297.2 🩺 國考版

297.2.1 高頻考點

297.2.1.1 Risk Assessment

  • PCE (US)
  • SCORE2 / SCORE2-OP (Europe)
  • PREVENT (2024 AHA)
  • QRISK3 (UK)
  • Risk enhancers: FHX, CKD, autoimmune, ethnic background, Lp(a), CAC

297.2.1.2 LDL Targets

  • Very high risk (clinical ASCVD): < 55
  • High risk (ASCVD ≥ 20%, FH, severe CKD): < 70
  • Intermediate (7.5-20%): < 100 with 50% reduction
  • Statin start ASCVD ≥ 7.5%

297.2.1.3 Drug Doses (High-Intensity)

  • Atorvastatin 40-80 mg
  • Rosuvastatin 20-40 mg

297.2.1.4 PCSK9i

  • Alirocumab, evolocumab
  • ↓ LDL 50-60%
  • For very high risk + FH

297.2.1.5 Inclisiran

  • siRNA q6mo
  • Alternative to PCSK9i

297.2.1.6 Bempedoic Acid

  • ACL inhibitor
  • For statin-intolerant
  • CLEAR Outcomes 2023

297.2.1.7 Aspirin Primary Prevention 2024

  • AVOID ≥ 70 yo (ASPREE)
  • Consider 40-59 + high ASCVD + low bleeding
  • Not for low risk or high bleeding

297.2.1.8 Other Trials

  • PREDIMED 2013: Mediterranean diet ↓ MACE 30%
  • REDUCE-IT 2018: icosapent ethyl in high TG + ASCVD → ↓ MACE
  • LoDoCo2 2020: colchicine 0.5 mg/d ↓ MACE in CCS
  • SELECT 2023: semaglutide obese + ASCVD ↓ MACE
  • SUSTAIN-6 / LEADER: GLP-1 RA DM + ASCVD ↓ MACE
  • CANVAS / DECLARE / EMPA-REG: SGLT2i in DM + CV
  • DAPA-CKD / EMPA-KIDNEY: CKD + non-DM

297.2.1.9 Coronary Artery Calcium

  • Useful for borderline/intermediate ASCVD
  • CAC = 0: very low risk (may defer statin)
  • CAC > 100 / > 75th percentile: high risk

297.2.2 易混淆比范

Strategy Tool Targets
Risk score PCE / SCORE2 / PREVENT ASCVD 10-yr
BP Office, ABPM, HBPM < 130/80
Lipid Fasting lipid + ApoB optional LDL < 55 / 70 / 100
Diabetes HbA1c < 7% (individualized)
Tobacco History Cessation
Diet Mediterranean PREDIMED-style
Exercise Activity history 150 min/wk
ASA Bleeding risk Avoid ≥ 70; selective 40-59

297.2.3 Special Topics

297.2.3.1 Familial Hypercholesterolemia (FH)

  • 1 in 250 heterozygous
  • LDL > 190 mg/dL untreated
  • Tendon xanthomas, premature CAD
  • High-intensity statin + ezetimibe + PCSK9i often needed
  • Family cascade screening

297.2.3.2 Lp(a)

  • Independent CV risk
  • Test once in lifetime (2024 NLA/ESC)
  • Threshold: ≥ 50 mg/dL or ≥ 125 nmol/L
  • Lipid-lowering: statins don’t help; emerging pelacarsen, etc.