Cardiometabolic IQ Challenge

Learn about a variety of cardiometabolic risk factors and prevention methods through our interactive challenge quizzes, with corresponding clinical explanations and correct answers.

  1. Eating foods rich in omega-3 fatty acids is recommended to prevent cardiovascular disease in people with diabetes

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    Answer: True

    Explanation: According to the American Diabetes Association 2018 Standards of Care, “Eating foods rich in long-chain n-3 fatty acids, such as fatty fish (EPA and DHA) and nuts and seeds (ALA), is recommended to prevent or treat CVD; however, evidence does not support a beneficial role for the routine use of n-3 dietary supplements.” For more information, please see:

    American Diabetes Association. "4. Lifestyle Management: Standards of Medical Care in Diabetes—2018." Diabetes Care 41.Supplement 1 (2018): S38-S50.

  2. A recent study in type 2 diabetics reported that a higher BMI was associated with:

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    Answer: A

    Explanation: AStudy found that eating breakfast at a later time is independently associated with higher BMI in a cohort of non-shift workers with type 2 diabetes. For more information, please see:

    Nimitphong, H., et al. "The relationship among breakfast time, morningness–eveningness preference and body mass index in Type 2 diabetes." Diabetic Medicine (2018).

  3. According to the American Diabetes Association, artificial sweeteners are safe to use and can substitute sugar sweeteners in people with type 2 diabetes

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    Answer: True

    Explanation: According to the American Diabetes Association 2018 Standards of Care, “nonnutritive sweeteners (containing few or no calories) may be an acceptable substitute for nutritive sweeteners (those containing calories such as sugar, honey, agave syrup) when consumed in moderation. For more information, please see:

    American Diabetes Association. "4. Lifestyle Management: Standards of Medical Care in Diabetes—2018." Diabetes Care 41.Supplement 1 (2018): S38-S50.

  4. High protein diets are recommended for type 2 diabetics with a history of hypoglycemia

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    Answer: False

    Explanation: According to the According to the American Diabetes Association 2018 Standards of Care, “In individuals with type 2 diabetes, protein intake may enhance or increase the insulin response to dietary carbohydrates. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia due to the potential concurrent rise in endogenous insulin.” For more information, please see:

    American Diabetes Association. "4. Lifestyle Management: Standards of Medical Care in Diabetes—2018." Diabetes Care 41.Supplement 1 (2018): S38-S50.

  5. People with type 2 diabetes and hypertension should not consume more 2300 mg/day of sodium

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    Answer: False

    Explanation: Although consuming <2300 mg/day of sodium is recommended for people with type 2 diabetes, further restriction may be indicated for people with both diabetes and hypertension. For more information, please see:

    American Diabetes Association. "4. Lifestyle Management: Standards of Medical Care in Diabetes—2018." Diabetes Care 41.Supplement 1 (2018): S38-S50.

  1. According to the 2013 ACC/AHA Guideline for the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk, which of the following statin benefit groups is not identified correctly?

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    Answer: B

    Explanation: “Patients with baseline elevation of LDL-C ≥ 190 mg/dL not due to secondary modifiable causes are at very high risk of first and recurrent ASCVD events because of their lifetime exposure to markedly elevated LDL-C levels, and therefore, 10-year ASCVD risk assessment is not indicated in this high-risk population.” Thus, the guideline indicates that “Adults aged ≥ 21 years with LDL-C ≥ 190 mg/dL” is a statin benefit group.

    Reference: Stone, Neil J., et al. "2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 63.25 Part B (2014): 2889-2934.

  2. The 2017 update now recommends the use of PCSK9 inhibitors or ezetimibe for primary prevention in patients with diabetes and LDL-C < 190 mg/dL

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    Answer: B

    Explanation: According to the update, “The ECDP writing committee judged that the new data did not warrant changes to the decision pathways and algorithms regarding the use of ezetimibe or PCSK9 inhibitors in primary prevention patients with LDL-C <190 mg/dL with or without diabetes mellitus.”

    Reference: Lloyd-Jones, Donald M., et al. "2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways." Journal of the American College of Cardiology 70.14 (2017): 1785-1822.

  3. Which of the following is not true of the recommended cholesterol thresholds to achieve a net benefit for patients with clinical ASCVD?

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    Answer: C

    Explanation: “Thresholds for consideration of net ASCVD risk-reduction benefit are LDL-C reduction ≥ 50% and may consider LDL-C <70 mg/dL or non-HDL-C <100 mg/dL for all patients with clinical ASCVD and baseline LDL-C 70–189 mg/dL.”

    Reference: Lloyd-Jones, Donald M., et al. "2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways." Journal of the American College of Cardiology 70.14 (2017): 1785-1822.

  4. For a 40-year old patient with clinical ASCVD and coronary artery disease that has not achieved an LDL-C reduction of ≥ 50% despite maximally tolerated statin therapy, which of the following may be considered:

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    Answer: D

    Explanation: “For patients ≥ 21 years of age, With Clinical ASCVD, With comorbidities, on Statin for Secondary Prevention, Baseline LDL-C 70–189 mg/dL, adding ezetimibe (in patients who require <25% additional LDL-C lowering) or a PCSK9 inhibitor (in patients who require >25% additional LDL-C lowering) may be added as initial non-statin agents in case of an inadequate response (LDL-C reduction of <50% from baseline) to maximally tolerated statin therapy; additionally, LDL-C <70 mg/dL or non-HDL-C <100 mg/dL may be considered -- Figure 2B.”

    Reference: Lloyd-Jones, Donald M., et al. "2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways." Journal of the American College of Cardiology 70.14 (2017): 1785-1822.

  5. Which of the following is an acceptable therapy for managing LDL-C in special population groups with ASCVD:

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    Answer: B

    Explanation: According to the update, there is limited information available, which does not support initiation of high-intensity statin therapy for secondary prevention in individuals >75 years of age, and PCSK9 inhibitor (alirocumab or evolocumab) therapy for patients with NYHA functional class II to III heart failure. Statin and ezetimibe therapy may only be resumed after completion of breastfeeding. Pregnant women with ASCVD or high ASCVD risk with significant elevations in LDL-C (recognizing that a progressive rise in both LDL-C and triglycerides is physiologic during pregnancy) may be managed with a bile acid sequestrant.

    Reference: Lloyd-Jones, Donald M., et al. "2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways." Journal of the American College of Cardiology 70.14 (2017): 1785-1822.