257.3 🩺 內科專科考前版

257.3.0.1 1️⃣ hs-cTn 0/1-Hr Algorithm

• Sample at 0 hr + 1 hr
• Cutoffs vary by assay (e.g., < 5 ng/L = rule-out very low; specific Δ + concentration thresholds)
• Allows rapid disposition in ED
• ESC + ACC/AHA endorse
• Combined with clinical risk + ECG

257.3.0.2 2️⃣ Coronary Artery Calcium (CAC) Score

• Non-contrast cardiac CT
• Quantifies coronary calcification
• CAC 0: very low risk → consider deferring statin
• CAC 1-99: low-intermediate risk
• CAC 100-300: intermediate risk
• CAC > 300 or > 75th percentile: high risk → statin
• Especially useful in intermediate ASCVD risk for decision-making
• Not for low or high risk (decision already clear)

257.3.0.3 3️⃣ Lp(a) — Genetic Risk Marker

• Largely genetic (90% heritable)
• Independent of LDL

• 50 mg/dL = elevated risk

• One-time measurement (doesn’t change with lifestyle)
• PCSK9 inhibitors reduce Lp(a)
• Pelacarsen (RNA-based) — Phase 3 specifically for Lp(a) lowering
• Olpasiran + zerlasiran — Phase 2/3

257.3.0.4 4️⃣ PREVENT Risk Calculator (AHA 2023)

• Replacement for older Pooled Cohort Equations (ASCVD)
• Includes:
  • Total CVD risk (atherosclerotic + HF)
  • 10-year + 30-year predictions
  • Race-neutral
  • Includes BMI, urine albumin-creatinine ratio, eGFR, HbA1c
• More accurate, especially in younger
• Implemented in clinical use 2024+

257.3.0.5 5️⃣ Pregnancy Complications + Future CVD Risk

• Preeclampsia: 4× CVD risk later
• Gestational HTN: 2× CVD risk
• Gestational DM: 2× T2DM + CVD risk later
• Preterm delivery: increased CVD risk
• Pregnancy = “stress test” for future CVD
• Counseling + risk factor management postpartum

257.3.0.6 6️⃣ SGLT2i Beyond Diabetes

• Empagliflozin, dapagliflozin, canagliflozin, ertugliflozin
• Originally diabetes drug → now:
  • HFrEF (DAPA-HF, EMPEROR-Reduced)
  • HFpEF (DELIVER, EMPEROR-Preserved)
  • CKD (CREDENCE, DAPA-CKD, EMPA-KIDNEY)
  • MASLD investigational
• Cross-CKM benefits
• Adverse: euglycemic DKA (rare), genitourinary infections

257.3.0.7 7️⃣ GLP-1 RA in CV

• Semaglutide (Ozempic, Wegovy): weight + DM + CVD (SELECT trial — 20% CV event reduction in non-diabetic obese)
• Liraglutide (Victoza, Saxenda)
• Tirzepatide (Mounjaro, Zepbound) — GIP/GLP-1 dual agonist; STEP-HFpEF Phase 3 success
• HF reduction + weight loss + CV benefit
• Diabetes + obesity + CKD + CVD intersection

257.3.0.8 8️⃣ 健保 / Taiwan

• 健保 statins + SGLT2i + GLP-1 RA + ACEi/ARB widely covered
• ASCVD calculator increasingly used in primary care
• Cardiology + endocrinology + nephrology coordination
• Insurance coverage of PCSK9 inhibitors limited but expanding

257.3.0.9 9️⃣ 老化 + CVD

• Cardiovascular aging: arterial stiffness, ventricular remodeling
• HFpEF common in elderly (with HTN + DM + obesity)
• AF common in elderly
• Polypharmacy + frailty considerations
• Individualized targets
• 2024 guidelines incorporate geriatric assessment

257.3.0.10 10. AI + Predictive Analytics

• Machine learning models for ASCVD prediction
• Wearables for arrhythmia (Apple Watch, Fitbit)
• AI-ECG (LVEF estimation, arrhythmia detection)
• Increasing integration in clinical practice

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