary prevention. Do not use a single risk score in young patients or those with severe family history. Statins are not interchangeable by dose; know high-intensity options. Aspirin bleeding risk matters. Do not ignore adherence and statin intolerance mislabeled as muscle disease.
Worked example / rule of thumb
A 55-year-old with intermediate 10-year risk, no diabetes, and a coronary calcium score of zero may reasonably defer a statin after shared decision-making. Rule: risk score first, risk enhancers second, shared decision always.